Archives of Iranian Medicine
Volume:17 Issue: 2, Feb 2014

The objective of this study isto develop a questionnaire to study risk factors of pancreatic cancer in Iran and to assess its reliability and validity. Following a comprehensive literature search and consultingwith six expert gastroenterologists,these domains were included in the questionnaire: demographic variables; anthropometric indices; socioeconomic status indicators; signs and symptoms of the current disease; occupational history and exposure to certain physical and chemical agents; medical and drug history; family history of cancer; history of alcohol, tobacco, or opium use; history of tea and coffee consumption; pregnancy and menstrual data (only for women); and dietary habits and cooking methods. Atotal of 113 questions were developed and included in the questionnaire. Content validity was assessed by six gastroenterologists, three lay experts, and one methodologist. Reliability was evaluated using test-retest. Ten case subjects and 15 control subjects completed the questionnaire twice with time intervals of two or three weeks. Overall, the validity and reliability of the questionnaire wereacceptable. Item content validity index for clarity was above the predetermined level of 0.80 or higher for 112 (out of 113) questions. The corresponding index for relevancy was 0.80 or higher for 111 (out of 113) questions. The overall scale validity index for clarity and relevancy were 0.97 and 0.96, respectively. Inter-rater agreement for clarity and relevancy were 0.81 and 0.83 respectively. The scale comprehensiveness score was 100%. Regardingreliability, the intraclass correlation coefficients and kappa statistics were above the predetermined level of 0.70, except for four items. For the small minority of items that did not meet the predetermined standards (0.80 for validity and 0.80 for reliability), modifications were made based on consensus. The questionnaire can be used for research purposes in the relevant studies.

Although serological screening tests for blood-borne hepatitis viruses have effectively reduced the risk of HBV transmission through transfusion of infected blood, there is still a possibility that infected blood units from occult carriers being released into the blood supply. The aim of this study was to determine the prevalence of anti-HBc among Iranian blood donors and evaluate the presence of HBV DNA in HBsAg negative plasma samples. In the present study, 5000 HBsAg negative samples were collected from donors in blood transfusion centers in Tehran. All HBsAg negative samples were tested for the presence of anti-HBc antibody and anti-HBs antibody (HBsAb) using ELISA method. Also, all HBsAg negative samples were tested for the presence of HBV DNA by real-time PCR. Four hundred ninety nine (9.98%) out of the 5000 HBsAg negative blood donors were anti-HBc positive. Out of 499 anti-HBc positive samples that were tested for anti-HBs, 394 (78.4 %) were anti-HBs positive, and 275 (62.7%) had an antibody titer greater than 100 IU/mL. HBV DNA was detected in two samples. In countries with intermediate rate of HBV infection like Iran, the prevalence of anti-HBc antibody in HBsAg negative blood donors is found to be high. As a result, routine anti-HBc screening of HBsAg-negative blood donors without complementary tests (anti-HBs / HBV-DNA) can limit the number of blood transfusions. Therefore, it might be better to include the detection of HBV DNA along with the routine tests.

The stigma attached to substance use is considered as a barrier to treatment, resulting in continued dependence and harmful consequences for the health of drug abusers and society. In the current study, stigma and its relation with patient characteristics and secrecy was examined in people who were in treatment of drug dependency. Participants were 144 patients from two referral methadone treatment centers who completed a survey containing questionnaires about stigma, secrecy and other measures of drug use. Patients reported high levels of self-stigma and moderate levels of stigma-related rejection and perceived stigma as well as commonly using secrecy, as a way of coping. More experiencing of self -stigma was associated with unemployment, positive history of IV drug use, incarceration and heroin consumption, compared to opium use. IV drug users and unemployed persons also reported more contacts with stigma- related rejection. No association was found between stigma and previous history of treatment for substance abuse. Findings indicate stigma in individuals who are in the treatment for substance dependence and highlight the need for more studies to clarify all aspects of drug use stigma.

Colorectal cancer (CRC), one of the most important causes of morbidity and mortality, has earned the attention of healthcare systems widely. Screening programs are designed to detect patients at risk as effectively as possible. One of the major CRC risk factors is having a family member with diagnosed CRC. To investigate the association between presence of polyps on colonoscopy and family history of CRC. DESIGN AND This was a retrospective cohort study in which the data was collected from colonoscopy reports of patients with/without familial history of CRC in Masoud private clinic, Tehran, Iran from October 1, 2011 to October 1, 2012. The association between presence of colorectal polyps on colonoscopy and family history of CRC was then assessed. A total of 210 patients were included in the study, constituting two groups with/without familial history of CRC with a 1:1 ratio (105 subjects in each group). Compared to subjects with a negative family history of CRC, a 2.7-fold (CI 95%: 1.2–6.24) fold increase was observed in those with a positive family history to have colorectal polyps. In multivariate regression analysis, family history of CRC was the only independent variable associated with presence of colorectal polyps (odds ratio: 3.12, CI 95%:1.22–8). A positive family history of CRC is a risk factor for colorectal polyps.

There are many patients awaiting liver transplantation withonly few donors providing the organ. The Child-Turcotte-Pugh score (CTP) and the Model for End stage Liver Disease (MELD) are the most common scores for prioritizingpatients on waiting lists. In this study, we compared the ability of these scores to predict mortalityor removal from the waiting list due to poor medical conditions. A total of257 patients were included in our study and we observed their status in the waiting list overa 9-month period. MELD and CTP of the patients at the time of listing were calculated. We used both ROC-curve and Area Under the Curve (AUC) to calculate the predictive ability of these scores. During follow up, 22 patients died and 9 patients were removed from the waiting list due to poor medical conditions. Comparing the predictive ability of CTP and MELD, the AUC for CTP was larger than that of MELD (0.75 versus 0.69; P-value = 0.065). The best cutoff point for discriminating mortality or removal from the waiting list due to severe deterioration is 8 for CTP and 13.67 for MELD. The sensitivity and specificity was 0.74 and 0.67, respectively for CTP and 0.74 and 0.58, respectively for MELD. The CTP score can predict mortality or removal from the liver transplantation waiting list better than the MELD overa 9-month period. However, better improved models need to be developed for prioritization of patients in the waiting list.

A rare variant of Leishmaniasis is Localized Leishmania Lymphadenitis which has been occasionally reported from south-eastern parts of Iran. So far, no molecular assay has been performed for diagnosing this variety of Leishmaniasis. MATHERIALS AND Nineteen lymph node paraffin blocks were collected from 1994 to 2007. Parasite load count and histopathological patterns reported on Hematoxylin-Eosin and Giemsa stained slides.DNA extraction was carried out just on the remaining available 7 lymph node paraffin blocks according to QIAamp DNA FFPE kit instructions. A pair of primers and a probe were designed for rRNA ITS region with Allele ID 6.0 software, followed by real time PCR amplification. The most common histopathological pattern was necrotizing granuloma with few Leishman bodies. Parasite load was the highest in submental lymph node (3 ± 1.41 per oil field) which was significantly higher compared to cervical and inguinal nodes (P < 0.05). Absolute load of parasite DNA was detectable in all 7 cases. The positive cases revealed a 201 bpamplicon after electrophoresis of end product which was confirmative for Leishmania tropica. Real time PCR revealed Leishmania tropica as the etiologic agent of Localized Leishmania Lymphadenitis. Although this molecular method is a sensitive diagnostic tool, histopathological findings are still important.

Multilocular cystic renal cell carcinoma (MCRCC) is a rare tumor with an excellent prognosis. We report a case of MCRCC in a 33-year-old male who presented with vague discomfort in the right flank for the last 1.5 years. Computed tomography (CT) scan revealed a multiseptate cystic mass in the upper pole of the right kidney. Surgically resected well-circumscribed cystic mass was formed entirely by thin-walled non-communicating cysts of variable size separated from surrounding renal parenchyma by a distinct fibrous wall. On histopathological examination, clear cells with prominent cytoplasmic border and low nucleocytoplasmic ratio were present in the lining epithelium as well as in the intervening septa. No solid area was appreciated in the cystic mass. Finally, after corroboration with the imprint cytology findings, the tumor was diagnosed as MCRCC with TNM staging and Fuhrman nuclear grading of T1bN0M0 and grade 1, respectively.