Archives of Iranian Medicine
Volume:18 Issue: 3, Mar 2015

High blood pressure is the second most important risk factor of cardiovascular diseases (CVDs) in Iran. It is imperative to estimate the burden of CVDs that can be averted if high blood pressure is controlled at the population level. The aim of the current study was to estimate the avertable CVD mortality in the setting of Golestan Cohort Study (GCS). Over 50,000 participants were recruited and followed for a median of 7 years. The exposures of interest in this study were non-optimal systolic blood pressure (SBP) and hypertension measured at baseline. Deaths by cause have been precisely recorded. The Population Attributable Fraction (PAF) of deaths and Years of Life Lost (YLLs) due to CVDs attributable to exposures of interest were calculated. Overall, 223 deaths due to ischemic heart disease (IHD), 207 deaths due to cerebrovascular accidents (CVA), and 460 deaths due to all CVDs could be averted if the SBP of all subjects in the study were optimal. Similarly, 5,560 YLLs due to IHD, 4,771 YLLs due to CVA, and 11,135 YLLs due to CVDs could be prevented if SBP were optimal. In all age groups, the avertable deaths and YLLs were higher due to IHD compared with CVA. Deaths and YLLs attributable to non-optimal SBP in women were less than men A very large proportion of CVD deaths can be averted if blood pressure is controlled in Iran. Effective interventions in primary and secondary health care setting are mandatory to be implemented as early as possible.

Psoriasis has a significant negative impact on patients’ health-related quality of life (HRQOL). This study aims to evaluate HRQOL of adult patients with psoriasis in Iran, and explore the relationship between general and disease-specific outcome measures in psoriasis. Between May and August 2013, a cross-sectional questionnaire survey of consecutive outpatients was conducted at a single clinic in Shiraz, Iran. HRQOL was assessed by the general measure EuroQol 5 dimensions (EQ-5D), visual analogue scale (EQ VAS), and the disease-specific Dermatology Life Quality Index (DLQI). Disease severity was measured by the Psoriasis Area and Severity Index (PASI). Sixty-two patients (76% males) completed the questionnaire with a mean age (SD) of 40.4 (17.5) years. Overall, 39% of the patients used only topical and 48% received systemic non-biological therapy in the past 12 months. Median EQ-5D, EQ VAS, DLQI and PASI scores were 0.73, 60, 8 and 11.75, respectively. Out of the 62 patients, 18%, 26%, 28%, 63%, and 63% reported some or severe problem in mobility, self-care, usual activities, pain/discomfort and anxiety/depression, respectively. EQ-5D and EQ VAS correlated moderately with DLQI (rs = -0.44 for both, p < 0.001), but only EQ VAS correlated significantly with PASI (rs = -0.31, p < 0.01). This is the first study from Iran that assesses HRQOL in adult patients with psoriasis by EQ-5D and EQ VAS. Reduction in general HRQOL measured with EQ-5D and EQ-VAS is considerable, mostly in anxiety/depression and pain/discomfort dimensions. EQ-5D scores evaluated in this study provide country-specific data for economic evaluations.

The incidence and mortality rates of cancer are increasing worldwide, particularly in the developing countries. Valid dataare needed for measuring the cancer burden and making appropriate decisions toward cancer control. We evaluated the completeness of death registry with regard to cancer death in Fars P roviance, I.R.of iran.We used data from three sources in Fars Province, including the national death registry (source 1), the follow-up data from the pathology-based cancer registry (source 2) and hospital based records (source 3) during 2004 – 2006. We used the capture-recapture method and estimated underestimation and the true age standardized mortality rate (ASMR) for cancer. We used log-linear (LL) modeling for statistical analysis. We observed 1941, 480, and 355 cancer deaths in sources 1, 2 and 3, respectively. After data linkage, we estimated that mortality registry had about 40% underestimation for cancer death. After adjustment for this underestimation rate, the ASMR of cancer in the Fars Province for all cancer types increased from 44.8 per 100,000 (95% CI: 42.8 – 46.7) to 76.3 per 100,000 (95% CI: 73.3 – 78.9), accounting for 3309 (95% CI: 3151–3293) cancer deaths annually. The mortality rate of cancer is considerably higher than the rates reported by the routine registry in Iran. Improvement in the validity and completeness of the mortality registry is needed to estimate the true mortality rate caused by cancer in Iran.

The probiotic microorganisms are live normal flora that provide nutritional benefits. When probiotic administered in adequate amounts, they also confer a health benefit on the host.Different mechanisms of probiotic effects include the following: stimulating the immune system, modifying the composition of normal intestinal flora and preventing the carcinogenic activity of fecal enzymes. In this study, direct effects of probiotic lactobacilli on tumor cells were investigated. Supernatants and bacterial extracts of two standard Lactobacillus species (L. acidophilus and L. casei) were prepared and CaCo-2 cells were treated with them. Probiotic effects on cell proliferation, necrosis, apoptosis, migration and invasion were assessed. The supernatants of Lactobacilli decreased cell proliferation and increased cell apoptosis, however, no significant effect on cell necrosis was reported. In contrast, Lactobacilli extract, reduced cell proliferation and increased cell apoptosis. Lactobacilli extract also led to cell necrosis. Furthermore, both supernatants and cell extracts of the probiotic agents resulted in decreased cells’ migration and invasion. In this study, it was shown that Lactobacilli probiotics useful effects are not confined to the enhancement of the immune system; however, they effectively suppress the malignant phenotypes of colorectal cancer cells.

MicroRNAs are involved in key cellular processes regulating, and their misregulation is linked to cancer. The miR-302-367 cluster is exclusively expressed in embryonic stem and carcinoma cells. This cluster also promotes cell reprogramming and stemness process. In contrast, miR-145 is mostly regarded as a tumor suppressor, where it regulates cellular functions such as cell division, differentiation, and apoptosis. By suppressing the main pluripotency factors (OCT4, SOX2, MYC and KLF4), miR-145 silences the self-renewal program in ESCs. Therefore, the main aim of this study is to find a potential link between the expression level of hsa-miR-302b and hsa-miR-145 with tumor vs. non-tumor as well as high-grade vs. low-grade states of the esophageal tissue samples. A total number of 40 formalin-fixed, paraffin-embedded (FFPE) samples of esophageal squamous-cell carcinoma (ESCC) were obtained, and the tumor and marginal non-tumor areas delineated and punched off by an expert pathologist. Total RNA was extracted with Trizol, and cDNA synthesized using the miRCURY LNA™ Universal RT microRNA PCR Kit. Real-time reverse transcription polymerase chain reaction (RT-PCR) assays were performed using specific LNA-primers and SYBR Green master mix. The expression level of miR-302b failed to show any significant difference, neither between tumor and their non-tumor counterparts, nor among tumors with different grades of malignancies (P > 0.05). In contrast, miR-145 was significantly down regulated in all grades of tumor samples (P < 0.001). However, its expression level could not discriminate between different grades of malignancy (P > 0.05). Our data revealed a significant down-regulation of miR-145 in ESCC tissue samples. Based on our ROC curve analysis data (AUC = 0.74, P < 0.001) miR-145 could be regarded as a potential tumor marker for diagnosis of esophageal cancer.

Knowledge of the genes responsible for intellectual disability, particularly autosomal recessive forms, is rapidly expanding. Increasing numbers of the gene show great heterogeneity and supports the hypothesis that human genome may contain over 2000 causative genes with a critical role in brain development. Since 2004, we have applied genome-wide SNP genotyping and next-generation sequencing in large consanguineous Iranian families with intellectual disability, to identify the genes harboring disease-causing mutations. The current study paved the way for identification of responsible genes in two unrelated Iranian families. We found two novel nonsense mutations, p.C77* and p.Q115*, in the calpain catalytic domain of CAPN10, which is a cysteine protease known to be involved in pathogenesis of noninsulin-dependent diabetes mellitus. Another different mutation in this gene (p.S138_R139ins5) has previously been reported in an Iranian family. All of these patients have common clinical features in spite of specific brain structural abnormalities on MRI. Different mutations in CAPN10 have already been found in three independent Iranian families. These results have strongly supported the possible role of CAPN10 in human brain development. Altogether, we proposed CAPN10 as a promising candidate gene for intellectual disability, which should be considered in diagnostic gene panels.

Recently, there is an increased focus on waiting time as a barrier to access to treatment in outpatient services. The aim of this study is to determine related factors to outpatient waiting time in specialty levels. This was a cross sectional study. The target population of this study consisted of specialist’s and subspecialist’s offices in Tehran. All the population (5475 cases) was studied; however 43.4% of them were not accessible. Accessible cases consist of 3098 physicians were included. Data gathered by telephone interview and analyzed by SPSS. According to the findings, the level of care; type of specialty, being a faculty member, and office location was related to waiting time (p < 0.001). Waiting time was also correlated with the number of outpatient offices and clinics of each physician (rs= 0.11, P < 0.001), as well as office working hours per week (rs= -0.18, P < 0.001). The estimated waiting time was acceptable, but the range of this parameter was too wide. This situation was more severe for some specialties and need some consideration. It should be considered that this study was restricted to Tehran. Waiting time is likely to be higher in other provinces of the country especially in deprived areas.

Microvesicles are membranous sac structures released from cell surfaces of many eukaryotic cells. Their presence in the blood and urine also signify their potential use as biomarkers for early detection and diagnosis of different diseases. At present, synthesis and release of these vesicles from mammary tumor cells and their role in disease progression requires further research. In this report, correlation of microvesicles along with breast cancer metastasis has been explored. Metastasis is a process of a non-randomized set of events, which begins with a loss of cancer cell adhesion at the primary tumor site. Later on, these cells invade the surrounding tissue and enter into circulation. After compromising host immune response, these cells extravasate and localized at the suitable distant site for a secondary growth. Involvement of microvesicles in modulating this process has also been observed. Microvesicles released from primary cancer cells may carry mRNA, miRNAs, DNA and various proteins. These vesicles may also influence multi drug resistance as observed in breast and leukemia cancer cell lines. A thorough understanding of microvesicles synthesis and their potential implication in metastasis would facilitate the design of novel therapeutic approach for breast cancer.

A 16-year-old girl was referred for the evaluation of headache exacerbation and progressive loss of visual field from one month ago. She also suffered from intermittent diarrhea since 12 months ago and secondary amenorrhea, headache, weight loss (4 – 5 kg) and weakness from six months ago. She had a history of transient polydipsia and excessive urine output during this period. Brain Magnetic Resonance Imaging (MRI) reported a 15 x 15 x 9 millimeters mass lesion in the sellar region. It was extended to the suprasellar cistern with mild compression of the optic chiasm and mild thickening of the pituitary stalk with posterior displacement were reported. In an exisional biopsy of pituitary stalk lesion, the pathology result was indicative of Langerhans cell histiocytosis (LCH). The patient underwent four periods of chemotherapy with prednisolone and vinblastin in 28-day intervals followed by one cycle of radiation therapy. In three months follow up after treatment the tumor size was reduced, Levothyroxin and Prednisolone were tapered, and pituitary hormones were improved.

Complex regional pain syndrome type 1 (CRPS1) refers to a disorder usually caused by trauma; it is characterized by pain, swelling, limited range of motion, vasomotor instability, skin changes, joint stiffness, and patchy bone demineralization. Most often it occurs after trauma. Other etiologies include myocardial ischemia, cerebrovascular accidents, infection and emotional stress.We report a case of bilateral CRPS1 of the upper extremities in a 52-year-old woman suffering from major depressive disorder. She was complaining about her hands’ stiffness and pain. She also reported swelling of both upper extremities and anhydrosis, thickening of the skin and muscle wasting, finger movement limitation, contracture of the digits and trophic skin changes. The diagnosis of CRPS1 was suspected, according to history, physical examination, radiographic changes and bone scintigraphy.

Alveolar hydatid disease is a highly malignant form of echinococcosis caused by the larvae of the cestode echinococcus multilocularis. Alveolar hydatid disease always affects the liver and can metastasise to the lung and brain. Early diagnosis and precise evaluation of the localization as well as the extent of lesions are essential for treatment. In this report, we present ultrasound and computed tomography findings in a patient with hepatic alveolar echinococcosis. The patient, who was presented with hepatomegaly, jaundice, and an infiltrative solid tumor, diagnosed by ultrasound and computed tomography. In contrast to hydatid cyst caused by echinococcus granulosus, this is a rare disease in Iran.