[Pancreatobiliary cancers in Iran: a population- based study]

Our knowledge regarding the epidemiology of pancreatobiliary cancers in Iran is limited. This study presents the first population-based report on pancreatobiliary cancers performed in five provinces of Iran. Data used in this study were retrieved from population-based cancer registries in five provinces of Iran [Gilan, Mazandaran, Golestan, Ardabil and Kerman] from 1996 to 2000. Crude incidence rate, age standardized incidence rate [ASR] and age specific incidence rate were calculated for each cancer sites using the direct method. Overall ASR of pancreatic cancer in five provinces was 1.18 and 0.84 per 100, 000 person-years for men and women, respectively. These values for gallbladder and biliary tract cancers were 0.42 and 0.27 per 100, 000 person-years for men and 0.93 and 0.22 per 100, 000 person-years for women, respectively. ASR of pancreatobiliary cancer is low in Iran compared to western countries

Digestive and liver disease statistics in Iran

Gastrointestinal and liver diseases [GILD] are among the most common causes of morbidity in Iran and constitute a substantial proportion of mortality which imposes enormous economic consequences. Our purpose is to collect information and report current statistics on physician visits, hospitalizations, and deaths due to common GILD in Iran. Data on the leading causes of death were obtained from the Iranian Ministry of Health, Office of Health Statistics. A total of 213,322 deaths were reported from March 2003 to February 2004 [excluding mortality from the Bam earthquake] which equaled 4.4 deaths per 1000 population. Of these, 36,575 were due to accidents. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases [ICD-10; 1992]. The leading causes of hospitalization were obtained from the database of the GILD ward in Shariati Hospital, one of the largest and best known gastroenterology referral hospitals in Iran. Similarly, leading causes of out-patient referrals were identified from a large multi-physician outpatient clinic in Tehran. The five leading gastrointestinal causes of death in order of frequency were: gastric cancer, hepatobiliary cancer, liver cirrhosis, esophageal cancer, and colorectal cancer. The five leading causes of hospitalization in the GILD ward of Shariati Hospital were: liver cirrhosis, hepatitis, peptic ulcer disease, cholycystitis and cholangitis, and colorectal cancer. The most common outpatient diagnosis was gastroesophageal reflux disease followed by irritable bowel syndrome [IBS], duodenal ulcer [DU], non-ulcer dyspepsia, and chronic hepatitis B [HBV]. Gastrointestinal and liver malignancy along with chronic liver disease constitute the main GILD reasons for hospitalization and deaths in Iran. Gastroesophageal reflux disease, IBS, and chronic HBV are the most common GILD outpatient diagnoses

Epidemiology of breast cancer in the Islamic Republic of Iran: first results from a population-based cancer registry

This study presents the first population-based report on breast cancer in the Islamic Republic of Iran using data derived from a cancer registry. A retrospective study was conducted to find all new breast cancer cases in 5 provinces covered by the cancer registry during the 5-year period 1996-2000. There were 2421 cases recorded in the 5 registries. The age-standardized incidence rate [ASR] was 16.2 per 100 000 person-years. In contrast to more developed countries, the ASR of breast cancer was low, with the lowest rate seen in Ardabil province

first population-based Cancer survey in Kerman province of Iran

Cancer is the second most common cause of non-accidental death in Iran. Geographical, racial and habitual differences have led to the variation in the incidence of cancer in different regions of this country. This study was performed to determine the incidence of cancer in the Kerman Province, central Iran. All newly diagnosed cases of cancer in the Kerman Province were recorded in a five-year period [1996-2000]. In all, 5884 new cases [55.7% males] of cancer were found after elimination of repeated cases. Based on age-standardized incidence rates [ASR] the most common cancers in men were stomach [10.2], lung [7.1], bladder [6.7], colorectal [5.9] and non-Hodgkin's lymphoma [5.8], while in women the most common cancers were breast [16.9] colorectal [5.9], stomach [5.1], leukaemia [4.6] and non-Hodgkin's lymphoma [2.8]. For all cancers, ASR was 76 for males and 68 for females. The results indicate that upper gastrointestinal cancer, especially oesophageal cancer is very rare in central Iran in contrast to northern Iran, although these types of cancers are some of the most common cancers in the Kerman Province

Digestive and liver diseases statistics in several referral centers in Tehran, 2000-2004

Gastrointestinal and liver diseases [GILD] are among the most common causes of morbidity and substantial proportion of mortality with enormous economic consequences in Iran. We aimed to collect and report the most recent statistics on deaths, symptoms, physician visits, and hospitalizations for common gastrointestinal and liver diseases in gastrointestinal referral centers of Tehran. Data on the leading causes of death were obtained from Iranian Ministry of Health, office of Health Statistics, [Table 1]. A total of 189,747 deaths in the 23 [out of the 28] provinces of the country] were reported during March 2003 to February 2004. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases [ICD-10; 1992]. The leading causes of hospitalizations were obtained from the database of the GI ward of Shariati hospital, one of the biggest and well known GI referral hospitals in Iran, through years 2000 to 2004. Data on the leading symptoms prompting an outpatient clinic visit and related physician's diagnosis were gathered from a large multi-physician outpatient clinic, located in Tehran, during 2000-2004. The first 5 leading gastrointestinal causes of death in the country were: stomach cancer, hepatobiliary cancers, cirrhosis of liver, esophageal cancer and colorectal cancer respectively. The first 5 leading causes of hospitalizations in GI ward of Shariati Hospital were cirrhosis of liver, hepatitis, peptic ulcer diseases, cholycystitis and cholangitis and colorectal cancer. The most common outpatient diagnosis was GERD followed by IBS, DU, Non-ulcer Dyspepsia, and chronic hepatitis B. GI and liver malignancy along with chronic liver diseases constitute the main GI and liver etiology for hospitalization and death in Iran.Gastroesophageal reflux disease, IBS, DU, Non ulcer Dyspepsia, and Chronic HBV are the most common outpatient diagnosis in Iran

[Determination of the normal range of the number of intraepithelial lymphocytes in the duodenal mucosa of healthy Iranian individuals]

An increase in the number of intraepithelial lymphocytes [IEL] in the duodenal mucosa is an important criterion for the histological diagnosis of celiac disease [CD]. We determined the normal range for intraepithelial lymphocytes [IEL] in the second part of duodenum in healthy Iranian population. Four biopsy samples of the endoscopically normal appearing mucosa at the second part of duodenum were obtained from 50 individuals referred to Shariati hospitals [48 for epigastric pain, 2 for esophageal varices]. They had no sign, symptoms and evidence for malabsorption or small intestinal disorders in history, physical examination, Laboratory tests and IgA anti tissue transglutaminase [t.T.G]. Four-micrometer thick sections were stained with Hematoxillineosine [H and E] and immunohistochemistry [IHC] for leukocyte common antigen [LCA]. At least 500-600 cells from the tip and body of villi were counted separately and the number of IEL was given as mean/ 100 epithelial cells. The mean for IEL count in total villi in IHC method was 21/100 [23/100 in tip, 21/100 in body, p = 0.058] and 19/100 in H and E method [19/100 in tip, 18/100 in body, p =0.035] [p = 0.006]. Considering total villi, the normal upper limit [Mean+2SD] was calculated to be 35/100 in IHC and 34/100 in H and E stained sections and normal upper limit of confidence interval [the 95 percentile] was 39/100 in IHC and 37/100 in H and E stained sections. The villus height to crypt depth ratio was 3/94 in average. Respectively in IHC and H and E methods, the amounts equal or less than 35/100 and 34/100 are considered as normal., values between 35-39/100 and 34-37/100 as border line and counts more than 39/100 and 37/100 represent a pathology. Although the difference between two staining methods was statistically significant, considering cost effectiveness, we recommend H and E staining for routine clinical practice

[HCV in intravenous drug users]

Hepatitis C [HCV] is increasing worldwide including Iran. HCV is more prevalent among intravenous drug abusers [IDU], especially if imprisoned, mostly due to needle sharing. We determined the rate of HCV seropositivity among IDU prisoners and compared it with those of non prisoners. A cross-sectional survey was done on consenting IDU inhabiting two prisons and attending three rehabilitation centers in Tehran, Iran. A questionnaire was completed for each subject and 5mL blood drawn. The samples were kept at 2-8°C until the sera were separated and stored at -70°C. HCV Ab [ELISA 1, third generation, DIA. PRO, Italy] with a sensitivity and specificity of 98% was checked by a single technician. Chi-square, Fisher's exact test and multivariable analysis were used where appropriate. Four-hundred and sixty seven subjects [346 [74.1%] prisoners; 425 [91%] male] were enrolled. Overall 66% tested positive for HCV Ab [287 male [67.5%], 21 female [50%], p<0.02]. HCV seropositivity was higher among prisoners [78.3% vs. 30.6%, p<0.001] and older IDU [76.9% vs. 62.9%, p=0.002]. Multivariable analysis showed association between HCV seropositivity and imprisonment [OR= 9.32, 95%CI: 5.60- 15.51], sharing syringes [OR=2.00, 95%CI: 1.27-3.17], duration of intravenous drug use annually [OR=1.16, 95%CI: 1.08-1.24] and male sex [OR=4.18, 95%CI: 2.02- 8.67]. HCV is rather common among IDU prisoners. Imprisonment is an independent risk factor. The infected IDU going back to the community may be an important source of HCV. Taking effective strategies [high risk group education, provision of sterile syringes, identification and treatment of infected IDU] to reduce the risk of this public health problem is needed urgently

[HCV in intravenous drug users]

Hepatitis C [HCV] is increasing worldwide including Iran. HCV is more prevalent among intravenous drug abusers [IDU], especially if imprisoned, mostly due to needle sharing. We determined the rate of HCV seropositivity among IDU prisoners and compared it with those of non prisoners. A cross-sectional survey was done on consenting IDU inhabiting two prisons and attending three rehabilitation centers in Tehran, Iran. A questionnaire was completed for each subject and 5mL blood drawn. The samples were kept at 2-8°C until the sera were separated and stored at -70°C. HCV Ab [ELISA 1, third generation, DIA. PRO, Italy] with a sensitivity and specificity of 98% was checked by a single technician. Chi-square, Fisher's exact test and multivariable analysis were used where appropriate. Four-hundred and sixty seven subjects [346 [74.1%] prisoners; 425 [91%] male] were enrolled. Overall 66% tested positive for HCV Ab [287 male [67.5%], 21 female [50%], p<0.02]. HCV seropositivity was higher among prisoners [78.3% vs. 30.6%, p<0.001] and older IDU [76.9% vs. 62.9%, p=0.002]. Multivariable analysis showed association between HCV seropositivity and imprisonment [OR= 9.32, 95%CI: 5.60- 15.51], sharing syringes [OR=2.00, 95%CI: 1.27-3.17], duration of intravenous drug use annually [OR=1.16, 95%CI: 1.08-1.24] and male sex [OR=4.18, 95%CI: 2.02- 8.67]. HCV is rather common among IDU prisoners. Imprisonment is an independent risk factor. The infected IDU going back to the community may be an important source of HCV. Taking effective strategies [high risk group education, provision of sterile syringes, identification and treatment of infected IDU] to reduce the risk of this public health problem is needed urgently

Molecular detection of prostate specific antigen in patients with prostate cancer or benign prostae hyperplasia the first investigation from Iran

Prostate cancer is the second common form of cancer in men. Detection of circulating Prostate Specific Antigen [PSA] transcripts has effectively been used for early diagnosis of prostate cancer cells. This investigation employed a reverse transcriptase polymerase chain reaction [RT-PCR] technique to distinguish the patients with either localized or metastatic prostate cancer [CaP] vs. Benign Prostate Hyperplasia [BPH] and control subjects, as compared with clinical and pathological records. With reservation of ethical issues, blood samples were collected from 60 cases. Based on pathological and clinical findings, 25 patients [20 with localized cancer, 5 with metastatic], 22 with BPH, and 13 healthy [including 3 females] subjects as negative controls, were selected from Shariati, Mehrad, Sina,, Khatam and Atie Hospitals in Tehran, Iran. RT-PCR for a 260 bp PSA transcript was then performed. Clinical and pathological records were used for the assessment and comparison of PSA RT-PCR results. None of the control subjects and BPH [with 7 exceptions] were found positive by RT-PCR [Relative specificity= 72.7%]. In patients with prostate cancer, 21 out of 25 were found PSA positive [Relative sensitivity=83.4%] and the remaining 3 have been shown to be PSA negative [Positive predictive value= 83.4%]. All of 5 metastatic patients [100%] revealed PSA positive results. Our data reflects the clinical relevance and significance of RT-PCR results as assessed with clinical and pathological examinations. PSA RT-PCR might be used as a powerful means for diagnosis, even when either pathological or clinical findings are negative, and could be employed for further molecular epidemiology surveys

[Ecologic study of serum selenium and upper gastrointestinal cancers in Iran]

Both observational and experimental studies have shown that higher selenium status reduces the risk of upper gastrointestinal cancers in selenium deficient populations. Recent cancer registry data have shown very different rates of esophageal cancer [EC] and gastric cancer [GC] in four provinces of Iran, namely Ardabil, Mazandaran, Golestan, and Kerman. The aim of this study was to have a preliminary assessment of the hypothesis that high rates of EC in Golestan and high rates of GC in Ardabil may be partly attributable to selenium deficiency. We measured serum selenium in 300 healthy adults from Ardabil [n=100], Mazandaran [n=50], Golestan [n=100], and Kerman [n=50], using inductively coupled plasma, with dynamic reaction cell, mass spectrometry [ICP-DRC-MS] at the US Centers for Disease Control [Atlanta, Georgia]. The median serum selenium concentrations were very different in the four provinces. The medians [IQR] for selenium in Ardabil, Mazandaran, Golestan, and Kerman were 82 [75-94], 123 [111-132], 155 [141-173], and 119 [110 -128] micro g/L, respectively [p<0.001]. The results of linear regression showed that the province variable, by itself, explained 76% of the variance in log selenium [r2=0.76]. The proportion of the populations with a serum selenium more than 90 micro g/L [the concentration at which serum selenoproteins are saturated] was 100% in Golestan, Kerman, and Mazandaran but only 29% in Ardabil. Our findings suggest that selenium deficiency is not a major contributor to the high incidence of EC seen in northeastern Iran, but it may play a role in the high incidence of GC in Ardabil province