[Effect of referral of cancer patients to medical centers outside Golestan province on the coverage and quality of population-based cancer registry data]

Background and Objective: Considering the importance of coverage and quality of data in Golestan population-based Cancer Registry [GPCR], northern Iran. This study was conducted to determine the effect of the referral of cancer patients to medical centers outside Golestan province on the coverage of the population-based cancer registry program

Methods: This descriptive-analytic study was performed on all cancer patients registered in the diagnostic centers of Golestan province, northern Iran during 2008-10. Data of patients referred to the centers of the province from the bank of the Golestan province cancer registry program and data of patients referred to the centers outside the province were received from the Ministry of Health Department of Cancer. Data were analyzed using the record linkage method

Results: A total of 6083 new cases of cancer were registered in Golestan province. According to the cancer data, 678 [11%] of them were referred to outside of Golestan province centers. 343 of these 678 patients [50.6%] were found as duplicate records between the two datasets. The most frequent cases were gastric cancers [70.4%], breast [63.5%] and esophagus [62.5%]

Conclusion: This study suggested that referrals of cancer patients to centers outside the Golestan province may result in an underestimation of about 5% in GPCR. This level of underestimation seems to have no considerable effects on completeness and quality of data in the GPCR

Comparison of the serum levels of trace elements in areas with high or low rate of esophageal cancer

Background: there is a critical role for trace elements in cancer prevention. Since northeast Iran is known as a high risk area for esophageal cancer, this study was designed to compare the serum levels of some trace elements in high and low rate areas of Golestan province

Methods: we used 240 fasting serum samples obtained in 2011 from eastern and western parts of Golestan province during the non-communicable diseases' screening program. To carry out laboratory examinations, the samples were firstly deproteinated and then the concentrations of the intended elements were measured by an atomic absorption spectrometer. A total of 227 samples were used in the present study and the remaining 13 samples were excluded due to inappropriate conditions

Results: the mean serum level of zinc in the high-risk region was significantly lower than that in the low-risk region. But no significant difference was detected in serum levels of copper, magnesium, and manganese in the low-risk and high-risk regions

Conclusion: as this study was an ecological study with no comparison between patients with cancer and healthy population, its results cannot be used for the general population. Therefore, complementary studies including case-control studies are suggested for further evaluation of the relationship between these elements and the incidence of esophageal cancer

Bowel preparation for a better colonoscopy using polyethylene glycol or c-lax: a double blind randomized clinical trial

Background: Ideal bowel preparation regimen for a suitable colonoscopy should be safe, and well tolerated, and should rapidly clear gastrointestinal tract. Soluble polyethylene glycol [PEG] is the most common cleansing drug and Senna or C-Lax [Cassia angustifolia Vahl] is an alternative herbal one. This study was designed to compare the efficacy of PEG and C-lax in bowel preparation

Methods: In this randomized double blind trial [registry number in IRCT.ir: IRCT201601161264N7], 320 patients were randomly assigned in PEG or C-lax groups. PEG solution was prepared from 5><70 gr sachets in 20><250cc water [250 ml every 15 minutes], prescribed 24h before the colonoscopy. In the other group 3x60 ml C-lax syrup glasses [each containing 90 mg senozid B] was given in two divided doses [1.5 glasses of 250cc every 12 hours], 24h before the colonoscopy. Ottawa score was used to evaluate the quality of bowel preparation. Chi-square test, Student t test, Mann-Whitney test and multivariate analysis were used to analyze the data

Results: Of these patients with the mean [SD] age of 50 [15.16] years, 162 [50.8%] were men. Mean [SD] Ottawa score was 2.57 [0.2] and 3.15 [0.31] in the PEG and C-lax group, respectively [p value = 0.81]. Multivariate analysis showed that less opium consumption [p < 0.001] and higher educational level [p =0.005] were associated with better bowel preparation

Conclusion: C-Lax is non-inferior to PEG solution in cleansing colon. The quality of bowel preparation was lower in opium consumers and better in those with higher educational level

Factors associated with outcome in patients with acute upper gastrointestinal bleeding in a tertiary referral center in Northern Iran

Background: Upper gastrointestinal bleeding [UGIB] is a major healthcare problem and is the most frequent gastrointestinal reason for admission to hospital. We aimed to investigate the prognosis of patients with UGIB referred to a referral hospital in northern Iran in 2013

Methods: All patients with UGIB who admitted to Sayyad Shirazi Hospital, in Gorgan, northern Iran, in 2013 were enrolled. The patients' demographic data as well as data about admission, diseases, drug history, and patients' prognosis were collected by structured questionnaire using information in hospital files. The relationships between different factors with the proportion of mortality and recurrence were assessed using Chi-square test

Results: In total, 168 patients were enrolled of whom 109 [64.9%] were male. The mean [SD] age of the patients was 59.4 [18.2] years. Mortality and recurrence occurred in 23.2% and 34.5% of the subjects, respectively. We found significant relationships between older age and diagnosis of malignancy with mortality [p =0.03 and p <0.01] and recurrence [p<0.01 and p <0.01]

Conclusion: We found relatively high rates of mortality and recurrence among patients with UGIB. Our results suggested older age and diagnosis of malignancy as the most important indicators of mortality and recurrence in such patients. Considering these factors in clinical settings may result in better and more effective management of patients with UGIB

Esophageal cancer in golestan province, Iran: a review of genetic susceptibility and environmental risk factors

Esophageal squamousi cell carcinoma [ESCC] is an aggressive tumor that is typically diagnosed only when the tumor has gained remarkable size, extended to peripheral tissues, and led to dysphagia. Five-year survival of advanced cancer is still very poor [19%], even with improved surgical techniques and adjuvant chemoradiation therapy

Therefore, early detection and prevention are the most important strategies to reduce the burden of ESCC

Our review will focus on the studies conducted in Golestan province, an area with a high prevalence of ESCC in northern Iran. We review three aspects of the research literature on ESCC: epidemiological features, environmental factors [including substance abuse, environmental contaminants, dietary factors, and human papilloma virus [HPV], and molecular factors [including oncogenes, tumor suppressor genes, cell cycle regulatory proteins, and other relevant biomarkers]

Epidemiological and experimental data suggest that some chemicals and lifestyle factors, including polycyclic aromatic hydrocarbons [PAHs], cigarette smoking, opium use, and hot tea drinking are associated with the development of ESCC in Golestan

HPV infects the esophageal epithelium, but so far, no firm evidence of its involvement in esophageal carcinogenesis has been provided. Some of these factors, notably hot tea drinking, may render the esophageal mucosa more susceptible to injury by other carcinogens

There are few studies at molecular level on ESCC in Golestan

Increasing awareness about the known risk factors of ESCC could potentially reduce the burden of ESCC in the region. Further studies on risk factors, identifying high risk populations, and early detection are needed

Correlation between low bone density and disease activity in patients with ulcerative colitis

Different clinical and epidemiological studies using dual-energy X-ray absorptiometry have shown an increased prevalence of low bone mineral density in patients with inflammatory bowel diseases. The aim of this study was to assess the correlation between bone density and the disease activity in patients with ulcerative colitis. In this cross-sectional study, 52 patients with ulcerative colitis [duration of the disease less than 5 years] were invited to our research center, Golestan province, northeast of Iran, during February 2012 up to August 2012. A demographic checklist and Simple Clinical Colitis Activity Index was completed for each patients and 5 cc of blood sample was taken after obtaining the informed consent. We used colorimetry method for measuring serum calcium, UV method for serum phosphorus and ELISA for serum vitamin D. Dual-energy X-ray absorptiometry was done to evaluate the bone density. Data analysis was done using SPSS software version 16. Normality of data was assessed using Kolmogorov-Smirnov test. T and ANOVA tests were used if data had normal distribution. Mann-Whitney U or Kruskal-Wallis tests were used for the remaining data. Correlation between qualitative variables was evaluated by Chi-square test. The mean [ +/- SD] age and disease activity of the patients were 37.72 [ +/- 12.18] years and 4.78 [ +/- 1.98], respectively. There were no correlation between disease activity and mean age Low bone density was seen in 30.8%, 11 .5%, and 15.4% in spine, femur neck, and hip, respectively. There was no relationship between Z-score of total hip, spine, and femur neck with disease activity, age, and duration of disease [p>0.05]. Our results showed an acceptable rate of low bone density in patients with ulcerative colitis without any correlation with the disease activity index

Selenium levels in rice samples from high and low risk areas for esophageal cancer

To assess the relationship between selenium [Se] concentration in rice and the incidence of esophageal cancer [EC] in a high risk area in Northern Iran. This ecological study was conducted in Golestan province of Iran in 2012. In this area, 45714 acres of land are cultivated by rice. A total of 69 rice samples were taken. We investigated Se concentrations by the voltammetric method. Statistical analysis was performed using the Pearson correlation test and Mann-Whitney U test. The mean [ +/- SD] Se level in rice samples was 0.229 [ +/- 0.145] mg/kg. The Se concentration was significantly higher in rice samples from high EC rate areas [0.35 mg/kg] compared with low risk areas [0.16 mg/kg] [p<0.001]. There was a significant positive correlation between the levels of Se in rice and the incidence rate of EC [p=0.03]. We found a high rice Se concentration and a significant positive relationship between rice Se levels and EC rates in the Golestan province of Iran. High soil and rice Se levels may play a possible role in the pathogenesis of EC in this area

Predictors of Colorectal Cancer Survival in Golestan, Iran: A Population-based Study / 한국역학회지

OBJECTIVES: We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran. METHODS: We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates. RESULTS: Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model. CONCLUSIONS: Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs.

Goiter Frequency Is More Strongly Associated with Gastric Adenocarcinoma than Urine Iodine Level

PURPOSE: We designed our study to evaluate the hypothesis that gastric cancer is correlated with iodine deficiency or thyroid dysfunction. MATERIALS AND METHODS: We investigated the total body iodine reserve, thyroid function status and autoimmune disorder in 40 recently diagnosed gastric adenocarcinoma cases versus 80 healthy controls. The participants came from a region with high gastric cancer rate but sufficient iodine supply due to salt iodination. The investigation included urine iodine level, thyroid gland clinical and ultrasonographic examination, and thyroid function tests. RESULTS: Goiter was detected more frequently in the case group (P=0.001); such a finding, however, was not true for lower than normal urine iodine levels. The free T3 mean level was significantly lower in the case group compared to the control group (P=0.005). CONCLUSIONS: The higher prevalence of goiter rather than low levels of urinary iodine in gastric adenocarcinoma cases suggests that goiter, perhaps due to protracted but currently adjusted iodine deficiency, is more likely to be associated with gastric adenocarcinoma compared to the existing iodine deficiency itself.

Epidemiology of Helicobacter pylori infection among Iranian children

Background and study aims: Infection with Helicobacter pylori [HP] either in children or in adults is a risk factor for gastric cancer. The Golestan province located in northeast Iran has been known to be a high-risk area for oesophageal and gastric cancers. This study was conducted to assess the epidemiology of this infection in the children of Golestan

Patients and methods: This study was carried out in 2009 on healthy children [1-15 years] of the Golestan province. Serum immunoglobulin G [Ig G] antibody against HP was tested in these children and positive samples were tested for anti-cytotoxin-associated antigen A [anti-CagA] antibody. To assess the relationship between HP infection and the risk of gastric cancer, the Golestan province was divided into high- and low-risk areas based on the incidence rate of gastric cancer. The chi-squared test was used to assess the relationship between variables

Results: Totally, 194 subjects were recruited. The prevalence of HP infection in our area was 50.5%. The prevalence of HP infection was significantly higher in the high-risk than in the low-risk area for stomach cancer [p = 0.004]. The seropositivities of HP [p = 0.03] and CagA [p = 0.04] were significantly lower in children <5 years than in others

Conclusion: Our results showed a high prevalence of HP infection in children of the Golestan province of Iran. We also found a significant positive relationship between childhood HP infection and the risk of gastric cancer. Hence, childhood HP infection may be considered a possible determinant of gastric cancer in this high-risk area. Implementation of preventive programmes may help to reduce the burden of childhood HP infection and, consequently, gastric cancer in this area

Polycyclic aromatic hydrocarbons and esophageal squamous cell carcinoma

Esophageal cancer [EC] is the 8[th] most common cancer and the 6[th] most frequent cause of cancer mortality worldwide. Esophageal squamous cell carcinoma [ESCC] is the most common type of EC. Exposure to polycyclic aromatic hydrocarbons [PAHs] has been suggested as a risk factor for developing ESCC. In this paper we will review different aspects of the relationship between PAH exposure and ESCC. PAHs are a group of compounds that are formed by incomplete combustion of organic matter. Studies in humans have shown an association between PAH exposure and development of ESCC in many populations. The results of a recent case-control study in a high risk population in northeastern Iran showed a dramatic dose-response relationship between PAH content in non-tumor esophageal tissue [the target tissue for esophageal carcinogenesis] and ESCC case status, consistent with a causal role for PAH exposure in the pathogenesis of ESCC. Identifying the main sources of exposure to PAHs may be the first and most important step in designing appropriate PAH-reduction interventions for controlling ESCC, especially in high risk areas. Coal smoke and drinking mate have been suggested as important modifiable sources of PAH exposure in China and Brazil, respectively. But the primary source of exposure to PAHs in other high risk areas for ESCC, such as northeastern Iran, has not yet been identified. Thus, environmental studies to determining important sources of PAH exposure should be considered as a high priority in future research projects in these areas

None-endoscopic screening for esophageal squamous cell carcinoma- a review

Esophageal cancer [EC] is the eighth most common cancer and sixth most frequent cause of cancer mortality worldwide. Esophageal squamous cell carcinoma [ESCC] is the most common type of EC. ESCC develops by progression from premalignant lesions, which are called esophageal squamous dysplasia [ESD]. Prevention is the most effective strategy for controlling this disease. Generally, two methods may be defined for ESCC prevention. The aim of the first preventive method is to prevent the initiation of ESD by avoiding the known risk factors, or primary prevention. Secondary prevention focuses on detection of the disease in its early curable stage, thus preventing its progression into advanced stages. Endoscopy with iodine staining and biopsy is the diagnostic choice for ESD. However it is invasive and expensive, and not accepted by asymptomatic ESD cases. Therefore, it is necessary to find a non-endoscopic screening method. Despite the large number of studies conducted worldwide, no approved method has been developed for ESCC screening. Regarding the multi-factorial nature of ESCC, it is proposed that the use of a combination of various criteria, such as cytological examination, risk factors, genetic alteration, and molecular markers may result in the development of a comprehensive and effective ESCC screening program

Cancer incidence in golestan province: report of an ongoing population-based cancer registry in Iran between 2004 and 2008

Golestan Province, at the western end of the Asian esophageal cancer [EC] belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry [GPCR]. The GPCR collected data from newly diagnosed [incident] cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer [IARC]. Age-standardized incidence rates [ASR] of cancers were calculated using the 2000 world standard population. From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean [SD] age was 55.5 [18.6] years, and 54% were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach [ASR:30.7], esophagus [24.3], and lung [15.4] were the most common cancers in males. In females, breast cancer [ASR:26.9] was followed by malignancies of the esophagus [19.1] and stomach [12.4]. The diagnosis of cancer was based on histopatho-logical reports in 71% and on death certificate only in 9% of cases. The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase

role of IL-6 for predicting neonatal sepsis: a systematic review and meta-analysis

Neonatal sepsis [NS] is a common and life-threatening disorder in infants. Previous studies showed that interleukin-6 [IL-6] may be a valid non-invasive and rapid method for diagnosis of NS. We conducted this review to assess the validity of IL-6 for predicting NS. This was a systematic review with meta-analysis. Embase, Medline and Web of Science databases were searched between January 1990 and December 2009. The search terms used were [cytokine], [neonate], [sepsis] and [interleukin-6]. We used standard methods recommended for meta analyses of diagnostic test evaluations. The analysis was based on a summary ROC [SROC] curve. Meta-regression analysis was used to assess the effects of some confounding factors on the results of meta-analysis. Potential presence of publication bias was tested using funnel plots and the Egger test. Meta-analysis was performed on 13 publications including 353 infants with sepsis and 691 control infants. The pooled sensitivity and specificity of IL-6 was 0.79 and 0.84, respectively. The maximum joint sensitivity and specificity [i.e., the Q value] in SROC curve was 0.82 and the area under curve [AUC] was 0.89 [95% CI: 0.84-0.94]. Meta-regression analysis showed that the diagnostic accuracy of IL-6 was not affected by confounding variables. The evaluation of publication bias showed that the Egger test was not significant [P=0.07]. IL-6 seems to be a valid marker for predicting NS. It may be considered for early diagnosis of sepsis in neonatal care units

Incidence of childhood cancers in Golestan province of Iran

This paper presents the incidence rates of childhood cancers using the data obtained from Golestan population based cancer registry [GPCR] between 2004 and 2006. GPCR registers only primary cancers based on standard protocols of the international association of cancer registries [IACR]. We collect data on newly diagnosed [incident] cancer cases from all public and private diagnostic and therapeutic centers of the whole province. CanReg-4 software was used for data entry and analysis. Totally 5076 cancer cases [all ages] were diagnosed in GPCR between 2004 and 2006. Of these, 139 [2.74%] were children [aged 0-14 years] with mean [ +/- SD] age of 8.06 [ +/- 4.48] years. The age standardized incidence rates for childhood cancer were 119.8 and 78.3 per 1000000 person-years in male and female children, respectively. Leukemia was the most common childhood cancer in Golestan province of Iran. Lymphomas and central nervous system tumors were the second and third ones, respectively. The incidence rates of childhood cancers were relatively high in Golestan province of Iran. So, controlling of childhood cancers should be mentioned as an important issue in health policy making in this area

[Relation between drinking water hardness and the incidence of esophageal and gastric cancers]

Esophageal and gastric cancers are among the most prevalent cancers in the world which cause a high mortality rate annually. Several risk factors are supposed for them. Water hardness is considered as a protective factor against above cancers. This ecologic study was designed to determine the correlation between water hardness and upper gastrointestinal cancers. In this ecological study data on water components in Golestan's urban areas were obtained during 2004-05 and the averages were reported. All cases of esophageal and gastric cancers resided in urban areas which were diagnosed during this period were recruited to estimate the incidence and age standardized rates [ASR]. The province was divided into low, intermediate and high incidence, based on 33% and 66% quartiles of both cancers. Pearson correlation coefficient test and regression model were used to analyze the data. The water hardness was in the normal standard range permitted for the drinking water, and did not have any relation with the risk of esophageal and gastric cancers. This study showed that water hardness has no effect on the incidence of esophageal and gastric cancer in this area

[Nutritional characteristics in patients with colorectal cancer in Golestan Province of Iran, a case-control study]

Colorectal cancer is the third common malignancy in the world. Personal habits including life style and nutrition have been proposed as risk factors of colorectal cancer. We conducted this study to assess the nutritional characteristics in colorectal cancer patients in Golestan province of Iran. This case-control study was done on 47 colorectal cancer cases, diagnosed during 2004-05 and 47 healthy controls. A questionnaire containing socio-demographic and nutritional characteristics [FFQ] was filled for each of the participants. Chi square test was used to assess the relationship between variables. In each of the two groups, 40.4% were females and 59.6% were males. The mean +/- SD age of age in cases and controls were 52.4 +/- 13.4 and 52.1 +/- 13.1 years, respectively. Total energy expenditure of higher than 1837.5 Kcal/day was significantly related to colorectal cancer [OR= 3.8; 95% CI: 1.2-11.3]. Colorectal cancer risk was higher in individual with frying cooking method [OR=3; 95% CI: 0.8-11.1]. The risk of colorectal cancer was 6.5 times higher in individuals with fat consumption of higher than 118.5 grams/day [95% CI: 1.5-28.8].No significant relationship was seen between vegetables consumption and the risk of colorectal cancer. This study showed that high total energy expenditure, high fat consumption and using frying method for cooking are risk factors of colorectal cancer in Golestan province in Northern of Iran

[Short-term survival rates of upper gastrointestinal cancers in rural areas of Golestan province, Iran]

Esophageal and gastric cancers are among the most common and fatal cancers. These are diagnosed at the latest phase and the prognosis is too poor. Due to the importance and high incidence rate of the upper gastrointestinal cancers in Golestan province, this study was conducted to explore the overall survival rate of these patients in rural area of this region. In this descriptive cross-sectional study, a total of 121 pathologically confirmed esophageal or gastric cancers, with rural place of residence, were retrieved from the cancer registry at the health department in Gorgan. After conducting interview with patients or their relatives, analysis of their sociodemographic and clinicopathologic features was performed. The median survival rate was compared regarding age groups and gender using Kaplan-Meier statistical test. Male to female ratio in esophageal and gastric group were 1.2 to 1 and 3.8 to 1, respectively. Short-term survival rates were 54.76% and 26.2% for esophageal cancer and 66.6% and 37.5% for gastric cancer. Collected information regarding patients' sociodemographic and clinicophathologic factors did not have significant association with patients' survival in both esophageal and gastric cancers. The mean survival rate in patient with gastric and esophageal cancers according to age and gender was not significant. This study showed that the overall short-term survival rates for upper gastrointestinal cancers are very low in Golestan province. Therefore the need for intervention the need and allocating more diagnosis and therapeutic resources for upper gastrointestinal cancers are required