Spatial Inequalities in the Incidence of Colorectal Cancer and Associated Factors in the Neighborhoods of Tehran, Iran: Bayesian Spatial Models / 예방의학회지

OBJECTIVES: The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models. METHODS: This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The Besag-York-Mollié (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis. RESULTS: The Moran index was statistically significant for all the variables studied (p < 0.05). The BYM model showed that having a women head of household (median standardized incidence ratio [SIR], 1.63; 95% confidence interval [CI], 1.06 to 2.53), living in a rental house (median SIR, 0.82; 95% CI, 0.71 to 0.96), not consuming milk daily (median SIR, 0.71; 95% CI, 0.55 to 0.94) and having greater household health expenditures (median SIR, 1.34; 95% CI, 1.06 to 1.68) were associated with a statistically significant elevation in the SIR of CRC. The median (interquartile range) and mean (standard deviation) values of the SIR of CRC, with the inclusion of all the variables studied in the model, were 0.57 (1.01) and 1.05 (1.31), respectively. CONCLUSIONS: Inequality was found in the spatial distribution of CRC incidence in Tehran on the neighborhood level. Paying attention to this inequality and the factors associated with it may be useful for resource allocation and developing preventive strategies in atrisk areas.

Spatial Inequalities in the Incidence of Colorectal Cancer and Associated Factors in the Neighborhoods of Tehran, Iran: Bayesian Spatial Models / 예방의학회지

OBJECTIVES@#The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models.@*METHODS@#This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The Besag-York-Mollié (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis.@*RESULTS@#The Moran index was statistically significant for all the variables studied (p < 0.05). The BYM model showed that having a women head of household (median standardized incidence ratio [SIR], 1.63; 95% confidence interval [CI], 1.06 to 2.53), living in a rental house (median SIR, 0.82; 95% CI, 0.71 to 0.96), not consuming milk daily (median SIR, 0.71; 95% CI, 0.55 to 0.94) and having greater household health expenditures (median SIR, 1.34; 95% CI, 1.06 to 1.68) were associated with a statistically significant elevation in the SIR of CRC. The median (interquartile range) and mean (standard deviation) values of the SIR of CRC, with the inclusion of all the variables studied in the model, were 0.57 (1.01) and 1.05 (1.31), respectively.@*CONCLUSIONS@#Inequality was found in the spatial distribution of CRC incidence in Tehran on the neighborhood level. Paying attention to this inequality and the factors associated with it may be useful for resource allocation and developing preventive strategies in atrisk areas.

Altered miR-223 expression in sputum for diagnosis of non-small cell lung cancer

Background: Diagnosis of Non-small Cell Lung Cancer [NSCLC] at an early stage is a daunting challenge due to the deficiency of specific noninvasive markers. MicroRNAs [miRNAs] play important roles in the initiation and progression of NSCLC. Measuring miRNA expression levels could provide a potential approach for the diagnosis of NSCLC. Our goals were to examine miR-223, miR-212, miR-192, miR-3074, SNORD33 and SNORD37 expression levels in tissue and sputum of NSCLC patients and cancer free subjects for molecular diagnosis of NSCLC

Methods: Relative expressions of miR-223, miR-212, miR-192, miR-3074, SNORD33 and SNORD37 were examined with quantitative real-time RT-PCR assay in tissue and sputum obtained from 17 NSCLC patients and 17 controls

Results: miR-3074 was upregulated in tissue samples of NSCLC patients compared with control group. miR-223 was upregulated, miR-212 and SNORD37 were downergulated in sputum samples of patients compared with controls. miR-223 quantification produced 82% sensitivity and 95% specificity with areas under the ROC curve at 0.90 in detection of NSCLC

Conclusion: miR-223 clearly discriminated cancer patients from cancer-free subjects and our results suggest that miR-223 could be a diagnostic useful biomarker. The measurement of altered miRNA expression in sputum samples manifested the potential noninvasive approach for detection of lung cancer

Survey of Sonoanatomic Distances For Lumbar Medial Branch Nerve Blocks in Healthy Volunteers

BACKGROUND: The precise knowledge of anatomy and the region of transverse process (TP) and superior articular processes (AP) and their distance from the skin are important in blocking and treating lumbar facet syndrome. Evaluation of these anatomic distances from 3rd and 5th lumbar vertebrae in both sides and in different body mass index (BMI) in healthy volunteers might improve knowledge of ultrasound (US) lumbar medial branch nerve blocks (LMBB). METHODS: Bilateral US in the 3rd and 5th lumbar vertebrae of 64 volunteers carried out and the distance between skin to TP and skin to AP was measured. These distances were compared on both sides and in different BMI groups. The analysis was done using SPSS 11. Analysis of variance was used to compare the means at three vertebral levels (L3-L5) and different BMI groups. P values less than 0.05 were considered statistically significant. The paired t-test was used to compare the mean distance between skin to TP and skin to AP on both sides. RESULTS: The distance between skin to TP and skin to AP of 3rd vertebrae to 5th vertebrae was increased in both right and left sides (P < 0.001) from up to down. The mean distance from skin to TP were greater on the left side compared to the right in all three vertebral levels from L3 to L5 (P values 0.014, 0.024, and 0.006 respectively). The mean distance from skin to TP and the skin to AP was statistically significant in different BMI groups (P < 0.001). CONCLUSIONS: We found many anatomic distances which may increase awareness of US guided LMBB.

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.

comparison between two different prophylactic doses of unfractionated heparin for deep venous thrombosis prevention in laparoscopic bariatric surgery

Deep Venous Thrombosis [DVT] is a major risk of morbidity and mortality in morbid obese patients underwent bariatric surgery. There are some controversies in different kind of prophylactic strategies for DVT in laparoscopic bariatric surgeries. Unfractionated heparin [UFH] is an available and reversible anticoagulant used for DVT prophylaxis. This study aimed to compare clinical results of two different dosage regimes of unfractionated heparin for short term prophylaxis of DVT after bariatric surgery. 139 patients with morbid obesity who underwent laparoscopic bariatric surgery [laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding] were evaluated in two groups: group A received 5000 IU unfractionated heparin q12h and group B received the same dose but q8h [preliminary dose received before induction of anesthesia followed by 2 or 3 times daily]. All patients were evaluated by physical examination and Doppler ultra sound for DVT before and 10 days after surgery. There was no statistically significant difference between two groups in venous thrombosis. No thrombotic events were observed before and after operations. There were no heparin induced thrombocytopenia and no meaningful difference between two groups in postoperative bleeding. This study showed that in combination with non-pharmacologic methods for prevention of thromboembolic events, both regimes of UFH prophylaxis had similar clinical effects

Do clinical and demographic features of patients with upper-gastrointestinal cancer affect their health-related quality of life?

Oesophagogastric [OG] cancer as a globally common and deadly malignancy, which is widely spread in Northeast Iran, has an extensive impact on health-related quality of life [HRQL]. Demographic and histopathologic changes have been apparent in oesophagogastric cancer, therefore. HRQL could be used, as an outcome, to assess and determine the efficacy and impact of cancer care. A consecutive sample of upper-gastrointestinal cancer patients admitted to the main oncology/ radiotherapy departments in the North-East of Iran were recruited into the study. All participants completed the European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 and QLQ-OG25questionnaires in a face to face interview. Of the total 275 patients participated in the study, 54% had oesophageal, 34% stomach and 12% OG junction cancers. About 73.1% had TNM [tumour, node, metastasis] staging; of which 69% were in stage III and IV. The most common type of cancer in oesophagus was Squamous Cell Carcinoma [SCC] [95.3%] in lower third, Adenocarcinoma in stomach [97.8%] and in the OG junction [93.8%]. Patients with stomach or OG junction tended more to present in higher stages [P < 0.001]. Unlike QLQ-C30, the EORTC QLQ-OG25 was able to differ patients significantly in anxiety scale [P = 0.01], body image, chocking and weight loss [P < 0.05]. Those who had self care ability had better quality of life scores [P < 0.001] in more scales and items. SCC is predominant type of upper GI cancer in Khorasan provinces similar to the high risk area in Northern Iran. The specific health-related quality of life tool [EORTC QLQ-OG25] was able to distinguish most of the symptoms in patients with upper GI cancer

Demographic and prognostic factors of 455 patients with acute leukemia admitted to two referral hospitals in Tehran-Iran during ten years [2001-2011]

Global death toll of Acute Leukemia [AL], as a heterogeneous group of hematopoietic malignancies, is rather high, i.e. almost 74% of 300,000 new cases die every year. This reflects a poor prognosis of this malignancy in most parts of the world, where contemporary and rather complex remedies are not available. There are a few well documented reports about the epidemiologic features of AL at national level in Iran. This retrospective study demonstrates demographic and laboratory features of Acute Myeloid Leukemia [AML] and Acute Lymphoblastic Leukemia [ALL] patients admitted to the main referral oncology hospitals in the ex-Iran University of Medical Sciences in Tehran [Firoozgar and Rasoul-Akram hospitals] during the last decade [2001-2011]. Medical records of all patients admitted to the both hospitals diagnosed with AML and ALL were reviewed during the study period for demographic, biological and clinical characteristics at diagnosis. Four-hundred fifty five patients were diagnosed with AML and ALL, who admitted to the both hospitals during ten years, of whom 59.6% [271 patients] were male. Fifty five percent of patients had AML and 44.6% had ALL, both significantly dominated in men [p<0.001]. AML patients died more significantly [p<0.05] and the most deaths occurred in older patients [p<0.001]. Initial WBC count was significantly related to death [p= 0.001], where the least death [13%] occurred in the group with initial WBC between 5-10x103/microL and most of deceased had an initial WBC more than 10x103/microL. Logistic regression showed that age, fever and WBC were significant prognostic factors. Demographic characteristics of AL patients were almost the same as other global reports. Most deaths occurred in older patients, those who had fever, and patients with higher WBC count at first admission, which warrants more investigations accurately and also improvements in hospital records