Epidemiological features of hepatitis B and C infection in a high risk population: results of screening programs

The aim of this study was to report the epidemiological features of HBV and HCV infection in an Iranian high risk population. Hepatitis B and hepatitis C infections are worldwide serious public health problems. Iran has an intermediate prevalence of infection and a. screening program was started in 2010 among high risk individuals. This cross-sectional study was conducted on 4455 new patients during two past years. Demographic information, age, gender, occupational status, medical history, history of vaccination against HBV, high risk exposure and laboratory findings were collected for each patient. Then distribution of demographic and risk factors was evaluated in each type of hepatitis. The mean age of patients was 45.6 +/- 17.3 years. More than two-thirds of the diagnosed cases were infected with HBV. 74% of patients were carriers of hepatitis virus. 60% of patients had no symptoms at diagnosis. Illicit intravenous drug use was most common high risk exposure in patients under study [n=366, 8.2%]. High risk behaviors including illicit intravenous drug use and unprotected sex were relatively higher in patients infected with hepatitis C compared to patients with hepatitis B infection. Findings of this study suggest that illicit intravenous drug use, contact with an infected household member and unprotected sex are the most common high risk exposure in Iranian patients infected with viral hepatitis. Therefore, preventive strategies such as health education, vaccination and screening programs should be directed to these groups. The results also show that a majority of patients have no symptoms at the time of diagnosis, therefore periodic screening tests in high risk groups is required

History of upper gastrointestinal cancers in relatives: a community-based estimate

The present study aimed to evaluate the prevalence of positive family history of these cancers in a large population-based sample of Tehran province, capital of Iran. Upper gastrointestinal [UGI] cancers [gastric and esophagus cancer] constitute a major health problem worldwide. A family history of cancer can increase the risk for developing cancer and recognized as one of the most important risk factors in predicting personal cancer risk. This study designed as a cross-sectional survey in general population [2006-2007] of Tehran province. Totally 7,300 persons [age>= 20 years] sampled by random sampling on the basis of the list of postal, of whom 6,700 persons agreed to participate [response rate 92%]. Respondents were asked if any first-degree [FDR] or second-degree [SDR] relatives had gastric or esophageal cancer. Totally, 6,453 respondents [48% male] entered to the study. The mean age of responders with positive FH was significantly higher than those with negative FH [P<0.05]. In total, 341 respondents [5.3%] reporting a history of UGI cancers in their relatives, 134[2.1%] in FDRs, and 207[3.2%] in SDRs. Our findings showed that the reported prevalence of FH of UGI cancers was relatively low and varied by specific respondent characteristics such as age and sex. However, the estimates of prevalence presented here are likely to be conservative compared with actual prevalence because of self-reported data gathering

Epidemiological features of gastro-esophageal reflux disease in Iran based on general population

The aim of this study was to evaluate the epidemiology of GERD base on population study in Tehran providence. Gastro-esophageal reflux disease [GERD] is a common and chronic problem. Recent reports from developing counties indicate increment in the incidence and prevalence of the disease over the past. This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran. Participants completed a valid gastro-esophageal reflux Questionnaire. The questionnaire included personal and family characteristics such as age, gender, and educational status. In addition, interviewers asked them regarding 10 GI symptoms. Altogether 18180 individuals participated in this cross-sectional study. The mean +/- SD age of participant was 38.7 +/- 17.1 and 9072 [49.9%] were women. The prevalence of GERD was 8.85 [8.43-9.26]. There was significant relationship between age, sex, marital and educational status with GERD. GERD symptoms were more common in women, older people, individuals with low education and married people. There was overlap between GERD, irritable bowel syndrome [IBS] and uninvestigated dyspepsia [UD]. According to our finding although the prevalence of GERD in our population is less than other studies, this prevalence is increasing in recent years

Estimation of average diagnosis and treatment costs of hepatitis C

the objective of this study was to estimate the average cost of diagnosis and treatment of hepatitis C among patients based on their treatment regime, during the one course of treatment and six-month after stopping that. Hepatitis C virus [HCV] infection is a major cause of liver-related morbidity and mortality worldwide and a major public health problem. All data for this cross-sectional study were collected from medical records of 200 patients with hepatitis C, who referred to a private gastroenterology clinic between years 2005 through 2009. Information related to the 200 patients was extracted from their medical records and finally, 77 patients of them, who their treatment was not interfering with any other disease entered in this study. Therefore diagnosis and treatment costs of these patients were calculated. Attributable costs were reported as purchasing power parity dollars [PPP$]. Mean costs of diagnosis and treatment in one course of treatment and six month after that with standard interferon plus ribavirin [INF-RBV] exceeds 3,850 PPP$ and for patients who treated with peg-interferon plus ribavirin [PEG-RIBV] was 16,494 PPP$. Also in both types of treatment, medication cost was found to be a dominant cost component. Hepatitis C represents a very important and potentially costly disease to managed care organizations. Patients with this disease require expensive drug therapies and consume significant health care resources

[Association of stomach cancer risk in individuals with family history of cancer]

Though increased risk of gastric cancer in individuals with family history of the disease has been observed consistently in previous studies, data on the association between gastric cancer and family history of cancer from Iran is scanty. The purpose of this study is to evaluation of gastric cancer risk associated with family history cancer. The present study was designed as unmatched case-control study. Cases were 746 histopathologically confirmed gastric cancer and 746 controls were randomly selected among the healthy participants in a health survey. The family history of cancer was extracted from a standard history form completed by the patients or health care providers. Mantel-Heanszel Odds Ratio was computed for removing the confounding effect of age and sex. A positive family history of cancer was reported by 9.7% and 5.6% of cases and controls, respectively. Gastric cancer risk increased two-fold for subjects reporting any first degree relative with gastric cancer. There is no statistical association among family history of other cancers and gastric cancer [P>0.05]. In conclusion, this study showed that family history of gastric cancer, especially in firstdegree relatives, increases the risk of gastric cancer. Further studies are needed to better understand the role of genetic factors and environmental factors and their interaction in gastric cancer development in Iranian community

Bloating in irritable bowel syndrome

The purpose of this study was to describe the occurrence of self report bloating and related factors n patients with irritable bowel syndrome [IBS]. Bloating symptoms are common in patients with IBS and have significant impact on normal daily function. This study was a community-based cross-sectional survey that conducted using a valid questionnaire base on Rome III criteria. Univariate analysis was used for investigation about distribution of self reported bloating according to demographic and psychological factors in irritable bowel syndrome patients. Out of 18180 subjects under study, 198 cases met criteria for the diagnosis of the irritable bowel syndrome according to criteria ROME III and 61.6% reported bloating symptoms. Bloating symptoms were more prevalent among patients with intermittent symptoms and diarrhea that in patients with constipation. Catastrophic events and depression were independent risk factors for bloating. Findings of this study support the clinical impression regarding the high prevalence of bloating symptoms in patients with irritable bowel syndrome. Further studies are needed to understand the role of physiological and psychological factors and their interaction in development of bloating in irritable bowel syndrome patients

Economic burden of gastro-oesophageal reflux disease and dyspepsia: a community-based study

Gastro-oesophageal reflux disease [GERD] and dyspepsia are common digestive disorders that inflict serious harm, burden and economic consequences on individuals worldwide. The aim of this study was to estimate the direct and indirect economic burden of GERD and dyspepsia in the whole population of Tehran, the capital of Iran. The study was performed on a total of 18,180 adult subjects [age > 18 years] taken as a random sample in Tehran province, Iran [2006-2007]. A valid and reliable questionnaire was used to enquire about the symptoms of GERD, dyspepsia and the frequency of the utilization of health services including physician visits, hospitalisations and productivity loss due to GERD/dyspepsia symptoms in the preceding 6 months. GERD was found in 518 [41.9% males] patients and dyspepsia in 404 patients [38.9% males]. Further 1007 subjects had both GERD and dyspepsia. The total direct costs of disease per patient for GERD, dyspepsia and their overlap were PPP$97.70, PPP$108.10 and PPP$101.30, respectively [PPP, purchasing power parity dollars]. The total indirect cost of disease per patient was PPP$13.7, PPP$12.1 and PPP$32.7, for GERD, dyspepsia and their overlap, respectively. According to our results, hospitalisation and physician visits were the main cost of disease that could be minimized by revision of the insurance business in Iran

[Frequency of colorectal cancer in healthy individual's relatives: a cross-sectional population-based study]

Family history of colorectal cancer has been shown to be related to the risk of developing colorectal cancer. This risk depends on the number of affected relatives and the age at diagnosis. In this study we aimed to estimate the frequency of a positive family history of colorectal cancer in a random sample from Tehran population. This study was a community-based cross-sectional survey conducted from May 2006 to December 2007 in Tehran province, Iran. A total of 5,500 peoples [age >/= 20 years] drawn up randomly by random sampling according to postal codes and invited to participate in the study. All participants completed a detailed health data registry form on family history status of colorectal cancer. The mean age of men with a positive family history was significantly different from men with negative family history. There was no significant difference between mean age of women responders with or without positive family history. Among all participants [n=5,500], 162 responders [2.9%] had a history of colorectal cancer. Of 162, 67 responders [1.22%] had one and 4[0.07%] had two or more first-degree relative with colorectal cancer. Of 5,500 participants, 18 subjects [0.33%] reported having two or more first-degree relative with colorectal cancer or one first-degree relative with colorectal cancer diagnosed at age<50 years. Four subjects [0.07%] had three or more first-degree relative with colorectal cancer. Based on the findings, we estimate that more than 570,000 subjects in the Iran in the age group >/= 20 years have at least two to three times increased risk of developing colorectal cancer which should be identified and encourage to participate in screening and surveillance protocols of colorectal cancer

[Cancer-related fatigue in breast cancer patients under chemotherapy]

Fatigue is a common and frequently disabling symptom in cancer patients. Fatigue may be caused by the disease itself, by treatment for the disease, by physical symptoms or conditions resulting from the disease or its treatment. The aim of this study was to assess fatigue and related factors in breast cancer patients. We conducted a cross-sectional study on 119 random samples of breast cancer patients. The Iranian version of QLQ-C30 and QLQ-BR23 questionnaires were used. Univariate methods and multiple regression analysis were performed to identify predictors of fatigue. Overall, 78% of the patients indicated that they were experiencing fatigue to some degree. The mean score on the fatigue subscale was 41.74 +/- 26.91. Of all functional subscales, fatigue showed the strongest influence on social functioning. Linear regression analyses showed that total fatigue was best predicted by pain, appetite loss, body image and type of treatment. Our results support the notion that fatigue in cancer patients is a major problem, which deserved yet more attention from health professionals, and that quality of life in cancer patients might be improved markedly by interventions that effectively reduce fatigue

Functional bowel disorders in Iranian population using Rome III criteria

To study the prevalence and risk factors of functional bowel disorders [FBD] in Iranian community using Rome III criteria. This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran, including 18, 180 participants who were selected randomly and interviewed face-to-face by a validated questionnaire based on Rome III criteria. In all, 1.1% met the Rome III criteria for irritable bowel syndrome [IBS], 2.4% for functional constipation [FC], and 10.9% of the participants had any type of FBD. Among participants with functional dyspepsia, 83.3% had FBD; the majority cases were unspecified functional bowel disorder [U-FBD]. Of the subjects fulfilling the IBS criteria, IBS with constipation [52%] was the most frequent subtype. In the multivariate analysis, women had a higher risk of any FBDs than men, except for functional diarrhea [FD]. The prevalence of FBD, FC and FD increased and IBS decreased with increasing age. Marital status was only associated with a decrease in the risk of FBD and FD, respectively. IBS subtypes compared with FC and FD. There was no significant difference between FC and IBS with constipation [IBS-C], except for self-reported constipation; while, IBS with diarrhea [IBS-D] had more symptoms than FD. This study revealed a low rate of FBDs among the urban population of Tehran province. The ROME III criteria itself, and the problems with interpretation of the data collection tool may have contributed in underestimating the prevalence of FBD. In addition the reliability of recall over 6 months in Rome III criteria is questionable for our population

[Prognostic factors in gastric cancer using log-normal censored regression model]

Gastric cancer is one of the most common cancers in the world. Although its incidence is decreasing, it rarely is detected early, and the prognosis remains poor. The aim of this study was to evaluate prognostic factors in gastric cancer using log-normal regression model. This retrospective study was done on 746 patients with gastric adenocarcinoma from February 2003 through January 2007. Gender, age at diagnosis, family history of cancer, tumor size and pathologic distant of metastasis were entered to a log-normal model. Relative risk [RR] was employed to interpret the risk of death. Results indicated that patients who were upper than 45 years at diagnosis had an increased risk for death [RR= 1.01 95% CI, 1.01-1.03], followed by greater tumor size [RR= 1.64, 95% CI, 1.07-2.25] and pathologic distant metastasis [RR=2.14, 95% CI, 1.60-2.86] and similar results in multivariate analysis for greater tumor size [RR= 2.04, 95% CI, 1.23-3.33] and pathologic distant metastasis [RR= 2.01, 95% CI, 1.13-3.56]. This study showed that the early detection of patients in younger and in primary stages and grade of tumor is important to decrease the risk of death in patients with gastric cancer and increase the survival rate

[Study of the cases of esophagus cancer registered in the province of Fars [2001-2005]]

Cancer is considered among the second largest groups of noncommunicable diseases and the third cause of death in Iran. Ranking in the top ten cancers in the world. Espophagus cancer comes out on the sixth place. This study examines the epidemiology of esophagus cancer in Fars cancer registry. This was a descriptive -analytic study of cases of esophagus cancer registered in Fars between 2001 and 2005. Data were analyzed using t-student and chi square tests. Overall 161 cancer patients had been registered. 61.5% were males. Mean age at diagnosis was 61.9 [SD= 13.07]. 91.3% were married. Fars ethnic background accounted for 55.3% of the patients. Males and females were mainly farmers and housewives respectively. There was a history of smoking in 52.6% of the cases. Grade of tumor at diagnosis for most patients was well-differentiated. According to our follow-up, the disease resulted in death in 57.1% of the cases. Our results indicate the importance of eliminating risk factors for cancer of the esophagus including smoking and family history. Early detection of the disease in primary stages is also emphasized

Colorectal cancer in Iran: an epidemiological study.

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide. But information regarding CRC in Iran is limited; the aim of this study was to investigate the epidemiologic features of CRC in Iran, using 5-year data from cancer registry. METHODS: This survey is a descriptive-analytic study consists of 1138 colorectal cancer patients who registered in Cancer Registry Center of Research Center for Gastroenterology and Liver Disease, Tehran, Iran. These data gathered using interview and pathology reports that registered in cancer registry forms. Data analysis was performed with descriptive and univariate methods. RESULTS: Of 1138 patients, 696 cases were male and 442 female. There was no significant difference between males and females regarding age at diagnosis. 400 patients (35.1%) had a family history of cancer. The most common histology type of tumor was adenocarcinoma, NOS. In most cases (39.1%) tumor grading was well differentiated and there was no significant difference between males and females. CONCLUSION: Colorectal cancer is a disease with nonspecific symptoms. Family history of cancer was evident in 35.1% of our cases and also 42.9% of patients were below the age of 50 years old, suggests that genetic factors may be play an important role in the development of this disease in our country.