Influence of working in auto factory on gastroesophageal reflux disease.

AIM: Present study aimed to evaluate association between job -related factors and gastroesophageal reflux disease (GERD) among Iranian auto factory's workers. BACKGROUND: Many of the gastrointestinal disorders may be caused as the result of stress-related occupations and biorhythm disruption. METHODS: We performed a cross-sectional study on 3590 Iranian Auto factory employees. GERD symptoms, demographic information, work shift, work section and history of some gastrointestinal disease were asked from all employees by physician. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for GERD symptoms according to the potential risk factors. RESULTS: The prevalence of GERD was 25.57%, which was higher in rotatory shift (91.6%) than the fixed shift (8.4%) (P-value = 0.009). Smoking (OR: 1.31; 95% CI: (1.09, 1.57)), working in official section (P-value < 0.001), history of GERD (OR: 8.63; 95 % CI (6.53, 11.40)), history of peptic ulcer (OR: 2.96; 95 % CI (2.08, 4.20)), family history of gastrointestinal cancers (OR: 1.47; 95 % CI (1.19, 1.81)) were the factors associated with GERD symptoms. CONCLUSION: The prevalence of GERD in the rotatory shift was more than the fixed shift. Smoking, family history of gastrointestinal cancers and peptic ulcer could be associated with GERD symptoms. Working in the special job with high activity, may probably lead to decrease in the risk of reflux.

Trend of hepatocellular carcinoma incidence after Bayesian correction for misclassified data in Iranian provinces.

AIM: To study the trend of hepatocellular carcinoma incidence after correcting the misclassification in registering cancer incidence across Iranian provinces in cancer registry data. METHODS: Incidence data of hepatocellular carcinoma were extracted from Iranian annual of national cancer registration reports 2004 to 2008. A Bayesian method was implemented to estimate the rate of misclassification in registering cancer incidence in neighboring province. A beta prior is considered for misclassification parameter. Each time two neighboring provinces were selected to be entered in the Bayesian model based on their expected coverage of cancer cases which is reported by medical university of the province. It is assumed that some cancer cases from a province that has an expected coverage of cancer cases lower than 100% are registered in their neighboring facilitate province with more than 100% expected coverage. RESULTS: There is an increase in the rate of hepatocellular carcinoma in Iran. Among total of 30 provinces of Iran, 21 provinces were selected to be entered to the Bayesian model for correcting the existed misclassification. Provinces with more medical facilities of Iran are Tehran (capital of the country), Razavi Khorasan in north-east of Iran, East Azerbaijan in north-west of the country, Isfahan in central part and near to Tehran, Khozestan and Fars in south and Mazandaran in north of the Iran, had an expected coverage more than their expectation. Those provinces had significantly higher rates of hepatocellular carcinoma than their neighboring provinces. In years 2004 to 2008, it was estimated to be on average 34% misclassification between North Khorasan province and Razavi Khorasan, 43% between South Khorasan province and Razavi Khorasan, 47% between Sistan and balochestan province and Razavi Khorasan, 23% between West Azerbaijan province and East Azerbaijan province, 25% between Ardebil province and East Azerbaijan province, 41% between Hormozgan province and Fars province, 22% betweenChaharmahal and bakhtyari province and Isfahan province, 22% between Kogiloye and boyerahmad province and Isfahan, 22% between Golestan province and Mazandaran province, 43% between Bushehr province and Khozestan province, 41% between Ilam province and Khuzestan province, 42% between Qazvin province and Tehran province, 44% between Markazi province and Tehran, and 30% between Qom province and Tehran. CONCLUSION: Accounting and correcting the regional misclassification is necessary for identifying high risk areas and planning for reducing the cancer incidence.

Bayesian correction model for over-estimation and under-estimation of liver cancer incidence in Iranian neighboring provinces.

AIM: The aim of this study was to obtain more accurate estimates of the liver cancer incidence rate after correcting for misclassification error in cancer registry across Iranian provinces. BACKGROUND: Nowadays having a thorough knowledge of geographic distribution of disease incidence has become essential for identifying the influential factors on cancer incidence. METHODS: Data of liver cancer incidence was extracted from Iranian annual of national cancer registration report 2008. Expected coverage of cancer cases for each province was calculated. Patients of each province that had covered fewer cancer cases than 100% of its expectation, were supposed to be registered at an adjacent province which had observed more cancer cases than 100% of its expected coverage. For estimating the rate of misclassification in registering cancer incidence, a Bayesian method was implemented. Beta distribution was considered for misclassified parameter since its expectation converges to the misclassification rate. Parameters of beta distribution were selected based on the expected coverage of cancer cases in each province. After obtaining the misclassification rate, the incidence rates were re-estimated. RESULTS: There was misclassification error in registering new cancer cases across the provinces of Iran. Provinces with more medical facilities such as Tehran which is the capital of the country, Mazandaran in north of the Iran, East Azerbaijan in north-west, Razavi Khorasan in north-east, Isfahan in central part, and Fars and Khozestan in south of Iran had significantly higher rates of liver cancer than their neighboring provinces. On the other hand, their neighboring provinces with low medical facilities such as Ardebil, West Azerbaijan, Golestan, South and north Khorasans, Qazvin, Markazi, Arak, Sistan & balouchestan, Kigilouye & boyerahmad, Bushehr, Ilam and Hormozgan, had observed fewer cancer cases than their expectation. CONCLUSION: Accounting and correcting the regional misclassification are necessary for identifying high risk areas of the country and effective policy making to cope with cancer.

Protein profiling of infected human gastric epithelial cells with an Iranian Helicobacter pylori clinical isolate.

AIM: The main objective of this study was to use high throughput approach to characterize the response of human gastric epithelial cells to Helicobacter pylori (H. pylori) infection at protein level. BACKGROUND: Alteration of host cell protein profiles occurs due to H.pylori infection. This alteration seems to be strain specific. High throughput approaches, such as proteomics, can describe changes that occurs at the protein levelin the infected cells in response to H.pylori infection. In accordance with this point of view, we used two dimensional electrophoresis (2-DE)/MS to determine changes in proteome profile of gastric epithelial cells infected with a clinical isolate of H. pylori from an Iranian patient. METHODS: Human gastric epithelial cells (AGS) were infected by an Iranian H.pylori isolate (complete cagPAI, vacA s2m2, babA2, iceA1, sabA). The altered protein patterns separated by 2-DE were identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis. RESULTS: The results showed 40 spots with significantly different intensities between the 2-DE gels. Protein SETSIP and Endoplasmic reticulum resident protein 29 were identified by MALD-TOF and Mascot search. Proteomic analysis for functional roles of these proteins showed that mechanisms to deal with stress conditions and transcriptional activator related to cell reprogramming are involved in H. pylori infection. CONCLUSION: Using high throughput approaches, such as proteomics, we can provide further molecular details about interaction of H. pylori strains with the infected cells at protein level.

Systematic review of pancreatic cancer epidemiology in Asia-Pacific Region: major patterns in GLOBACON 2012.

Pancreatic cancer is one of the deadliest cancers with short-term survival rates. Trends for pancreatic cancer incidence and mortality varied considerably in the world. To date, the causes of pancreatic cancer are not known sufficiently, although certain risk factors have been identified such as, smoking, obesity, life style, diabetes mellitus, alcohol, dietary factors and chronic pancreatitis. Since there are no current screening recommendations for pancreatic cancer, primary prevention is very important. Therefore, up-to-date statistics on pancreatic cancer occurrence and outcome are essential for the primary prevention of this disease. Due to the lack of information on epidemiology of pancreatic cancer in most Asian countries, and limited of statistics and registration system in this area, we conducted a systematic review study to evaluate the most recent data concerning epidemiology of pancreatic cancer in Asia-Pacific region. In this review we focused on collected recent data on incidence, mortality, survival and risk factors of pancreatic cancer in this region. In addition, we reviewed and used the data of GLOBOCAN 2012 in this paper to complete the information as a source of compiling pancreatic cancer incidence and mortality rate.

Helicobacter pylori CagA induced interleukin-8 secretion in gastric epithelial cells.

AIM: Since, contradictory data have been reported about the effect of diverse variants of H. pylori virulence factors on IL-8 induction, we aimed to analyze the effect of this diversity on levels of IL-8 secretion in AGS cell line. BACKGROUND: Helicobacter pylori colonizes the human stomach and induces the activation of inflammatory cytokines, including interleukin (IL)-8, in the gastric mucosa. This induction promotes neutrophil and monocyte recruitment that causes gastric tissue damage. METHODS: To determine whether different strains of H. pylori and their CagA variants have possible roles on IL-8 induction, polarized AGS cell line was infected with CagA+ H. pylori strains carrying different EPIYA motifs (ABCCC and ABC) and CagA- strain for 24 hours. Difference in stimulation of IL-8 was measured by ELISA. RESULTS: IL-8 secretion was elevated in the treated cells with CagA encoding strains compared with the negative one. Furthermore, a noticeably increased level of IL-8 induction was measured by the CagA-EPIYA type ABCCC encoding strain in compare to that carried EPIYA type ABC. CONCLUSION: Results of this study provide new evidence about different effects of H. pylori strains and possible roles of their CagA variants on IL-8 induction. It seems that not only carriage of cagA and its expression, but also diversity in EPIYA motif be involved in IL-8 induction in the gastric epithelial cells.

Prospective study of BK virus infection and nephropathy during the first year after kidney transplantation.

INTRODUCTION: The aim of this study was to assess the prevalence and severity of BK virus infection, BK virus nephritis, and related risk factors among kidney transplant recipients. MATERIALS AND METHODS: BK viremia during the first year of kidney transplantation was assessed prospectively in 32 successive recipients. BK virus DNA was extracted and determined in all samples by real-time polymerase reaction assay for 1 year after kidney transplantation. RESULTS: The mean age of the patients was 33.3 ± 15.3 years. Sixteen patients (50%) received antithymocyte globulin for induction therapy. Living donor transplant consisted of 75% of the kidney donations. Maintenance immunosuppressive therapy included cyclosporine A in 27 patients (84.4%), plus tapering prednisolone and mycophenolate mofetil. BK viremia was detected in 8 patients (25%). The highest detected plasma viral load was less than 4000 copies per milliliter. BK virus was respectively positive in 5 (62.5%), 2 (25%), and 1 (12.5%) patients during the first 4, 8, and 12 months after transplantation. Biopsy-proven rejection and antirejection therapy by methylprednisolone pulses were 5 and 2.3 times more common in patients with BK virus infection (P = .01 and P = .01), respectively. CONCLUSIONS: Despite occurrence of BK virus infection in 25% of our patients, BK nephropathy did not develop in any of them. Routine screening of BK virus infection, particularly in centers with low prevalence of BK virus nephritis, may not be cost effective for predicting this disease.

Mutational analysis of HBs Ag-positive mothers and their infected children despite immunoprophylaxis.

Hepatitis B vaccination is safe and effective, although breakthrough infection occasionally occurs in those who receive the vaccine and hepatitis B immunoglobulin (HBIg) prophylaxis. Sequence variation in their antigenic regions is one of the most powerful strategies that are used by viruses to escape recognition by B and T cell-mediated immune responses. The aim of this study was to explore the mutational profile of HBV in vertical transmission.Six HBsAg-positive mothers and their children who developed HBV infection despite immunoprophylaxis were enrolled. After extraction of HBV DNA from sera, the full HBV genome or surface gene was amplified by Gunther and hemi-nested PCR, respectively. After sequencing, the mutational analysis on paired samples between mothers and children were carried out and compared.Different mutations were found in four children, at least, one arose in functional and/or immune epitope activities. Of 30 amino acid changes, 11 (36.6%) were located within the known HBV immune epitopes. In three children, mutations occurred within the "a" determinant region, one mutation (B2) was identical to the mother of patient, an indication of vertical transmission. The other two (B4 and B5) were considered as vaccine escape mutations. Three children harbored wild-type HBsAg, similar to their mothers. Regarding transmission in infected children, the immunoprophylaxis had no effect and failure of vaccination was observed in 2 isolates.These findings emphasized the need for an alternative regimen, such as the administration of boosters or a more effective HBV vaccine for high-risk children who are born to HBsAg-positive mothers. 

Drug-related mutational patterns in hepatitis B virus (HBV) reverse transcriptase proteins from Iranian treatment-naïve chronic HBV patients.

BACKGROUND: Immunomodulators and Nucleotide analogues have been used globally for the dealing of chronic hepatitis B virus (HBV) infection. However, the development of drug resistance is a major limitation to their long-term effectiveness. OBJECTIVES: The aim of this study was to characterize the hepatitis B virus reverse transcriptase (RT) protein variations among Iranian chronic HBV carriers who did not receive any antiviral treatments. MATERIALS AND METHODS: Hepatitis B virus partial RT genes from 325 chronic in active carrier patients were amplified and directly sequenced. Nucleotide/amino acid substitutions were identified compared to the sequences obtained from the database. RESULTS: All strains belonging to genotype D.365 amino-acid substitutions were found. Mutations related to lamivudine, adefovir, telbivudine, and entecavir occurred in (YMDD) 4% (n = 13), (SVQ) 17.23% (n = 56), (M204I/V + L180M) 2.45% (n = 8) and (M204I) 2.76% (n = 9) of patients, respectively. CONCLUSIONS: RT mutants do occur naturally and could be found in HBV carriers who have never received antiviral therapy. However, mutations related to drug resistance in Iranian treatment-naïve chronic HBV patients were found to be higher than other studies published formerly. Chronic HBV patients should be monitored closely prior the commencement of therapy to achieve the best regimen option.

Mortality trends of gastrointestinal cancers in Iranian population.

AIM: The aim of this study was to evaluate the mortality rates and trends from Gastrointestinal (GI) cancer in Iranian population from 1995 to 2003. BACKGROUND: Cancer is the third most common cause of death in Iran. Gastrointestinal cancer is the most important causes of mortality due to cancer. The cancer mortality data is important to monitor the effects of screening program, earlier diagnosis, demographic data and other prognostic factors. PATIENTS AND METHODS: National death Statistic Reported by the Ministry of Health and Medical Education (MOH&ME) from 1995 to 2003, stratified by age group, sex, and cause of death is included in this analysis. Colorectal cancer (CRC) [ICD-9; 153-154], Gastric cancer (GC) [ICD-9; 151], Pancreas cancer (PC) [ICD-9; 25], Esophageal cancer (EC) [ICD-9; C15] and Hepatocellular carcinoma (HCC) [ICD-9; 20] were expressed as the annual mortality rates/100,000, general and/or per gender, and age group. RESULTS: The cause specific mortality rate of CRC slightly increased during the years under study and for GC and EC showed a sharp increasing. In contrast, the mortality rate of PC decreased slightly during the years under the study. The rate of HCC mortality moderately increased. All mortality rates were higher for male than female. CONCLUSION: Our study indicated remarkable increasing trends in mortality of GI cancer in Iran specifically for CRC and GC. Developing for a GC and EC for both primary prevention and early detection programs and providing the facilities for CRC screening, would be the options to control the mortality and burden of GI cancers in the future.

Leukemia cancer mortality trend in iran, from 1995 to 2004.

BACKGROUND: Cancer is the third most common cause of death in Iran, the leukemia cancer is one of the most important causes of cancer mortality. Regarding cancer mortality, data would be important to monitor the program screening effects, earlier diagnosis, demographic data and other prognostic factors. The aim of this study was mortality rates evaluating, then leukemia cancer trends among the Iranian population within almost a period of a decade, i.e. from 1995 to 2004. METHODS: National death Statistic Reported by Ministry of Health and Medical Education (MOH&ME) from 1995 to 2004, stratified by age group, sex, and cause of death, have included in this study. Leukemia cancer has expressed as the annual mortality rates/100,000, in general, and/or per gender, and age group. RESULTS: The general mortality rate of leukemia cancer has slightly increased within the mentioned study period, from 0.44 to 2.54, then leukemia cancer mortality has often seen in men more than women. CONCLUSION: The mortality rate of leukemia has significantly increased throughout Iran. Associated risk factors with leukemia have headmost identified for their prevention and control. So, future studies to reveal leukemia risk factors among the Iranian population would be crucial in order to control its burden.

Increased oesophageal cancer mortality rate in Iran.

BACKGROUND AND STUDY AIMS: The aim of this study is to present the mortality trends of oesophageal cancer (EC) in the Iranian population, to provide updated information regarding time trends for this cancer. PATIENTS AND METHODS: We analysed the national death statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004. EC [International Classification of Diseases (ICD-9); C15] were expressed as the annual mortality rates/100000, overall, by sex and by age group (<15, 15-49 and ≥ 50 years of age) and age standardised rate (ASR). RESULTS: The age standardised mortality rate of EC increased dramatically during the study period. EC mortality was higher for males and the mortality rate also increased with age. CONCLUSION: This study provides a comprehensive projection for the burden of death due to EC, indicating that the trend of EC mortality dramatically increased in the recent decade.

High prevalence of occult hepatitis B virus infection in children born to HBsAg-positive mothers despite prophylaxis with hepatitis B vaccination and HBIG.

BACKGROUND & AIMS: Occult hepatitis B virus (HBV) infection is a well-recognized clinical entity characterized by the detection of HBV DNA in serum and/or liver in the absence of detectable hepatitis B surface antigen (HBsAg). The frequency of the diagnosis depends on the relative sensitivity of both HBsAg and HBV DNA assays. We aimed at determining the prevalence of occult HBV infection in a high risk group of children who developed HBV infection despite immunoprophylaxis. METHODS: The sera of 75 children born to HBsAg-positive mothers previously immunized by HBIG and prophylaxic vaccine regimen were assayed for HBV DNA by real-time PCR. Subsequently, the samples were tested using a sensitive standard PCR, with an independent set of primers for all HBV genes, and analyzed by direct sequencing. RESULTS: HBV DNA was detected in 21/75 (28%) children, and ranged between 77 and 9240 copies/ml. All were positive for anti-HBs. Five (24%) children were found to be positive for anti-HBc, while anti-HBc-only positive individuals were not observed. Eight isolates (38%) did not carry any mutation. Thirteen infected children (62%) had at least one mutation in regions known to be involved in functional and/or immune epitope activity. Ten had G145R mutations. CONCLUSIONS: HBV occult infection seems to be relatively frequent in immunized children born to HBsAg-positive mothers. HBsAg negativity is not sufficient to completely exclude HBV DNA presence. These findings emphasize the importance of considering occult HBV infection in hypo-endemic areas.

Increased trend of breast cancer mortality in Iran.

BACKGROUND: Breast cancer is the most commonly diagnosed cancer in women worldwide In Iran, it ranks first among cancers diagnosed in women and is the fifth most common cause of death. The aim of this study was to present the mortality trends from breast cancer for Iranian women during a period of almost a decade, in order to provide update information regarding the likely future. METHODS: We analyzed National death Statistic reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004 to generate annual mortality rates/100,000, overall, by age group (<15, 15-49 and ≥ 50 years of age) and age standardized rate (ASR). RESULTS: The age standardized mortality rate of breast cancer increased dramatically during these years from 1.40 to 3.52 per 100,000 and its mortality was increasing 151.4% for Iranian women, although it seemed that the rate leveled off from 2002 to 2004. Moreover the increasing rate was higher for those aged between 15-49 compared to age > 50 years old. CONCLUSION: There is an increasing trend for breast cancer mortality in Iran. Thus, health education programs to rectify the lack of women awareness about breast cancer signs and effective screening are urgently needed.

Mortality of oral cavity cancer in Iran.

BACKGROUND: Oral cavity cancer is the eighth most frequent cancer among men in the world. Its incidence varies widely geographically and two-thirds of the incident cases are diagnosed in developing countries. The aim of this study was to present the mortality trends from this cancer for Iranian population during a period of almost a decade, in order to provide update information regarding time trends for this cancer. METHODS: We analyzed National death Statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004, stratified by age group, sex, and cause of death. Oral cavity cancer [ICD-10; C00-08] was assessed for annual mortality rates/100,000, overall, by sex and by age group (<15, 15-49 and ≥ 50 years of age) and age standardized rates (ASR) were calculated. RESULTS: The age standardized mortality rate of oral cavity cancer increased dramatically during these years from 0.09 per 100,000 in 1995 to 0.59 per 100,000 in 2002. However, a sharp decrease was observed from 2002 to 2004. Moreover the mortality of oral cavity cancer was higher for males except from 2000-2002 during which the rate of female's death was close to male's. Age specific rates for oral cavity cancer indicated higher mortality rate for older age. CONCLUSION: In conclusion, this study provides comprehensive projection for burden of death due to oral cavity cancer, indicating that the trend of its mortality was increased in recent decade and then would be leveled off. While the burden of oral cavity cancer in Iran is lower than other Asian countries, further studies are required to establish risk factors or modifiers for this cancer in Iranian population in order to decrease its incidence and mortality.

Pancreatic cancer mortality and misclassification--bayesian analysis.

BACKGROUND: Pancreatic cancer is a fatal cancer with a 5-year survival of only about 4% for all tumors. Mortality is a familiar projection to address the burden of cancers, but according to the Iranian death registry, about 20% of death statistics are still recorded in misclassified categories. The aim of this study was to estimate pancreatic cancer mortality for Iranian population, using a bayesian approach in order to revise this misclassification. METHODS: National Death Statistics reported by the Ministry of Health from 1999 to 2004, stratified by age group, sex and cause of death, were the basis for this analysis. Pancreas cancer [ICD-10; 25] were expressed as the annual mortality rates/100,000, overall, by sex and by age group (<50 and ≥50 years of age) and age standardized rate (ASR). The bayesian approach to correct and account for misclassification effects in Poisson count regression was employed with a beta prior to estimate the mortality rate by age and sex group. RESULTS: According to the bayesian analysis, there were between 20 to 30 percent underreported mortality records in deaths due to pancreatic cancer and the rate decreased slightly during the years of the study. CONCLUSION: Our findings suggest a substantial undercount of pancreatic cancer mortality in the Iranian population. Therefore policy makers who determine research and treatment priorities should note these underreported data for death rates.

Burden of hepatocellular carcinoma in Iran; Bayesian projection and trend analysis.

BACKGROUND: Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide. Iran is located in a low risk area but, while the true prevalence of HCC in Iran is unknown, it is not an uncommon malignancy. The aim of this study was to provide quantitative estimations of the burden of death due to HCC cancer in Iran and its trend during over recent decades for the Iranian population. METHODS: National death statistics reported by the Ministry of Health and Medical Education (MOH and ME) from 1999 to 2004, stratified by age group, sex, and cause of death (ICD-9) were used to generate HCC mortality (ICD-9; 20) expressed as the mortality rate per 100,000 people. The Bayesian approach to correct for misclassification was employed and a time series model was applied to predict mortality. The burden of HCC, including years of life lost (YLL), was calculated using Iranian life expectancy. RESULTS: The rate of HCC mortality and YLL moderately increased from 1999 to 2004 but according to our prediction it seems that these rates are going to level off. Also HCC mortality and YLL was higher for older age, and was considerably greater in men than in women. CONCLUSION: Burden of HCC is low in Iran because most of cases are due to HBV and this infection is less common in Iran than Southeast Asia and Africa and there is nomajor increase projected for the future. However, up to 40% of its death statistics are underreported. Screening can be advised for early HCC detection in chronic HCV and HBV carriers.