A dosimetric comparative study following RTOG and ESTRO contouring guidelines for breast radiation therapy.

PURPOSE: To compare the dosimetric parameters considering the Radiation Therapy Oncology Group (RTOG) and European Society for Radiotherapy and Oncology (ESTRO) guidelines for breast cancer radiotherapy. Two radiotherapy techniques, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT), were considered. PATIENTS AND METHODS: Twenty-eight patients with left-sided medially-located TanyN2M0 tumors were contoured based on RTOG and ESTRO guidelines. 9-field IMRT, 10-field IMRT, 11-field IMRT, and VMAT treatment plans were applied as radiotherapy (RT) techniques for both contouring sets. The dosimetric parameters of the RT plans were extracted and compared. RESULTS: Comparing dose-volume histogram (DVH) parameters, equivalent uniform dose (EUD), and normal tissue complication probability (NTCP) of OARs across the contouring guidelines and considering each RT technique showed that the only significant differences were higher Dmax, Dmean, V30, and V45, EUD, and NTCP of the thyroid in all treatment modalities when the RTOG guideline had been adopted. Using the VMAT technique, PTV's EUD and the tumor control probability (TCP) were considerably higher when the ESTRO guideline was adopted. Moreover, the conformity index (CI) of VMAT plans was significantly higher when the ESTRO guideline was used. CONCLUSION: Unless having higher doses to thyroid when the RTOG guideline was adopted, the doses to other organs-at-risk (OAR) were similar between the two considering guidelines. Moreover, except for higher EUD, TCP, and CI for VMAT when the ESTRO guideline was used, no other significant differences were obtained between dosimetric parameters of target volumes considering the RT techniques and contouring guidelines.

Lithium and preventing chemotherapy-induced peripheral neuropathy in breast cancer patients: a placebo-controlled randomized clinical trial.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of some chemotherapy regimens. Lithium has been suggested for CIPN in some animal studies. We aimed to study lithium's preventive effect on CIPN in breast cancer patients treated with taxanes and platinum-based medications. METHOD: A double-blind placebo-controlled randomized clinical trial (RCT) was implemented on 36 breast cancer patients in two equal-size groups by block randomization. Participants in both groups consumed daily tablets, either placebo or lithium (300 mg), for 5 days in each course of chemotherapy. The tablets were prescribed 1 day before the start of chemotherapy. The electromyography (EMG) and nerve-conduction-velocity (NCV) tests were achieved before the first chemotherapy, 3 and 9 months after the treatment. The changes and signs or symptoms of CIPN, such as numbness, tingling, freezing, sensitivity to touch, muscle weakness, fibrillation, and knee and elbow reflex disorders, were recorded by examination. The trend of outcome changes was compared between two groups during the 9 months of study. RESULTS: In both groups, neurologic signs and symptoms were exacerbated during the first 3 months and improved up to the ninth month of study. Results showed significant changes of all EMG-NCV variables during the 9 months of research in each group (P < 0.001), but the interaction of time and group effect was not significant in none of those indices. All symptoms changed significantly over the study time (P < 0.001) without significant statistical difference between the two groups (P=0.352). No side effect was found during the study. CONCLUSION: The study showed that 300 mg lithium prescription once daily for 5 days might not effectively prevent CIPN in breast cancer patients. Evaluation of lithium effect on CIPN on different cancers in future studies is suggested. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20160813029327N10 .  Registration date: May 16, 2018.

Evaluation of the Alternative Healthy Eating Index as a predictor of 10-year cardiovascular disease risk in a group of Iranian employees.

BACKGROUND: Noncommunicable diseases, of which almost half are some form of cardiovascular disease (CVD), have overtaken communicable diseases as the world's major disease burden. There is growing evidence that indices of diet quality could have an association with a decreased risk of CVD in several countries. We aimed to examine the association between diet quality, as measured by the Alternative Healthy Eating Index (AHEI), and 10-year predicted CVD risk based on the Framingham Risk Score (FRS) in a group of Iranian employees. METHODS: A cross-sectional descriptive study was conducted on 296 (232 male, 64 female) employees aged ≥30 years selected by nonrandom sampling. AHEI was calculated according to a food frequency questionnaire with complementary questions on intake of cooking fats and oils among households. The 10-year risk of CVD was calculated based on FRS. Total and high-density lipoprotein-cholesterol, fasting blood sugar and blood pressure were measured to help in the calculation of FRS. RESULTS: AHEI did not have a significant relationship with FRS (r = -0.02, P = 0.67). However, some of its components, such as the intake of nuts and soy groups (r = -0.11, P = 0.04) and fruits (r = -0.14, P = 0.01), had a significant relationship with a reduced risk of CVD. According to stepwise multiple linear regression results, for every single increase in the intake of fruit servings, there would be a 0.14 reduction in the 10-year CVD risk score (ß = -0.14, P = 0.01). CONCLUSIONS: The present study showed no significant relationship between AHEI and the 10-year predicted risk of CVD among Iranian employees.

An Exploration of the Maternal Experiences of Breast Engorgement and Milk Leakage after Perinatal Loss .

INTRODUCTION & PURPOSE: Perinatal loss is one of the toughest events of life. Physiological milk secretion after perinatal loss adds to complicacy of the hardships of the event. The present study is aimed at exploring women's experience with breast problems and milk leakage after perinatal loss. METHODS: The Study was carried out through explorative quality approach with 18 participants. Sampling method was purposeful and selecting the participants from widest variety was ensured. Data gathering was through deep semi-structured interview and data analyses were done by conventional content analysis. Reliability and validity of the data were ensured by collecting data from a wide range of participants and frequent revisions. FINDINGS: Data analysis indicated four themes including beyond pain, longing being mother, insufficiency of provided information and coping Strategies, and beliefs and values regarding milk leakage and breast engorgement. CONCLUSION: The findings suggested that health care givers needed to inform the patients about probability milk leakage and breast engorgement and remedies to reduce pains and problems of breast engorgement.

Assessing the trend of HIV/AIDS mortality rate in Asia and North Africa: an application of latent growth models.

Over the last 30 years, HIV/AIDS has emerged as a major global health challenge. This study evaluates the change of HIV/AIDS mortality rates in Asian and North African countries from 1990 to 2010 using the Global Burden of Disease (GBD) study. HIV/AIDS mortality rates were derived from the GBD database from 1990 to 2010, for 52 countries in Asia and North Africa. First, a Latent Growth Model was employed to assess the change in AIDS mortality rate over time in six different regions of Asia, and also the change in AIDS mortality rate over time for males and females in Asia and North Africa. Finally, Latent Growth Mixture Models (LGMMs) were applied to identify distinct groups in which countries within each group have similar trends over time. Our results showed that increase in mortality rate over time for males is about three times greater than for females. The highest and lowest trend of AIDS mortality rates were observed in South-East Asia and high-income Asia-Pacific regions, respectively. The LGMM allocated most countries in the South and South-East region into two classes with the highest trend of AIDS mortality rates. Although the HIV/AIDS mortality rates are decreasing in some countries and clusters, the general trend in the Asian continent is upwards. Therefore, it is necessary to provide programmes to achieve the goal of access to HIV prevention measures, treatment, care, and support for high-risk groups, especially in countries with a higher trend of AIDS mortality rates.

Evaluation of nursing care associated with infants born to mothers with drugs abuse and its comparison with the standards in selected hospitals in Kerman 2013-2014.

Background. Pregnancy of women addicted to drugs is a public health problem in most countries, leading to various problems in the mother, the fetus, and the newborn. Since these babies are at risk of various complications and even death, competent and appropriate care of these children is needed. The present study aimed to assess the quality of nursing care provided to newborns and its comparison with the existing standards in infants and neonatal intensive care units of the selected Hospitals in Kerman. Materials and Methods. In this descriptive conducted study, 400 nursing cares, provided to infants born to mothers with drugs abuse, observed and were compared to standard checklists provided by the latest resources and the world's scientific papers. The checklist provided was based on the evaluation of infants and included two distinct categories: non-drug therapy and drug treatment. Finally, the data were analyzed. Results. The consistency quality of the nursing cares provided to infants born to mothers with drugs abuse was evaluated with the existing standards in children, 73% receiving non-drug therapy and 81% of the infants receiving drug treatment. Conclusion. Compared to standards in the normal state, nursing care was associated with babies born to mothers with drugs abuse. The reduction in the incidence of morbidity and mortality in this group of infants was expected in the case of familiarity and training of nursing and the use of caring standards, particularly when applying non-drug therapy.

Historical cohort study of shift work and blood pressure.

BACKGROUND: It has been suggested that shift work (SW) is associated with changes in blood pressure (BP). However, studies have reported contradictory results. AIMS: To prospectively examine the association between SW and BP among male workers. METHODS: A historical cohort study, involving workers of Esfahan's Mobarakeh Steel Company, in Iran, was conducted over 14 years. The association between SW, systolic BP (SBP) and diastolic BP (DBP) was investigated after adjusting for body mass index, age, work experience, marriage, smoking and education based on the Bayesian multilevel modelling approach. RESULTS: The study sample included 5331 male workers. The mean age (standard deviation, SD) was 34.8 (6.6) years and mean work (SD) experience was 9.4 (6.1) years. Among these subjects, 2348 (44%), 340 (6%) and 2643 (50%) were day workers, weekly rotating shift workers and routinely rotating shift workers, respectively. The mean SBP (SD) and DBP (SD) of these workers were 118.7 (8.1) and 73.1 (6.7) mmHg, respectively. After controlling for several confounding variables, there was no significant relationship between SBP and DBP and SW. CONCLUSIONS: No significant association between SW and BP was observed among these three groups (day workers, weekly rotating shift workers and routinely rotating shift workers). Prospective studies, which control for confounding factors, such as the healthy worker effect, occupational history, family history and psychological factors (e.g. occupational stress and job satisfaction), are required to evaluate this further.

Occupational exposure of petroleum depot workers to BTEX compounds.

BACKGROUND: Benzene, toluene, ethylbenzene and xylene (BTEX) are the most important toxic volatile compounds in the air and could be easily absorbed through the respiratory tract. In recent years, the risk of exposure to BTEX compounds, especially benzene as a carcinogen, has been considered in petroleum depot stations. OBJECTIVE: To assess the occupational exposure of petroleum depot workers in Iran to BTEX compounds. METHODS: After completing a questionnaire and assessing occupational exposure to BTEX compounds, 78 (46 exposed and 32 non-exposed) depot workers were randomly selected to participate in this study. Air sampling and analysis of BTEX was conducted according to the NIOSH method No. 1501. Analysis of urinary hippuric acid, as an indicator of toluene exposure, was carried out according to NIOSH method No. 8300. Personal monitoring of the high exposure group to BTEX compounds was repeated to verify the results obtained in the first phase of the monitoring. RESULTS: Among the 9 operating groups studied, occupational exposure to benzene and toluene was higher in quality control and gasoline loading operators-the median exposure ranged from 0.16 to 1.63 ppm for benzene and 0.2 to 2.72 ppm for toluene. Median exposure of other group members to BTEX compounds was below the detection limit of analytical method (0.07, 0.06, 0.05, and 0.05 ppm, respectively). The level of toluene exposure measured showed correlation with neither post-shift urinary hippuric acid (Spearman's rho = 0.128, p = 0.982) nor with the difference between post- and pre-shift urinary hippuric acid (Spearman's rho = 0.089, p = 0.847) in depot operational workers. CONCLUSION: Gasoline loading operators are exposed to a relatively high level of benzene.

Genetic variability of Blastocystis sp. isolated from symptomatic and asymptomatic individuals in Iran.

Blastocystis is an unusual enteric protozoan parasite of humans and many animals whose pathogenic potential is still controversial. To increase the understanding of the molecular epidemiology of this emerging parasite and due to its potential impact on public health, its subtypes (STs) in Iranian symptomatic and asymptomatic individuals were determined. A total of 100 Blastocystis isolates by microscopy and culture methods were obtained. DNA was extracted from the positive culture isolates, and the Blastocystis subtypes were identified using seven subtype-specific sequenced-tagged site (STS) primers. Four subtypes, ST3 as dominant (53 %), followed by ST1 (48 %), ST5 (33 %), and ST2 (7 %) were identified. In this study, ST1 in gastrointestinal patients compared to asymptomatic individuals was significantly dominant (p = 0.001). From 33 (33 %) mixed subtype infections, ST1, 3 (14 %) was significantly related to GI symptoms (p = 0.045), and eight mixed infections with three different STs, which are under reported, were also identified.

Mercury exposure assessment in Iranian women's hair of a port town with respect to fish consumption and amalgam fillings.

In this study we aimed to estimate the level of mercury in women's hair and its association with fish consumption and amalgam fillings in an Iranian southern port town (named Mahshahr). A total number of 195 hair samples were collected randomly from women aged 25-45 years free from occupational exposures to mercury. Additional information about these women's age, weight, height, number of pregnancies, level of education, number of amalgam fillings and fish consumption were also gathered. The determination of Hg level in hair samples was carried out by the LECO, AMA 254, Advanced Mercury Analyzer, according to ASTM standard No. D-6722. The average mercury level in these women's hair was 2.95+/-2.33microg/g (ranged from 0.07 to 24.46microg/g). In the next stage, the study participants were divided into four groups with respect to their fish consumption and number of amalgam fillings; A) <3 amalgam fillings, <3 times fish consumption per month, B) <3 amalgam fillings, >7 times fish consumption per month, C) >6 amalgam fillings, <3 times fish consumption per month, and D) >6 amalgam fillings, >7 times fish consumption per month. Statistical analysis showed that the Hg level was significantly different in these four groups (P<0.001). Mercury levels in this sample exceeded the USEPA-recommended 1microg/g in 76.4% of the studied population. Finally, the multiple linear regression results revealed that frequency of fish consumption and amalgam restorations are the most important routes of Hg exposure. However, the main determinant of Hg exposure was the intake of Hg through fish consumption.

Scalp hair and saliva as biomarkers in determination of mercury levels in Iranian women: amalgam as a determinant of exposure.

The aim of this study was to determine the relationship between mercury concentrations in saliva and hair in women with amalgam fillings and its relation with age and number of amalgam fillings. Eighty-two hair and saliva samples were collected randomly from Iranian women who have the same fish consumption pattern and free from occupational exposures. The mean+/-SD age of these women was 29.37+/-8.12 (ranged from 20 to 56). The determination of Hg level in hair samples was carried out by the LECO, AMA 254, Advanced Mercury Analyzer according to ASTM, standard No. D-6722. Mercury concentration in saliva samples was analyzed by PERKIN-ELMER 3030 Cold Vapor Atomic Absorption Spectrophotometer. The mean+/-SD mercury level in the women was 1.28+/-1.38 microg/g in hair and 4.14+/-4.08 microg/l in saliva; and there were positive correlation among them. A significant correlation was also observed between Hg level of saliva (Spearman's rho=0.93, P<0.001) and hair (Spearman's rho=0.92, P<0.001) with number of amalgam fillings. According to the results, we can conclude that amalgam fillings may be an effective source for high Hg concentration in hair and releasing the mercury to the saliva samples.

Prevalence and risk indicators of periodontal disease among high-school students in Tehran.

To identify the prevalence and risk indicators of periodontal disease in high-school students in Tehran, Islamic Republic of Iran, the periodontal condition of 867 students aged 15-19 years was assessed using the community periodontal index of treatment needs (CPITN). The results showed that 88.7% of these students had less than perfect periodontal health. Multiple regression analysis revealed that sex, parents' educational level, frequency of toothbrushing and flossing, preventive dental visits and presence of extracted teeth were significant risk indicators for periodontal disease. School-based oral health promotion and prevention programmes are needed.

Prevalence and risk indicators of periodontal disease among high-school students in Tehran

To identify the prevalence and risk indicators of periodontal disease in high-school students in Tehran, Islamic Republic of Iran, the periodontal condition of 867 students aged 15-19 years was assessed using the community periodontal index of treatment needs [CPITN]. The results showed that 88.7% of these students had less than perfect periodontal health. Multiple regression analysis revealed that sex, parents' educational level, frequency of toothbrushing and flossing, preventive dental visits and presence of extracted teeth were significant risk indicators for periodontal disease. School-based oral health promotion and prevention programmes are needed

Penile size and somatometric parameters among Iranian normal adult men.

This study aimed to determine the penile size and its correlation with somatometric parameters in physically normal Iranian adult men. To do this, a random sample of 1500 normal men aged between 20 and 40 years underwent tape measurements of penile dimensions in the stretched state under the same condition. The mean total penile length was 11.58+/-1.45 cm, the mean granular length was 3.04+/-0.33 cm and the mean girth was 8.66+/-1.01 cm. Multivariate regression analysis showed that penile dimensions are significantly correlated with age (P=0.018), height (P<0.001) and index finger length (P<0.001). This analysis provided no evidence for significant effect of waist/hip ratio and weight on penile dimensions. As the penile augmentation is still in its experimental stage and its indications have not yet been clearly established, providing standardized data on penile dimensions seems to be necessary to make convenient decisions in the counseling and/or treatment of people with short penis concerns.

Incidence and risk factors of neonatal hypothermia at referral hospitals in Tehran, Islamic Republic of Iran.

To identify the incidence rate and risk factors of neonatal hypothermia at referral hospitals in Tehran, Islamic Republic of Iran, 900 neonates were randomly selected. Body temperature was measured repeatedly at different time points after birth. More than 50% became hypothermic soon after birth. Multiple regression analysis showed that low birth weight, low gestational age environmental temperature, low Apgar score, multiple pregnancy and receiving cardiopulmonary resuscitation were significantly associated with hypothermia. These findings suggested that there is an urgent need to sensitize and educate all levels of staff dealing with neonates in our country.

Incidence and risk factors of neonatal hypothermia at referral hospitals in Tehran, Islamic Republic of Iran

To identify the incidence rate and risk factors of neonatal hypothermia at referral hospitals in Tehran, Islamic Republic of Iran, 900 neonates were randomly selected. Body temperature was measured repeatedly at different time points after birth. More than 50% became hypothermic soon after birth. Multiple regression analysis showed that low birth weight, low gestational age, low environmental temperature, low Apgar score, multiple pregnancy and receiving cardiopulmonary resuscitation were significantly associated with hypothermia. These findings suggested that there is an urgent need to sensitize and educate all levels of staff dealing with neonates in our country