Clinical Breast Cancer Registry of IR. Iran (CBCR-IR): Study Protocol and First Results.

BACKGROUND: Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country. METHODS: We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards. RESULTS: We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients. CONCLUSION: The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.

Seroprevalence of COVID-19 in Blood Donors: A Systematic Review and Meta-Analysis.

Introduction: Determining the prevalence of SARS-CoV-2 in blood donors makes the control of virus circulation possible in healthy people and helps implement strategies to reduce virus transmission. The purpose of the study was to examine the seroprevalence of COVID-19 in blood donors using systematic review and meta-analysis. Materials and Methods: The electronic databases PubMed, Scopus, Web of Science, and the Google Scholar search engine were searched using standard keywords up to 2022-04-26. The variance of each study was calculated according to the binomial distribution. Studies were combined according to the sample size and variance. Q Cochrane test and I2 index were used to examine the heterogeneity of the studies. Data analysis was performed in STATA 14 software, and the significance level of the tests was P < 0.05. Results: In the 28 papers examined with 227894 samples, the seroprevalence of COVID-19 in blood donors was 10% (95% CI: 9%, 11%), estimated 5% (95% CI: 4%, 7%) among men and 6% (95% CI: 4%, 7%) among women. This rate in different blood groups was as follows: A 12% (95% CI: 10%-14%), B 12% (95% CI: 10%-15%), AB 9% (95% CI: 7%-12%), and O 13% (95% CI: 11%-16%). The seroprevalence of COVID-19 in blood donors in North America 10%, Europe 7%, Asia 23%, South America 5%, and Africa was 4%; Moreover, the seroprevalence of IgG antibodies was estimated to be 23% (95% CI: 18%-29%) and IgM 29% (95% CI: 9%-49%). Conclusion: The highest prevalence of COVID-19 serum in women blood donors was among blood group O and Asia. The seroprevalence of IgG and IgM antibodies was high too.

The frequency, related cause of disease, and treatment of hepatitis B virus infection: A systematic review and meta-analysis in Iran.

Background: Hepatitis B virus (HBV) is one of the most dreadful viruses causing high mortality rates and serious damages to hepatocytes. The aim of this study was to assess the frequency, related causes/risk factors, and treatments of HBV infection in Iran by systematic review and meta-analysis. Materials and Methods: The data were obtained by a literature search in the PubMed, Scopus, SID, and Web of Sciences databases. Keywords included prevalence, risk factors, causes, treatment, and HBV. The Persian equivalents of these keywords were also searched. The time span included 2004 to2021. The Q and I 2 statistics were used to check heterogeneity among studies. The data were analyzed using Stata (version 14). Results: The frequencies of HBV infection and its pharmaceutical therapy were P = 6% (95% confidence interval [CI]: 4-9, I 2 = 95.2%, P < 0.001) and 19% (95% CI: 18%-30%, I 2 = 98.9%, P < 0.001), respectively. The most common risk factors/causes of HBV were narcotic consumption, blood-related factors, and transmission from infected individuals with the respective frequencies of 27% (95% CI: 16%-38%, I 2 = 88.7%, P < 0.001), 32% (95% CI: 11%-53%, I 2 = 99.8%, P < 0.001), 25% (95% CI: 10%-41%, I 2 = 99.3%, P < 0.001), and 15% (95% CI: 7%-22%, I 2 = 98.4%, P < 0.001), respectively. Conclusion: The most important causes of HBV infection were transmission from infected people, narcotic consumption, and blood-related factors. The main therapeutic intervention for HBV was pharmaceutical therapy.

Prevalence of Osteoporosis and Osteopenia in People Over 60 Years in Iran: A Systematic Review and Meta-analysis.

Background: Osteoporosis in the elderly has dangerous complications, the most important of which are bone fractures and reduced quality of life in the elderly. The present study was aimed at estimating the prevalence of osteoporosis in Iranian elderly using systematic review and meta-analysis. Methods: This search was conducted using authentic Persian and English keywords in national and international databases including Scientific Information Database, Magiran, IranDoc, PubMed, Scopus, Cochrane, Embase, and Web of Sciencewith no time limit until 20.06.2020. Heterogeneity of studies was assessed using I2 index. Data were analyzed using STATA Ver. 15 software. Results: In 30 studies with a sample size of 13,347 people, the prevalence of osteoporosis and low bone density in people over 60 years in Iran were 34% (95% CI: 27%, 42%) and 47% (95% CI: 41%, 53%), respectively. We also found that 34% of women and 41% of men over the age of 60 suffer from osteoporosis. Prevalence of osteoporosis was in lumbar bone 23% (95% CI: 20%, 26%), spine 25% (95% CI: 19%, 31%), hip 35% (95% CI: 7%, 62%), and femur 23% (95% CI: 15%, 31%). Prevalence of low bone density was in lumbar bone 41% (95% CI: 19%, 63%), spine 30% (95% CI: 15%, 46%), and femur 35% (95% CI: 21%, 48%). Conclusion: The prevalence of low bone density in people over 60 years is higher than the prevalence of osteoporosis in them. About one-third of Iranian elderly people suffer from osteoporosis, but about half of them have low bone density.

Promising effects of parasite-derived compounds on tumor regression: a systematic review of in vitro and in vivo studies.

The parasites are repeatedly confronting their host to take advantage of nutrients for multiplication and survival. In this sense, a wide spectrum of molecules is released from both sides, with immune-regulatory activity, accompanying this biological battle. Such parasites and their valuable molecules can be directed toward microbial-based cancer therapy. Herein, we contrived a systematic review to gather information on the antitumor activity of parasite-derived compounds. Following systematic search in Web of Science, ScienceDirect, Scopus, PubMed, ProQuest and Embase until 31 December 2019, a total number of 51 articles (54 datasets) were finally included in this review. Thirteen parasitic agents were found to possess possible antitumor activity, comprising protozoan species Toxoplasma gondii, Trypanosoma cruzi, Trichomonas vaginalis, Acanthamoeba castellanii, Besnoitia jellisoni, Leishmania major, Plasmodium yoelii, and Plasmodium lophurae, as well as parasitic helminths Toxocara canis, Echinococcus granulosus, Taenia crassiceps, Trichinella spiralis, and Schistosoma mansoni. Most experiments were done based on antigenic preparations from T. gondii (16 studies), E. granulosus (10 studies), T. spiralis (8 studies), and T. cruzi (6 studies). Possible antitumor properties of the selected parasites were revealed in this review. However, precise molecular basis of anticancer activity for each parasite remains to be elucidated in the future.

Engineering a multi-epitope vaccine candidate against Leishmania infantum using comprehensive Immunoinformatics methods.

Visceral leishmaniasis (VL) is a severe disease with particular endemicity in over 80 countries worldwide. There is no approved human vaccine against VL in the market. This study was aimed at designing and evaluation of a multimeric vaccine candidate against Leishmania infantum through utilization of helper T lymphocyte (HTL) and cytotoxic T lymphocyte (CTL) immunodominant proteins from histone H1, KMP11, LACK and LeIF antigens. Top-ranked mouse MHC-I, MHC-II binders and CTL epitopes were predicted and joined together via spacers. Also, a TLR-4 agonist (RS-09 synthetic protein) and His-tag were added to the N- and C-terminal of the vaccine sequence, respectively. The final chimeric vaccine had a length of 184 amino acids with a molecular weight of 18.99 kDa. Physico-chemical features showed a soluble, highly-antigenic and non-allergenic candidate. Secondary and tertiary structures were predicted, and subsequent analyses confirmed the construct stability that was capable to properly interact with TLR-4/MD2 receptor. Immunoinformatics simulation displayed potent stimulation of T cell immune responses, with particular rise in IFN-γ, upon vaccination with the proposed multi-epitope candidate. In conclusion, immunoinformatics data demonstrated a highly antigenic vaccine candidate in mouse, which could develop considerable levels clearance mechanisms and other components of cellular immune profile, and can be directed for VL prophylactic purposes. Supplementary Information: The online version contains supplementary material available at 10.1007/s11756-021-00934-3.

Chlamydia pneumoniae and Mycoplasma pneumoniae as Two Emerging Risk Factors in Atherosclerosis: Meta-Analysis Study and Systematic Review.

BACKGROUND: Previous studies suggested an association between Chlamydia pneumoniae and Mycoplasma pneumonia with atherosclerosis, separately. Until now, according to inconsistent information, the relationship between C.pneumoniae and M.pneumoniae with atherosclerosis is controversial. OBJECTIVE: The aim of this study is to investigate the association between C.pneumoniae and M.pneumoniae as two separate risk factors with atherosclerosis through systematic review and metaanalysis study. METHODS: We searched databases, such as Pubmed, SID, Magiran, Google scholar and Iranmedex, using the following keywords in English and Persian language: C. pneumoniae, M. pneumoniae, and atherosclerosis. Data were analyzed with meta-analysis and a random effect model. Also, in this study, heterogeneity of articles was estimated by using the I2 index. Finally, the data were analyzed with STAT (version 11.2). RESULTS: Among thirty-eight articles for C. pneumoniae and five articles for M. pneumoniae individually reviewed that included 2980 samples for M. pneumoniae and 23298 samples for C. pneumoniae, the result demonstrated that the association between M. pneumoniae and C. pneumoniae with atherosclerosis is significant with OR (odds ratio) = 1.58 (95% Confidence Interval (CI): 1.00 to 2.50), OR (odds ratio) = 2.25 (95% Confidence Interval (CI): 1.91 to 2.64), respectively. CONCLUSION: This systematic review study provides strong evidence for the role of persistent bacterial infections, such as M. pneumoniae and C. pneumoniae, in potential atherosclerosis. Thus, a novel way should be employed for the complete management of bacterial infection.

In silico analysis and prediction of immunogenic epitopes for pre-erythrocytic proteins of the deadly Plasmodium falciparum.

Malaria is the deadliest parasitic disease in tropical and subtropical areas around the world, with considerable morbidity and mortality, particularly due to the life-threatening Plasmodium falciparum. The present in silico investigation was performed to reveal the biophysical characteristics and immunogenic epitopes of the six pre-erythrocytic proteins of the P. falciparum using comprehensive immunoinformatics approaches. For this aim, different web servers were employed to predict subcellular localization, antigenicity, allergenicity, solubility, physico-chemical properties, post-translational modification sites (PTMs), the presence of signal peptide and transmembrane domains. Moreover, the secondary and tertiary structures of the proteins were revealed followed by refinement and validations. Finally, NetCTL server was used to predict cytotoxic T-lymphocyte (CTL) epitopes, followed by subsequent screening in terms of antigenicity and immunogenicity. Also, IEDB server was utilized to predict helper T-lymphocyte (HTL) epitopes, followed by screening regarding interferon gamma induction and population coverage. These proteins showed appropriate antigenicity, abundant PTMs as well as many CTL and HTL epitopes, which could be directed for future vaccination studies in the context of multi-epitope vaccine design.

Development of a chimeric vaccine candidate based on Toxoplasma gondii major surface antigen 1 and apicoplast proteins using comprehensive immunoinformatics approaches.

This study was aimed at designing and evaluation of a multimeric vaccine construct against Toxoplasma gondii via utilization of SAG1 along with apicoplast ribosomal proteins (S2, S5 and L11). Top-ranked MHC-I and MHC-II binding as well as shared, immunodominant linear B-cell epitopes were predicted and joined together via appropriate linkers. Also, TLR-4 agonist (RS-09 synthetic protein) and His-tag were added to the N- and C-terminal of the vaccine sequence. The finally-engineered chimeric vaccine had a length of 291 amino acids with a molecular weight of 31.46 kDa. Physico-chemical features showed a soluble, highly-antigenic and non-allergenic candidate. Secondary and tertiary structures were predicted, and subsequent analyses confirmed the construct stability that was capable to properly interact with human TLR-4. Immunoinformatics-based simulation displayed potent stimulation of T- and B-cell mediated immune responses upon vaccination with the proposed multi-epitope candidate. In conclusion, obtained information demonstrated a highly antigenic vaccine candidate, which could develop high levels of IFN-γ and other components of cellular immune profile, and can be directed for toxoplasmosis prophylactic purposes.

Bioinformatics features and immunogenic epitopes of Echinococcus granulosus Myophilin as a promising target for vaccination against cystic echinococcosis.

Cystic echinococcosis (CE) is a neglected zoonosis especially in underdeveloped countries around the world. Hence, immunization strategies are beneficial to avert the infection. The present investigation was aimed to predict the primary biochemical characteristics of the EgMyophilin and its potential B-cell and human leukocyte antigen (HLA)-binding epitopes as a promising vaccine candidate. Different web servers were used to predict physico-chemical, antigenic and allergenic profiles, transmembrane domain, subcellular localization, post-translational modification (PTM) sites, secondary and 3D structure, tertiary model refinement and validations. B-cell and HLA-binding epitopes were predicted and screened in terms antigenicity, allergenicity, solubility (B-cell) or hydrophobicity (T-cell). The 89.82 KDa protein was non-allergenic, hydrophilic, stable, with improved thermotolerance and 94 post-translational modification sites. The secondary structure included 42.94% alpha helix, 42.82% random coil and 41.23% extended strand. Based on Ramachandran plot output for refined model, 96.2%, 99.5%, and 0.45% of amino acid residues were incorporated in the favored, allowed, and outlier regions of the refined model, respectively. After epitope screening, four B-cell and five HLA-binding epitopes possessed the highest antigenic index in the protein sequence. This paper is a premise for further researches, and provides insights for the development of a suitable vaccine against CE. More empirical studies are required using the EgMyophilin alone or in combination with other antigens/epitopes in the future.

Toxoplasma gondii ROP38 protein: Bioinformatics analysis for vaccine design improvement against toxoplasmosis.

Rhoptry proteins (ROPs) play a significant role in various stages of Toxoplasma gondii (T. gondii) life cycle, being critical for both invasion and intracellular survival. ROP38 is a key manipulator of host gene expression and has a function in tachyzoite to bradyzoite conversion. In this study, we've employed various bioinformatics online tools for immunogenicity prediction of ROP38 protein, comprising physico-chemical, antigenic and allergenic profiles, transmembrane domain, subcellular localization, post-translational modification (PTM) sites, secondary and 3D structure, B-cell, MHC-binding and cytotoxic T-lymphocyte (CTL) epitopes. The findings showed 54 PTM sites without a transmembrane domain. Also, ROP38 was proved a non-allergenic and antigenic protein. The protein had Sec signal peptide (Sec/SPI) with 0.8762 likelihood. The secondary structure included 52.68% random coil, 29.57% alpha helix and 17.74% extended strand. Based on Ramachandran plot output for refined model, 95.3%, 3.4%, and 1.4% of amino acid residues were incorporated in the favored, allowed, and outlier regions, respectively. B-cell epitopes TFPGDDIQTSS (67-72) and KAKNKWGRTRYTLQG (207-221) as well as T-cell epitope LSPVGFFTAL (6-15) possessed the highest antigenic index in the protein sequence. This paper is a premise for further researches, and provides insights for the development of a suitable vaccine against toxoplasmosis. More empirical studies are required using the ROP38 alone or in combination with other antigens/epitopes in the future.

Epidemiology of gastroesophageal reflux disease in Iran: a systematic review and meta-analysis.

BACKGROUND: Gastroesophageal reflux disease (GERD), which leads to acid reflux into the esophagus, is a common gastrointestinal disorder. Several studies have shown the prevalence of GERD in Iranian population, but their evidence is contradictory. Therefore, the present study was conducted to investigate the epidemiology of GERD in Iran. METHODS: The entire steps of this systematic review and meta-analysis were based on the MOOSE protocol, and the results were reported accordance with the PRISMA guideline. This review is registered on PROSPERO (registration number: CRD42020142861). To find potentially relevant published articles, comprehensive search was done on international online databases Scopus, Science Direct, EMBASE, PubMed/Medline, CINAHL, EBSCO, Cochrane Library, Web of Science, Iranian online databases and the Google Scholar search engine in June 2019. Cochran test and I2 index were used to assess the heterogeneity of the studies. Data were analyzed using Comprehensive Meta-Analysis software ver. 2. The significance level of the test was considered to be P <  0.05. RESULTS: The daily, weekly, monthly, and overall prevalence of GERD symptoms in Iranian population was 5.64% (95%CI [confidence interval]: 3.77-8.35%; N = 66,398), 12.50% (95%CI: 9.63-16.08%; N = 110,388), 18.62% (95%CI: 12.90-26.12%; N = 70,749) and 43.07% (95%CI: 35.00-51.53%; N = 73,189), respectively. The daily, weekly, monthly, and overall prevalence of heartburn in Iranian population was 2.46% (95%CI: 0.93-6.39%; N = 18,774), 9.52% (95%CI: 6.16-14.41%; N = 54,125), 8.19% (95%CI: 2.42-24.30%; N = 19,363) and 23.20% (95%CI: 13.56-36.79%; N = 26,543), respectively. The daily, weekly, monthly, and overall prevalence of regurgitation in Iranian population was 4.00% (95%CI: 1.88-8.32%; N = 18,774), 9.79% (95%CI: 5.99-15.60%; N = 41,140), 13.76% (95%CI: 6.18-44.31%; N = 19,363) and 36.53% (95%CI: 19.30-58.08%; N = 21,174), respectively. The sensitivity analysis for prevalence of all types GERD, heartburn and regurgitation symptoms by removing a study showed that the overall estimate is still robust. CONCLUSION: The present meta-analysis provides comprehensive and useful information on the epidemiology of GERD in Iran for policy-makers and health care providers. This study showed a high prevalence of GERD in Iran. Therefore, effective measures on GERD-related factors such as lifestyle can be among the health policies of Iran.

The Effects of Reflexology on Fatigue Severity of Patients with Cancer

Introduction: Breast cancer is a major threat to women's health and a common factor that can reduce their life expectancy. Complementary medicine such as reflexology is known to reduce fatigue severity in cancer patients. The present study aimed to cultivate the effect of reflexology on fatigue severity of patients with breast cancer. Methods: The present pre-post clinical trial recruited 57 patients with breast cancer and involved an experimental and a control group. All patients were livening in Ilam, Iran. Patients were randomly assigned to two groups of experimental (N=27) and control (N=30). The experimental group received reflexology for 4 sessions. Data were collected using Fatigue severity scale (FSS) and demographic information questionnaire. FSS was completed by the patients twice; before the intervention and 2 months after the intervention. Data were analyzed using SPSS and running t-test and ANOVA. Results: Results showed no significant difference in fatigue severity between experimental (45.44±5.30) and control (43.66±7.68) groups prior to the intervention (p>0.05). However, after conducting the intervention, a significant difference in fatigue severity was seen between the experimental (20.66±4.54) and control (40.36±9.58) groups (p=0.000). Conclusion: The present study showed that reflexology decrease fatigue severity in patients with breast cancer and community health nursing can to use of these complementary medicine to increase patients health conditions.

Investigating the Effect of Mindfulness-Based Training on Psychological Status and Quality of Life in Patients with Breast Cancer

Cancer poses substantial challenges to both physical and mental health of patients. On the other hand, breast cancer is one of the most common cancers among Iranian women. Therefore, the present study was conducted to investigate the effect of mindfulness-based training on psychological status and quality of life (QoL) of patients with breast cancer living in Ilam, Iran. This quasi-experimental study was performed on 66 patients diagnosed with breast cancer. The patients assigned into two groups of experimental and control. Experimental group received mindfulness-based group training through eight 90-min sessions. Sessions were conducted twice a week and were completed within 1 month. The research tools included a QoL questionnaire (WHOQOL-BREF), Schneider's life expectancy questionnaire, and the depression anxiety stress scale (DASS-21). The questionnaires were completed before and during the interviews with the patients 2 months after intervention. Data were analyzed using SPSS (version 16) and running descriptive and analytical statistics. Before the intervention, there was no significant difference between he experimental and control groups considering QoL, life expectancy, depression, anxiety, and stress (p>0.05). However, after the intervention, the patients in the experimental group reported higher QoL and life expectancy and less severe depression, anxiety, and stress (p < 0.05). Considering the positive effect of mindfulness-based training on the psychological status and QoL of patients with breast cancer, we recommend health nurses conduct mindfulness-based training for patients receiving clinical care services.

Positive Effects of Cognitive Behavioral Therapy on Depression, Anxiety and Stress of Family Caregivers of Patients with Prostate Cancer: A Randomized Clinical Trial

Background: The family caregivers of patients with cancer mightexperience various physical, mental, and spiritual difficulties, the neglect of which can causeseriousproblems for theentirefamily. If caregivers are left without appropriate treatment and intervention, their level of physical and mental health will substantially decrease-they will, in other words, become"hidden patients." Materials and Methods: The current study is a clinical trial of 80 family caregivers of patients with prostate cancer, who were allocated to control and experimental groups. The experimental group received 10 sessions of group cognitive behavioral therapy. The 21-item Depression Anxiety Stress Scales were completed before the intervention as well4 and 8 weeks after. Data were analyzed using descriptive statistics (means and standard deviations) andvariousstatistical tests. Results: The results showed thatthecognitivebehavioral intervention reduceddepression, anxiety, and stress among familycaregivers. Conclusion: Because of the positive impact of this intervention, its implementation in clinical care by nurses is recommended.