Archives of Iranian Medicine
Volume:21 Issue: 9, Sep 2018

The purpose of this study was to investigate the results of hearing screening in all newborn infants, and their followup in Babol, northern Iran. Between 2006 and 2014, all healthy neonates delivered in 3 hospitals were included in this cross-sectional study. Newborns were screened using the transient evoked otoacoustic emissions test before discharge. Those who failed to pass the examination were tested for auditory brainstem response (ABR) by the age of one month. The infants referred from the previous level underwent tests of auditory steady state response, ABR and impedance audiometry before the age of 3 months. For infants with the diagnosis of bilateral hearing impairment, it was recommended to use a hearing aid in 3 months. Then, their parents were recommended to take infants again to the hearing testing centers within next 6 months. If the infant’s hearing was not improved, he/she was advised to undergo cochlear implantation. In total, 40930 newborns were screened. Out of them, 62 (1.5 per 1000 live births) were finally diagnosed to have hearing impairment, of whom 14 had unilateral and 48 had bilateral disorders (candidate for supportive measures). Overall, 986 (2.4%) were lost to follow-up and 11 (0.03%) died over the first 3 months of age. At the end of the 6-month follow-up for supportive stage, 15 out of 48 infants received a hearing aid and 18 (0.4 per 1000 children) underwent cochlear implant surgery. Fourteen out of 48 cases were lost to follow-up over supportive stage. It is recommended that all newborns undergo hearing screening test before hospital discharge, and those with impairment receive supportive measures from 3 months of age, and be re-examined at 12 months of age.

Breast cancer is the major cause of death from cancer among women around the world. Given the drug resistance in the treatment of this disease, it is very important to identify new therapies and anticancer drugs. Many studies demonstrated that hypericin could induce apoptosis in different cancer cell lines; however, the underlying mechanism is not well understood yet. Therefore, this study aimed to evaluate the anticancer effect of hypericin in two breast cancer cell lines, one with wild type P53 and the other with mutant P53. In this study, the MDA-MB-231 and MDA-MB-175-VII cell lines were treated with different concentrations of hypericin for 24 and 48 hours. The measurement of cell death was performed by MTT assay. The cell apoptosis rate was measured using annexin V/propidium iodide assay through flow cytometry. The level of expression in P21 and P53 genes was evaluated by real time PCR. Immunocytochemistry (ICC) analysis was performed for P21 (direct target for P53 protein) to confirm the results. The results showed that hypericin could have dose-dependent cytotoxic effects on the MDA-MB-231 and MDA-MB-175- VII cell lines, and its cytotoxicity is much higher in the latter cells. According to flow cytometry results, 86% of MDA-MB-175-VII cells underwent apoptosis with IC50 dose of hypericin for MDA-MB-231 cells after 24 hours. Moreover, after 24 hours of exposure to hypericin with MDA- MB-231 IC50 concentration, the expression of P53 and P21 genes upregulated in MDA-MB-175-VII much more than MDA-MB-231 when both cell lines were treated with 24 hours IC50 dose of MDA-MB-231. The ICC analysis on P21 confirmed that by treating both cell lines with MDA-MB-231 IC50 dose of hypericin for 24 hours, this protein is overexpressed much more in MDA-MB-175-VII cells. The results of this study demonstrated that hypericin’s apoptotic and cytotoxic effects on cancer cells may be mediated via P53 overexpression, cell cycle arrest and the subsequent apoptosis. Therefore, it is of great importance to consider that hypericin would have better impact on cells or tumors with wild type P53.

Coronary artery ectasia (CAE) is identified as dilation of one or more segments of coronary arteries that reaches 1.5 times or more, compared with near segments that are normal. Several etiologies like atherosclerosis, autoimmune diseases and congenital anomalies have been proposed for this condition. Vitamin D deficiency activates the renin-angiotensin-aldosterone system, which affects the cardiovascular system. For these reasons, we investigated the serum level of vitamin D in patients with CAE compared with individuals with normal coronary arteries. The study group included 30 patients (20 males and 10 females, mean age: 57 ± 9 years) with isolated CAE without any stenotic lesions, and the control group consisted of 60 age/gender matched subjects who had normal coronary angiograms (CAG) (40 males and 20 females, mean age: 57 ± 8 years). All participants underwent CAG at Tehran Heart Center between December 2015 and March 2016. Along with routine lab tests, vitamin D, serum albumin, calcium, phosphorus and alkaline phosphatase levels were analyzed and the unadjusted and adjusted effects of vitamin D on CAE were evaluated using logistic regression model. The median vitamin D level of the patients with CAE was lower than that of the control group (6.5 [3.0, 18.8] ng/mL vs. 17.7 [8.9, 27.1] ng/mL; P = 0.002). The logistic regression model showed that vitamin D deficiency was a predictor for the presence of CEA (P = 0.013). After adjustment for confounding variables, this association remained significant (P = 0.025). An association between CAE and vitamin D deficiency was found in our study

The aim of this study was to evaluate the degradation of tryptophan (Trp), neopterin production and antioxidant capacity in patients with benign and malignant thyroid disease. For this reason, the levels of tryptophan, kynurenine (Kyn) and neopterin, and superoxide dismutase (SOD) and catalase (CAT) enzyme activities in 67 thyroid patients were evaluated in our study and the results were compared with 30 healthy controls. Tryptophan and kynurenine levels in thyroid patients decreased compared to the control group. Patients with thyroid disease had lower CAT activity than the control group. The neopterin and tryptophan levels in malignant and benign patients were also significantly different. The results of the present study suggest that thyroid disorders may lead to changes in tryptophan degradation, neopterin production and CAT enzyme activities

Golestan province, in Northern Iran, is a high-risk area for esophageal squamous cell carcinoma (SCC). SCC is also the most common histological type of cancers of the head and neck region including cancers of oral cavity, oropharynx, hypopharynx and larynx. We aimed to present the incidence rate of head and neck SCC (HNSCC) in Golestan province during 2004 and 2013. Data on HNSCC were obtained from Golestan population-based cancer registry (GPCR). Quality control and data analysis were performed using CanReg software. Age standardized incidence rates (ASRs) were calculated using the world standard population. The ASRs were presented per 100000 person-years for different genders, residence places and years. During the 10-year period from 2004–2013, 434 cases of HNSCC were registered. 327 (75.3%) of these cases were male, 51.2% (222 cases) lived in urban areas and 351 (80.9%) of the total HNSCCs occurred in the larynx. Overall, the ASR of HNSCCs in Golestan province was 4.8. The ASR of HNSCCs was more than two-fold higher in male (6.6) than female (3.0). Our results showed an increasing trend in ASR of larynx cancer during the study period both in male and female. We found relatively high rates of larynx cancer in Golestan province. Our results also showed higher rates of HNSCC in males and urban population. Considering common risk factors between HNSCCs and esophageal cancer, further studies are needed to clarify different aspects of HNSCCs (including epidemiology and risk factors) in this high-risk population.

Multiple myeloma (MM) accounts for a substantial mortality rate among hematological cancers. The prognosis of the disease has been noticeably changed during the past 2 decades. This study reports a retrospective analysis of 345 MM cases from 2 cancer centers. Medical records of 345 MM cases were analyzed in retrospect. Diagnosis of MM was defined in presence of at least 10% plasma cells in bone marrow biopsy and one of the CRAB findings (hypercalcemia, renal failure, anemia and myeloma bone lesions). Survival analysis was performed using Kaplan-Meier method, and the effects of prognostic variables were assessed by Cox proportional hazards model. The mean age of the patients was 61.98 ± 11.44 years. Comparing to Mayo Clinic series, our patients were relatively younger and suffered from more advanced disease. By a median follow up time of 45 months, 1- and 5-year overall survival (OS) rates were 78.0% and 35.6%, respectively. Regarding first progression free survival (PFS1), similar rates of 57.7% and 17.0% were observed respectively. In multivariate analysis, hypercalcemia (corrected serum calcium >11 mg/dL), pancytopenia and elevated serum creatinine (Cr) (>2 mg/dL) were found to be independent prognostic factors affecting OS. Presentation of MM in Iran which is a developing country, was significantly different from developed countries. This finding might be generalized to other developing countries as well. In addition, vincristine-adriamycin-dexamethasone (VAD) therapy was an inferior protocol compared to bortezomib as first and second lines. Furthermore, pancytopenia was observed in about 9% of the patients and was an independent prognosticator of the disease.

Hookah and cigarette smoking have adverse effects on individuals’ health and therefore place a great burden on public health. The aim of this study was to measure inequalities in socioeconomic position to determine contributing factors on cigarette and hookah smoking in Iran. In this study, secondary analysis of the Iran’s sixth national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) was conducted for 10,572 individuals aged 15 to 70 years old. Subjects were categorized into three groups according to their socioeconomic status (low, middle and high) in order to assess their inequalities using principal component analysis. At the end, the gap between the low and high socioeconomic groups was decomposed using Blinder-Oaxaca decomposition technique. The prevalence of cigarette and hookah smoking in high, middle, and low socioeconomic groups was 11.8%, 13.2%, and 13.1% (P=0.158), and 2.6%, 3.3% and 4.3%, (P<0.001), respectively. Blinder-Oaxaca decomposition technique showed a lower prevalence of hookah smoking in high socioeconomic group compared to low socioeconomic group (P<0.001). The gap between the two mentioned groups was measured to be 1.7%. However, this gap for cigarette smoking (1.5%) was not significant (P=0.093). The finding indicates the importance of socioeconomic status in hookah smoking. After decomposition of the gap between the 2 socioeconomic groups, age, gender and education level were reported to be the major contributors to the differences observed between the 2 groups.

Chronic infection with hepatitis C virus (HCV), can now be safely treated with oral, well-tolerated medications with >90% success rates, however, currently <5% of the infected individuals have been diagnosed and <1% have received treatment. This is believed to be due to the complicated, time-consuming and expensive disease management processes that require several referrals to specialized laboratories and hospital-based clinics, and also the epidemic of HCV infection among populations who have low uptake for evaluation, appointments, and treatment. Point of care (POC) policy emphasizes on delivering healthcare tests and services to patients at or near the place and time of patient care. A reasonable design for POC policy should contain all parts of the HCV management continuum including screening, diagnosis of viremia, genotyping, cirrhosis evaluation and treatment. Furthermore, successful implementation of this policy requires acceptability from the perspectives of healthcare providers, target populations, and policymakers. In this letter, we discuss the current applicability, acceptability, and cost-effectiveness of POC policy for the management of HCV infection.

In Iran and also throughout the world, Dr. Mahmoud Bahmanyar (1919-2007) is acknowledged as a well-known researcher mainly in the field of rabies and plague. As an expert of plague for the World Health Organization (WHO), he accomplished many missions in several countries such as India, Cambodia, Myanmar, Indonesia, Vietnam, Yemen, and Brazil. His research on rabies has played an important role leading to the successful combined use of immune-serum and anti-rabies vaccine for prevention of human rabies worldwide. He also conducted many studies in the field of typhus, relapsing fever, and polio. The present article aimed to review his activities.