kamran ghaffarzadehgan

Gastrointestinal (GI) tract is the most common site for extranodal lymphoma. The primary GI lymphoma pattern in Iran is different from western countries and has been changed during the past 40 years.

This study was done to determine the clinical and pathological characteristics of primary GI lymphoma in Tehran, Hamedan, and Mashhad regions in Iran.

In this cross-sectional comparative-descriptive study, 200 patients with primary GI lymphoma in Tehran, Hamadan, and Mashhad regions from 2011 to 2016 were enrolled in a consecutive manner, where the clinical and pathological characteristics of cases were determined.

Among 200 patients, 141 (70.5%) subjects were male and 59 (29.5%) subjects were female. The mean age at diagnosis was 54.3 ± 19.3 years. Also, 84%, 8.5%, and 7.5% of the patients’ specimens were from Tehran, Hamedan, and Mashhad, respectively. The stomach was the principal involved location in approximately half of the cases. Diffuse large B-cell lymphoma (DLBCL), was the main subtype that was observed in 64% of the cases. Treatment in 72% of cases was a combination of surgery and chemotherapy. The 5-year survival was assessed in 147 patients with a rate of 68%.

Primary GI lymphoma is seen more in male subjects younger than 60 years of age with non-specific symptoms. Also, DLBCL and MALToma are the main histologic types, and the 5-year survival for all cases is 68.0%. The clinical symptoms showed no specific pattern and accordingly, patients with weight loss and abdominal pain should be considered in in differential diagnosis of malignant lymphoma.

Malignant pericardial mesothelioma is a very rare tumoraccounting for 4% of all cardiac and pericardial tumors. We introduce a rare case of primary pericardial mesotheliomasince patients with mesothelioma mostly present with nonspecific symptomsand one-time diagnosis plays a major role in treatment. Our patient is a 29-year-oldCaucasian man with a complaint of worsening dyspnea and weight loss over the prior three weeks. After transthoracic echocardiography and CT scan, the patient underwent open-heart surgery and biopsy was achieved. Finally, the diagnosis of primary pericardial mesothelioma was confirmed.

Recent studies suggest that Denosumab reduces tumor size, therefore, makes the surgery easier with lower morbidity. However, some studies have reported several complications for this drug. So, this systematic review was performed to determine the effectiveness and safety of Denosumab in reducing bone destructions activity of giant cell tumor and skeletal-related events (SRE) in affected patients with giant cell tumor of bone (GCTB) and its recurrence. We explored studies in PubMed, and Cochrane Library. For this purpose, articles of various levels were retrieved until October 22, 2016. Two reviewers assessed the articles independently based on predefined criteria to extract the relevant data. Primary outcomes associated with skeletal-related event, overall survival, and secondary outcomes such as pain, quality of life and adverse events were evaluated and analyzed.The total population of this meta-analysis consisted of 686 patients. Of this population, 55% had primary GCTB and 45% had giant cell tumor recurrence, with 2% experiencing secondary recurrence. The results showed the effectiveness of Denosumab in reducing the tumor size due to inhibiting the Osteoclastogenesis. Denosumab didnot show any effect on reducing tumor recurrence, but, in cases where complete tumor surgery is not possible and tumor residuals may remain, Denosumab can be helpful. Also, the clinicians should consider the risk benefit of Denosumab.

The central nervous system (CNS) belongs to heterogeneous group of glial and non-glial brain tumors. Increase in the frequency of brain and CNS tumors in Iran have been a cause for debate and concern.
The aim of this study was to estimate the frequency of the principal CNS cancers, using CNS cancer data records in a 7-year period in a hospital in Mashhad, Iran.
This study is based on the records of department of surgical pathology, Razavi hospital, Mashhad, Iran. We analyzed 1,164 brain tumors and CNS cancers diagnosed from 2006 to 2013. It includes data on spinal cord tumors, primary brain such as lymphomas, which are hematological malignancies and metastatic tumors originating from external to the central nervous system. The frequency varies widely across this 7-year period.
The majority of brain tumor locations were frontal (13.2%), pituitary (11.7%), parietal (10.6%), Spinal (8.9%), Temporal (8%), and base of skull (6.3%). The most frequently reported histologies were meningiomas (33.6%) and glioblastomamultiforme (15.8%) that are strongly influenced the overall results. Higher numbers for glioblastoma, myxopapillaryependymoma, fibrillary astrocytoma, craniopharyngioma, hemangio-blastoma, oligodendro-glioma, and sarcoma were observed in male than in female patients. Meningioma, neurofibroma, and choroid plexus papilloma were the only tumors with a significant excess in female.
We noted that higher frequency of brain tumors and CNS cancers occurred at age group of 51 to 60 years. Although data are hospital-based, is the first study to delineate the brain tumors and CNS cancers burden in north-east of Iran by age, sex, histology type, anatomical site, and laterality.

Prisoners are a certain part of the population. Prisoners are kept in a closed environment for a long period of time and are prone to various diseases. Inflammatory biomarkers, including hs-CRP, are new risk factors for cardiovascular disease.

The aim of this study was to compare hs-CRP levels in male and female prisoners and investigate the relationship between hsCRP levels with related factors.

In this cross-sectional study, 316 prisoners in Mashhad Prison were investigated. A blood sample (7ml) was taken from each subject. Enzyme-linked immunosorbent assay (ELISA) technique was used to measure serum levels of highsensitivity C-reactive protein (hs-CRP). Descriptive statistics, chi-squared test, T-test, Pearson and Spearman’s correlation coefficients were used. P<0.05 was considered to be the level of significance.

316 prisoners were investigated of whom 211 (66.8%) were male and 105 (33.2%) were female. Mean hs-CRP level was 5.72±7.93 µg/ml in men and 7.48±8.39 in women. The difference between the two genders were statistically significant (p<0.001). The mean hs-CRP level was significantly higher in prisoners who did injection drug use compared to those who inhaled or consumed drugs (p<0.001). A significant correlation was observed between age, systolic blood pressure, frequency of imprisonment, height and BMI and hs-CRP levels.

Since hs-CRP is an important biomarker for non-communicable diseases, considering these factors and other risk factors for chronic diseases in the high-risk and vulnerable groups of prisoners, prevention and control measures can be planned by this group of people.

Chronic hepatitis B infection (CHB) is a major global health problem. Hepatitis B e antigen (HBeAg)-negative is a common type of CHB in Iran. Liver damage in HBeAg-negative CHB leads to progressive form of the liver disease with poor prognosis. Therefore, it seems necessary to perform a comprehensive evaluation of different spectrum of laboratory measurements accompanying histological findings. The aim of this study was to evaluate the association between the biochemical, virologic and histologic features in HBeAg-negative CHB. Furthermore, we assessed the application of new cut-off values for alanine aminotransferase in HBeAg-negative CHB patients.
HBeAg- negative CHB patients referring to hepatology clinics at Ghaem and Imam Reza hospitals during two years period were enrolled. Patients with alcohol consumption, liver mass, fatty liver and whom with positive results of Anti HDV, Anti HCV or Anti HIV were excluded. Liver enzymes were requested and Hepatitis B viral loads were measured by real time polymerase chain reaction (RT-PCR) in all patients. Liver biopsies were assessed by two expert pathologists. The relationship between viral loads, liver enzymes and histopathological features was analyzed using descriptive and analytic statistical methods.
One hundred and fifty HBeAg-negative and HBe Ab-positive CHB patients (males=110, mean age=38.44±11.34 years) were assessed. Serum ALT levels had a significant relation with the logarithm of serum HBV-DNA levels (P In HBeAg-negative CHB patients, serum AST levels had a better predicting value for liver necrosis and inflammation. Moreover, age could be regarded as an independent predictor of the stage of liver fibrosis. This study revealed that the new cutoff values for ALT had superiority over the conventional values to identify patients with a higher risk of liver fibrosis.

Bile duct adenoma (BDA) is a rare neoplasm of bile ducts with various clinical manifestations and imaging appearances. A few cases of BDA and their predisposing factors have been described. We report a 35-year-old woman with right upper quadrant pain who consumed oral contraceptive pills. Ultrasound study revealed three hypoechoic subcapsular liver masses; two of them were hypodense in computed tomography. Fine needle biopsy of the largest mass showed bile duct adenoma. Liver masses disappeared after discontinuing the pills over a 2-year follow-up. BDAs can manifest in imaging. Although previous studies have not reported tumor resolution over a follow-up period, we suggest paying more attention to predisposing factors in order to give an opportunity for tumor resolution by risk factor elimination.

As pain and nausea is usually associated with endoscopy procedure, its management is important to alleviate patients’ anxious in this regard.. The present study aimed to examine the effectiveness of conversational hypnosis in reducing anxiety and endoscopy-related complications as well as its role in increasing the satisfaction of patients exposed to endoscopic procedures..Patients and The participants of upper GI endoscopy procedure were randomly assigned to an experiment group (with conversational hypnosis intervention, n = 93) and a control group (n = 47). The participants’ hemodynamic indexes (HR, blood pressure, pulse oximetry), anxiety, satisfaction level, and complications resulted from the procedure were monitored and included in the self-administered questionnaire.. The results indicated that the participants in experiment group had a significant reduction of anxiety in the posttest. The adverse side effects such as vomiting, nausea, and hiccups in the experimental group was less than the control group, though this difference was not significant (P = 0.54).. The results suggested that conversational hypnosis technique could reduce anxiety as well as the sedation process in invasive procedures such as endoscopy..

Context:

 Triple negative breast cancer (TNBC) is a heterogeneous group of diseases that is negative for esterogen receptor (ER) progesteron receptor (PR) and human epidermal growth factor receptor 2 (HER2). This type of breast cancer is typically high-grade carcinomas, although low-grade tumors occur. The aim of this review is to focus on molecular classification and features, prognostic markers and targeted therapies of triple negative breast cancer.

Evidence Acquisition: 

We searched using electronic databases Pubmed/Medline, Dare, Scopus, Embase, and Cochrane Database of Systematic Reviews with terms of ‘Triple negative breast cancer’, ‘Breast cancer’, ‘Molecular classification’, ‘Immunohistochemical markers’, ‘Molecular features, ‘Targeted therapy’, and ‘Prognostic marker’.

It seems that TNBC itself can be subdivided into immunomodulatory, mesenchymal, mesenchymal stem-like, luminal androgen receptor, and distinct basal-like subtypes that differ substantially from basal-like tumors. There are several prognostic makers for TNBC including EGFR and ALDH1, Lysyl Oxidase-Like 2 protein (LOXL2), Synuclein gamma (SNCG), LDHB (Lactate Dehydrogenase B). The antiangiogenic agents, EGFR inhibitors, and PARP inhibitors are new therapeutic Implications and potent factors to targeted therapies of TNBC.

Only a few clinical trials are performed on TNBC patients because this disease has a low incidence. Therefore, it seems larger scale clinical trials are needed to be conducted in the future.

Esophageal Squamous-Cell Carcinoma (SCC) is one of the most common malignancies in Iran. To reduce the incidence of esophageal SCC, it is important to recognize the controllable risk factors and prevent them. Celiac disease is widely known as a possible risk factor for esophageal SCC. Thus, we decided to assess the frequency of celiac disease in esophageal SCC patients in North east of Iran in order to suggest correlation between two diseases. In a Cross-sectional study one hundred and forty-three cases of esophageal SCC were examined for anti tissue transglutaminase antibody (anti-tTG) between the years 2004 and 2009 in Ghaem and Omid Hospitals of Mashhad University of Medical Sciences, Iran. The enzyme-linked immunosorbent assay was the test of choice in this study since it provides the sensitivity and specificity needed for the diagnosis and screening of celiac disease. The results of this test were compared with those of the control group which were compatible in terms of sex and age. Data were analyzed through SPSS software and statistical analysis such as x2, exact x2 and T-test. 19.6% patients (SCC) had positive anti-tTG (>20) which was significantly different to 7.9% in control group (p -value=0.005). Comparing age groups of patients for positive anti_tTG using exact x square test showed significant difference in patients with. There seems to be a correlation between positive anti_tTG and esophageal SCC; that is to say, celiac disease might play a role in the earlier manifestations of esophageal SCC.

Colorectal Cancer (CRC) is the third most common cancer in Iran and its early detection is necessary. This study is based on perception of people in the east of Iran toward CRC screening. In a cross-sectional study, 1060 randomly selected individuals who referred to Razavi Hospital of Mashhad, Iran, between September the 1st, 2012 and February the 28th, 2013 as patients or their visitors involved in an interview to fill a questionnaire on CRC screening. The participants’ age ranged from 40 to 88 years (mean= 55). More than 90% had no knowledge of CRC and screening tests. The most cited reasons for not having screening tests were “did not have any problem” and “did not think it was needed”. Although, older people had more knowledge of CRC (P= 0.033), there was no relationship between gender, health insurance status, family history of individuals and their knowledge about CRC (P> 0.050). Employment, education and higher income had positive effect on the perception of people toward CRC screening (P< 0.050). Lack of knowledge in people in lower socio-economical class with limited literacy is the most important barrier to CRC screening. As such, designing educational programs involving physicians and media is important to improve CRC screening rates.

Inflammatory bowel disease (IBD) is among the most common diseases of gastrointestinal system and includes two chronic relapsing diseases: ulcerative colitis and Crohn's disease. These diseases are the result of dysregulated immune response to the gastrointestinal bacteria in people with genetic background (1). There are clinical and microscopic differences between ulcerative colitis and Crohn's disease in terms of pattern of intestinal involvement and involvement of layers of bowel. Although these differences make the differentiation of the two mentioned diseases possible, there is also gray zone; meanwhile, indeterminate colitis (recently known as IBD of undetermined etiology, IBDU) includes 10-15% of the cases. Ulcerative colitis generally starts in the rectum and spreads continuously to the proximal areas. Inflammation is limited to mucosa and sub- mucosa and diffuse and uniform involvement of the affected area. The characteristic histological finding for this disease is defined as destruction and irregularity of colon crypts. Crohn's disease affects most of the gastrointestinal system from the mouth to the anus. The characteristic for this disease is the existence of skip areas and transmural involvement. Granuloma, fissure ulcer and several lymphoid follicles are evident in histology. There may be three factors leading to ulcerative colitis and Crohn's disease: - Genetic background, - Immune response, that is not able to down- regulate

46-year-old woman presented with progressive dyspnea and cough. She was a known case of chronic hepatitis C (HCV) treated with pegylated (PEG)-interferon. Complete pulmonary studies and biopsy were compatible with bronchiolitis oblitrans with organizing pneumonia (BOOP) secondary to PEG-interferon. She discontinued PEG-interferon and was given a short course of steroids, after which the condition completely resolved. This report has shown that particular attention to possible side effects of PEG-interferon is necessary in the clinical practice.