Archives of Iranian Medicine
Volume:19 Issue: 10, Oct 2016

We conducted this study to estimate the prevalence of biomarkers, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) among patients with breast cancer and to explore their effects on disease mortality.
We conducted this registry-based retrospective cohort study in Tehran, in 2014, using the data on 1622 patients with breast cancer, diagnosed pathologically and registered with the Comprehensive Cancer Control Center from 1998 to 2013. The outcome of interest was the survival probability of patients with breast cancer based on receptor status along with other prognostic factors such as age, histopathology, stage/grade of tumor, metastatic status, and surgical procedures using the life table, Kaplan-Meier curves, and multivariate Cox proportional hazard model. We generated different subtypes based on expression of ER, PR, and HER2, positive () and/or negative (–).
ERﳴ综焑– subtype (51.5%) was the most common form of breast cancer cells. Compared to the ERﳴ综焑– subtype, the hazard ratio (95% confidence interval) of cancer mortality was 2.14 (1.13, 4.03) for ER–/PR–/HER2– subtype, 1.92 (1.03, 3.59) for ER–/PR–/HER2 subtype and 5.19 (1.51, 17.86) for ER–/PRﱱᇛ subtype.
In this study, breast cancer cases with ER–/HER2 tumors had shorter survival than those with ERﳴ综焑– tumors. Triple negative tumors were the only other subtype with a statistically significant poorer prognosis. The results of this study in a middle-income country further indicate the importance of receptor status, in particular HER2 status, in the prognosis of breast cancer.

Limited data is available on the effects of multispecies probiotic supplementation on metabolic status in pregnant women in the first half of pregnancy. The current study was carried out to determine the effects of multispecies probiotic capsule supplementation on metabolic status among pregnant women in the first half of pregnancy.
A randomized clinical trial was conducted among 60 pregnant women aged 18–37 years. The participants were randomly divided into two groups: group A (n = 30) received multispecies probiotic supplements containing three probiotic bacteria spices Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum (2 × 109 CFU/g each) and group B (n = 30) received placebo from 9 weeks of gestation for a duration of 12 weeks. Fasting blood samples were taken at the beginning of the study and after 12 weeks of intervention to determine metabolic profiles, inflammatory cytokines and biomarkers of oxidative stress.
After 12 weeks of intervention, compared to the placebo group, the pregnant women who consumed probiotic capsule had significantly decreased serum insulin concentrations (-1.5 ± 4.8 vs. .3 ± 5.2 µIU/mL, P = 0.03), the homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (-0.3 ± 0.9 vs. .3 ± 1.1, P = 0.04), the homeostasis model of assessment-estimated b cell function (HOMA-B) (-7.2 ± 23.1 vs. .3 ± 22.6, P = 0.03) and increased quantitative insulin sensitivity check index (QUICKI) (.01 ± 0.05 vs. -0.01 ± 0.02, P = 0.03). In addition, changes in serum triglycerides levels (-14.7 ± 46.5 vs. .3 ± 74.2 mg/dL, P = 0.002), high-sensitivity C-reactive protein (hs-CRP) (-1.0 ± 2.6 vs. .7 ± 4.3 mg/L, P = 0.004), plasma nitric oxide (NO) (.8 ± 9.3 vs. -4.7 ± 7.4 µmol/L, P Overall, probiotic supplementation for 12 weeks among pregnant women in the first half of pregnancy had beneficial effects on markers of insulin metabolism, triglycerides, biomarkers of inflammation and oxidative stress.

To investigate the association between non-alcoholic fatty liver disease (NAFLD) and quantitative measures of central adiposity in the general population using a semi-automated method on magnetic resonance imaging (MRI) data.
Subjects were recruited from Golestan Cohort Study. Two groups of 120 individuals with and without fatty liver were randomly selected based on findings of ultrasound. Non-invasive diagnosis of NAFLD was made by combination of ultrasound and MRI. Various anthropometric indices including body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured. Segmentation and calculation of visceral (VFA) and subcutaneous fat area (SFA) were performed on three levels of MRI slices using semi-automated software.
A total of 109 individuals fulfilled the NAFLD criteria, while 92 subjects were selected as the control group. All obesity measures, except for SFA, were significantly higher in subjects with NAFLD compared to controls. Significant associations were found between NAFLD and adiposity indices, except for SFA, with the highest odds ratio observed in WHR (OR: 3.37, CI: 1.40–3.70, P Quantitative measures of visceral adiposity are associated with NAFLD, while subcutaneous fat measures are poor indicators for identifying NAFLD. Compared to conventional anthropometric indices, VFA best correlates with ultrasound and MRI criteria of fatty liver.

Gancyclovir-resistant (GanR) cytomegalovirus (CMV) remains an issue, especially in solid organ transplant (SOT) recipients. Some mutations in UL54 and UL97 confer this resistance. Long-lasting high-dose drug exposure, high viral load, together with lack of sufficient compliance with treatment may account for these mutations. The aim of this study was to detect UL97 and UL54 putative mutations conferring ganciclovir-resistance in renal organ transplant recipients with high CMV load.
In this cross-sectional study, 58 serum samples were collected from renal transplant recipients who had referred to three hospitals in Tehran from January 2014 to June 2015. Specific criteria such as CMV syndrome, presence of CMV in blood and organ dysfunction were considered. Then, they were tested for viral load in their early fourth month of intravenous ganciclovir treatment. Fifty cases revealing more than 200 copies/mL were analyzed for mutations. Two fragments of UL54 and Ul97 genes were amplified and sequenced bidirectionally. Sequence alignment and statistical analysis were performed by Mutation Surveyor software and t-test respectively.
A significant difference was observed in viral load between seronegative and seropositive recipients (P  0.036). The most frequent mutation was related to D605E in UL97 gene with the rate of 25%. Regardless of viral load, neither putative mutation nor simultaneous mutation was detected in either UL97 and UL54 regions.
In spite of high viral load and persistence of symptoms, our population study did not reveal putative mutations. Hence, the direct relationship between the presence of high quantity of CMV and the occurrence of putative mutation cannot be considered. Non-putative gancyclovir resistant mutations and prolonged drug exposure may have a role in these manifestations.

Given the importance of regular physical activity, it is crucial to evaluate the factors favoring participation in physical activity. We aimed to report the psychometric analysis of the Farsi version of the Physical Activity and Leisure Motivation Scale (PALMS).
The Farsi version of PALMS was completed by 406 healthy adult individuals to test its factor structure and concurrent validity and reliability.
Conducting the exploratory factor analysis revealed nine factors that accounted for 64.6% of the variances. The PALMS reliability was supported with a high internal consistency of 0.91 and a high test-retest reliability of 0.97 (95% CI: 0.97–0.98). The association between the PALMS and its previous version Recreational Exercise Motivation Measure scores was strongly significant (r= 0.86, P We have shown that the Farsi version of the PALMS appears to be a valuable instrument to measure motivation for physical activity and leisure.

Xanthogranulomatous pyelonephritis is a chronic destructive granulomatous inflammation of the kidney. This pathology was firstly described in 1916 and a small number of patient series were reported in the literature. In this study, we aimed to report the patients with xanthogranulomatous pyelonephritis in our nephrectomy cases.
The patients who underwent nephrectomy and were diagnosed with xanthogranulomatous pyelonephritis in our hospital database were reviewed retrospectively. Preoperative laboratory results, radiological imaging findings, patients’ age and history of predisposing diseases were recorded.
A total of 13 cases of xanthogranulomatous pyelonephritis treated in our hospital from January 2003 to December 2015 were included in the study, consisting of 7 male and 6 female patients with a mean age of 56 ± 16.09 years. In urine analyse, pyuria was positive in 6 patients (46.15%) and leukocytosis was detected in one patient (7.7%). The disease site was the right kidney in 4 patients (30.7%) and the left kidney in 9 patients (69.23%). Radiological findings of the patients were pyonephrosis, renal ectasia, pyelonephritis, hydronephrosis, renal tumor, xanthogranulomatous pyelonephritis and non-functioning kidney with renal calculi. All patients were treated by open surgical techniques and perioperative and postoperative complications did not occur. Partial and radical nephrectomy was performed in one patient and the other patients were treated with simple nephrectomy.
Xanthogranulomatous pyelonephritis is an uncommon histologic variant of the kidney for patients who are surgically treated for pyelonephritis. Early diagnosis and treatment is very important for decreasing morbidity and mortality. Although radical surgery is the main treatment of choice for patients with diffuse xanthogranulomatous pyelonephritis, nephron sparing surgery is an alternative for patients who have the focal form, if technically possible.

Anogenital warts (AGWs) are epithelial tumors which develop as a result of human papilloma virus (HPV) infection. We aimed to assess the sociodemographic, sexual and other possible risk-factors, and awareness of the HPV infection among Turkish people with AGW in the Bagcilar district of Istanbul.
A cross-sectional study was conducted on 273 patients (183 men, 90 women) with AGW between October 2014 – March 2015. The patients’ sociodemographics were recorded along with their possible risk-factors and clinical findings. The patients’ answers to questions regarding HPV/AGW were checked for awareness. Data were analyzed by Chi-square test using SPSS (Statistical Package for the Social Sciences) version 15.0. The results were evaluated with P The major parameters detected were 26–39 age-range (52.6%), self-employed (54.6%), primary school graduate (44,7%), low/middle income (91.2%), married (59.3%), heterosexual (98.9%), sexually active (93.8%), sex in previous 3 months (87,6%), multi-partners (53.5%), partners without AGW (60.8%), mixed location (32.2%), concomitant verruca on hands (26%), 3–6 month duration (38.8%), non-recurrent lesion (98.2%), tinea cruris [TC](25.3%) and smoking (54.2%). However, self-employed (70.5%), middle-income (47%), polygyny (71.6%), pubic-location (43.2%), long-duration (46.4%), concomitant TC (31.7%) diabetes mellitus (9.8%), and verruca on hands (33.3%) were mostly encountered in males, while housewife (57.7%), low-income (60%), monoandry (67.8%), perianal-location (48.9%), short-duration (58.9%), smoking (64.4%), concomitant candidiasis (15.6%) and depression (31.1%) were mostly found in females. Awareness of HPV hearing, HPV-AGW and HPV-cancer relationships, transmission-routes, risk-factors (each at 5.5%), and prevention methods (2.2%) was very low.
AGWs are seen in sexually-active, less-educated, married heterosexuals in Bagcilar. Self-employed, middle-income, polygyny, pubic-location, long-duration, concomitant TC and diabetes mellitus, and verruca on hands are mostly seen in males, while housewife, low-income, monoandry, perianal-location, short-duration, smoking, candidiasis and depression are more common in females. Awareness is very low.

A significant contribution to the causes of hereditary hearing impairment comes from genetic factors. More than 120 genes and 160 loci have been identified to be involved in hearing impairment. Given that consanguine populations are more vulnerable to most inherited diseases, such as hereditary hearing loss (HHL), the genetic picture of HHL among the Iranian population, which consists of at least eight ethnic subgroups with a high rate of intermarriage, is expected to be highly heterogeneous. Using an electronic literature review through various databases such as PubMed, MEDLINE, and Scopus, we review the current picture of HHL in Iran. In this review, we present more than 39 deafness genes reported to cause non-syndromic HHL in Iran, of which the most prevalent causative genes include GJB2, SLC26A4, MYO15A, and MYO7A. In addition, we highlight some of the more common genetic causes of syndromic HHL in Iran. These results are of importance for further investigation and elucidation of the molecular basis of HHL in Iran and also for developing a national diagnostic tool tailored to the Iranian context enabling early and efficient diagnosis of hereditary hearing impairment.

In Iran, as in most countries, cardiovascular diseases are the leading cause of death (highest mortality rate), but rank third in terms of disease burden. On the other hand, the relationship between high salt intake, hypertension, and cardiovascular disease has been proven. Food consumption pattern in Iran shows that consumption of salt, pickled foods and salty snacks is common. Regarding the World Health Organization (WHO) target for salt intake (about 5 g per day), the evidence indicates that Iranian people consume 2–3 times more than the recommended amount of salt. Fortunately, serious attention has been paid to this matter since 2009 and along with arrangements for it, support of all relevant sectors (public and private) has been included in the agenda. At present, reduction of salt intake is among the major priorities of planners, policy makers, and experts of the Iranian health services system. On the other hand, many studies in EMRO have shown high levels of daily salt intake in these countries. In this review, the solutions used in the Islamic Republic of Iran at various levels were considered, including determination of salt intake measurement methods, revision in the amount of salt in processed food products, food labeling, promoting awareness of various social groups, gathering support from all relevant sectors, designing a regular public awareness campaign for reducing salt intake, and lessons learned in this regard, that can be helpful to countries in the region.

This paper presents a systematic literature review of studies that shed light on the health of migrants in Iran from the perspective of social justice.
A systematic search was conducted in PubMed and Iranian databases, including IranMedex, Magiran, and SID, in June 2012. All studies that were published until June 2012 describing the health status of migrants – including refugees – in Iran were included. The search results were categorized according to an adapted version of the six dimensions of well-being in Madison Powers’ and Ruth Faden’s theory of social justice in health. They consisted of access to health care, health, respect, self-determination and attachment, personal security, and social determinants of health.
The majority of papers mentioned issues related to infectious diseases (100 papers, 60.2%). Only a few papers mentioned socioeconomic status and access to health services, education, and work. Infectious diseases and high population growth among migrants and the problematic image of migrants as “threat” to the Iranian population’s health appear to be the most prominent results in our search.
It is imperative to combat the high numbers of infectious diseases among migrants in Iran while simultaneously making efforts to change the public image of migrants as a health and social service threat to Iran. Data concerning social and ethical issues of migrants’ health in Iran is scarce, and thus, future research is necessary using other methods and sources.