Archives of Iranian Medicine
Volume:24 Issue: 11, Nov 2021

The Isfahan Thyroid Cohort Study (ITCS) is one of the few population-based epidemiological studies in Iran that investigates the prevalence and incidence of thyroid disorders including hypothyroidism, hyperthyroidism, goiter, nodule, and iodine status.

This cohort is located in Isfahan, Iran. The first phase was initiated in 2006 with 2523 participants (1275 males, 1248 females). The participants were selected using multi-stage cluster sampling from the general residents of Isfahan, Iran. The study had two phases (2006 and 2011) and its third stage is planned for 2020–2021.

The prevalence of thyroid function states was euthyroid (89.3%, 95% CI: 88%–90%), overt hypothyroidism (2.8%, 95% CI: 2%‒3%), subclinical hypothyroidism (5.8%, 95% CI: 4%–6%), overt hyperthyroidism (0.8%, 95% CI: 0.4%‒1%), and subclinical hyperthyroidism (0.99%, 95% CI: 0.6%–1%). Hypothyroidism and hyperthyroidism were significantly associated with goiter. The incidence of thyroid dysfunction was reported as follows: overt hypothyroidism (2.7, 95% CI: 1.6–3.7), subclinical hypothyroidism (20.6, 95% CI: 18–23), overt hyperthyroidism (1.9, 95% CI: 1–2.7) and subclinical hyperthyroidism (2.7, 95% CI: 1.6–3.7) per 1000 (person-year).

We assessed the prevalence and incidence of thyroid disorders in Isfahan in the first and second phase, respectively. We are conducting the third phase of the ITCS in order to study the associations between thyroid peroxidase antibody (TPOAb) level and environmental factors such as infection.

Considerable variability in survival rate after ST-segment elevation myocardial infarction (STEMI) is present and outcomes remain suboptimal, especially in low- and middle-income contraries. This study aimed to investigate predictors of 30- day mortality after STEMI, including reperfusion therapy, in a tertiary hospital in western Iran.

In this registry-based cohort study (2016–2019), we investigated reperfusion therapies – primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone – used in Imam-Ali hospital, the only hospital with a PPCI capability in the Kermanshah Province. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), using Cox proportional-hazard models, to investigate the potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests.

Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy was performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of the referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/ percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95% CI: 1.36–2.97), referral from non-PPCI-capable hospitals (1.73, 1.22–2.46), age (1.03, 1.01–1.04), glomerular filtration rate (0.97, 0.96–0.97), heart rate>100 bpm (1.94, 1.22–3.08), and systolic blood pressure<100 mm Hg (4.92, 3.43–7.04). Mortality was lower with the pharmaco-invasive approach, although statistically non-significant, than other reperfusion therapies.

Reperfusion therapy, admission types, age, glomerular filtration rate, heart rate, and blood pressure were independently associated with 30-day mortality. Using a comprehensive STEMI network to increase reperfusion therapy, especially pharmaco-invasive therapy, is recommended.

Coronary sinus dimension is an important factor for diagnosing some types of cyanosis as well as congenital heart diseases and insertion of some devices into the coronary sinus if required. This study was designed to access the diameter and Z-score of the coronary sinus among children under 18 years of age.

In this cross-sectional study on 95 individuals, the coronary sinus diameter was measured by transthoracic echocardiography in the four-chamber view at the connection to the right atrium, middle part, and distal end. The linear regression equation was utilized to determine age-adjust reference values, Z-scores, and the relationship between the individuals’ coronary sinus diameter age, height, and body surface area. The study was conducted from March to July 2020 in Namazi hospital clinic of Shiraz University of Medical Sciences, Shiraz, Iran.

The mean age of the persons who entered this study was 5.87±4.25 years. The mean coronary sinus diameter was 4.91±1.29 mm at the site of connection to the right atrium, 4.50±1.44 mm at the middle part, and 3.74±1.32 mm at the distal end. Coronary sinus diameter correlates positively with the participants’ age, weight, height, and body surface area (P<0.001).

Coronary sinus diameter significantly correlates with the age, height, and body surface area of the cases. These features are useful in diagnosing some congenital heart diseases and insertion of suitable devices through it.

The COVID-19 outbreak is currently a critical challenge, and proper perception of the mental health situation of individuals in the working environments has become a crucial issue. This study aimed to investigate the psychological and psychosocial impact during the COVID-19 pandemic among Iranian oil refineries personnel.

This longitudinal study was conducted in two phases from November 2019 to July 2020 among the 850 employees of three refineries in Iran. To study the mental workload, job burnout, lifestyle, occupational stress, general health, and memory quotient of personnel, the NASA-TLX questionnaire, Maslach Burnout Inventory (MBI) questionnaire, Walker’s health-promoting lifestyle questionnaire, health and safety executive (HSE) job stress questionnaire, general health questionnaire, and Wechsler memory scale were used, respectively. Data were analyzed using paired sample t test, independent sample t test, and one-way ANOVA in SPSS version 25.

The study results revealed that the mean age of studied personnel was 34.62±13.48 years. There was a meaningful correlation between the values of mental workload, job burnout, occupational stress, general health, healthy lifestyle, and memory quotient of personnel before and during the COVID-19 pandemic (P value<0.05).

The COVID-19 pandemic can significantly affect the psychological and psychosocial parameters of employees in working environments. Therefore, implementing psychological interventions is absolutely necessary to promote personnel’s mental health during the COVID-19 pandemic.

The aim of this study was to evaluate the application of the rapid influenza antigen test and the contribution of the test result to patient management in febrile infants aged 29‒90 days.

The medical records of febrile infants without a focus who presented during influenza seasons from 2017‒2019 were analyzed retrospectively. The study was carried out in the Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital. The demographic characteristics, clinical and laboratory findings, and management of the patients were examined. The patients were divided into two groups as ‘with’ and ‘without’ testing based on whether a rapid influenza antigen test was performed or not. Test results were categorized as positive or negative. Serious bacterial infection (SBI) risk and patient management were evaluated according to test results.

A total of 173 patients (110 males/63 females) were evaluated. The influenza test was performed in 94 (54.3%) patients, and 31.9% were positive. SBI was present in 8.7% of all patients. The mean values of white blood cell (WBC), absolute neutrophil, platelet count, C-reactive protein (CRP) and, lumbar puncture, hospitalization, and initiation of antibiotic therapy were significantly lower in the positive group compared to the negative and without testing groups (P<0.05).

This study showed that using the influenza test in the emergency department in young febrile infants significantly reduced the use of antibiotics, hospitalization and the implementation of invasive procedures such as lumbar puncture, and the risk of SBI was not increased.

Hemodialysis (HD) patients face long-term complications which require ongoing dialysis and follow-up. The management of hypertension among HD populations has often been neglected. This study aimed at identifying the determinants of death in hypertensive HD (HTN-HD) patients.

In a multicenter retrospective cohort study (conducted from 2005 to 2018 in thirty-four HD centers affiliated with Shiraz University of Medical Sciences), the data of 725 HTN-HD patients who had at least 3 months of regular dialysis and follow-up were analyzed. Accelerated failure time mixture split-population (AFTMSP) regression was utilized to identify the factors with significant effects on long- and short-term overall survival (OS) separately.

Among the different AFTMSP models, the extended generalized gamma (EGG) model outperformed the others. Sex (male: event time ratio [ETR]=1.30), initial vascular access type (arteriovenous fistula: ETR=1.50), and the type of membrane flux used for HD (high-flux: ETR=1.27) had important impacts on short-term OS. Moreover, age (OR=1.06), dialysis adequacy (Kt/ Vurea≤1.2: OR=2.30), initial vascular access type (central venous catheter: OR=2.08), serum sodium (OR=0.90) concentration, and potassium (OR=0.66) concentration had significant effects on long-term OS.

The split-population analyses were able to demonstrate that the predictors of long-term OS were different from those of short-term OS. Although the superiority of the parametric EGG model was proved in this study, further research with different databases is suggested. Moreover, these findings can be considered by health policy decision-makers to create a new guideline to enhance the long-term OS of HTN-HD patients.

Ki-67 is a proliferation marker that is used not only to categorize patients in luminal A and B subtypes of breast cancers, but also to determine the aggressiveness of the disease in triple negative and human epidermal growth factor 2 (HER2) over expressed molecular subtypes. The present study was designed to evaluate the role of Ki-67 with cut off value of 14% in molecular subgroups and its association with patient prognosis.

Immunostaining was performed on histopathologically confirmed sections (n = 278) to assess expression of Ki-67, estrogen receptor (ER), progesterone receptor (PR) and HER2. Immunoreactivity of molecules was recorded as percentage scoring.

Adopting a cut off value of 14%, Ki-67 was high in 88%of the cases included in the study. High Ki-67 was significantly associated with pathological parameters including histological grade, advanced stage and nodal/distant metastasis. Immunoexpression of ER, PR and HER2 also showed strong correlation with high expression of Ki-67. Based on the St. Gallen classification, the cases were categorized into luminal A (10%) and luminal B (51%), triple negative (20%) and HER2 enriched (18%). Ki-67 index was also significantly high in 98% of HER2 enriched and 95% of TNBC patients. Interestingly, Ki-67 score with cut off value of 14% proved to be significant in deciphering prognosis in luminal patients. Moreover, high expression of Ki-67 also proved to be a marker of poor prognosis, especially in triple negative patients.

We suggest that utilization of IHC4 status i.e. ER, PR, HER2 and Ki-67 along with pathological findings and molecular subtyping can considerably affect clinical as well as therapeutic decisions.

Comb homolog enhancer 1 (EPC1) gene is one of the important members of epigenetic inhibitor PCG family. It shows carcinogenic potential in a variety of malignant tumors, but the expression and role of EPC1 in nasopharyngeal carcinoma are unclear. The aim of this study was to explore the expression and function of enhancer of polycomb homolog 1 (EPC1) in nasopharyngeal carcinoma (NPC).

The differential expression of EPC1 in the cancer tissues and cell lines of NPC was examined by quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR). EPC1 expression, cell proliferation, and apoptosis were detected in NPC cell lines after EPC1 silencing, and the levels of the epithelial-mesenchymal transition (EMT)-related proteins E-cadherin and vimentin were detected in NPC cells after EPC1 silencing. The study was performed at Fujian Provincial Hospital, Fujian, China, from 2018 to 2019.

We found that EPC1 was significantly upregulated in the cancer tissues and cell lines of NPC (P<0.001). Furthermore, knockdown of EPC1 inhibited the growth and metastasis of NPC cells. E-cadherin and vimentin were detected in NPC cells after EPC1 was knocked out. It was confirmed that inhibition of EPC1 resulted in increased E-cadherin expression (P<0.001) and decreased vimentin expression (P<0.001), suggesting that inhibition of EPC1 could inhibit the EMT in NPC cells.

EPC1 expression was upregulated in NPC tissues and cell lines. Knockout of EPC1 effectively inhibited the growth of NPC cells, induced apoptosis, and inhibited invasion and metastasis. Inhibition of EPC1 could inhibit the EMT in NPC cells. All of the above findings support the viewpoint that EPC1 plays a pro-cancer role in NPC.

Breast cancer is one of the rarest types of cancer in men. Its incidence increases with age, as in women. Neurofibromatosis type 1 is an autosomal dominant genetic disease that predisposes to many cancer types. Neurofibromatosis and breast cancer have been more frequently distinguished and better studied in women. Characteristically, estrogen, progesterone receptors, negative, and overexpression of human epidermal growth factor receptor 2 (HER2) are detected in patients with female neurofibromatosis breast cancers. In cases reported so far, estrogen and progesterone receptors have been evaluated as positive and HER2 negative in male patients. With the high possibility of breast cancer development in female patients with neurofibromatosis at an earlier age, prompt and careful evaluation is required in terms of both examination and radiological imaging. Unfortunately, there are no thorough recommendations for breast cancer follow-up in male patients with neurofibromatosis. Here, we present a breast cancer, which is an uncommon type of cancer in male neurofibromatosis.