The Potential Ameliorating Role of Spironolactone in Trastuzumab Mediated Cardiotoxicity: A Narrative Review

Background: Around 20% of breast cancers (BC) overexpress human epidermal growth factor receptor 2 (HER-2). HER-2 upregulation has been linked to increased tumor aggressiveness and poor prognosis. Trastuzumab, an anti-HER2 monoclonal antibody, has improved overall survival in early-stage and metastatic BC but at the expense of developing cardiac morbidity. In the current review, we aimed to discuss the pathogenesis of trastuzumab-induced cardiac toxicity and the potential preventive properties of spironolactone in this regard. Methods: We thoroughly searched PubMed, Embase, Scopus, and Web of Science according to the following search terms: trastuzumab, cardiotoxicity, heart failure, Spironolactone. Results: Trastuzumab deteriorates mitochondrial function and subsequently leads to the accumulation of reactive oxygen species (ROS) in cardiomyocytes. Published clinical studies have offered conflicting results regarding the efficacy of angiotensin-converting enzyme inhibitors (ACEI) and beta-blockers (BB) in respect of trastuzumab-induced cardiotoxicity. On the other hand, spironolactone has been found to exert both antioxidant and anti-inflammatory properties. Recent in vivo studies have supported the cardioprotective effect of spironolactone through maintaining mitochondrial ultrastructure and reducing ROS production. Conclusions: Although spironolactone mitigates oxidative stress and mitochondrial dysfunction, there is a lack of clinical evidence to support the effectiveness of spironolactone in trastuzumab-induced cardiotoxicity. Design and implementation of clinical trials are of the essence to determine the potential beneficial impacts of spironolactone upon trastuzumab-induced cardiotoxicity

Proinflammatory cytokines and thrombomodulin in patients with peptic ulcer disease and gastric cancer, infected with Helicobacter pylori

Backgrounds: Helicobacter pylori infect more than half of the global population. It is suggested to be related with gastritis, peptic ulcer disease (PUD), and gastric cancer. Aims: The aim of this present study was to evaluate proinflammatory cytokines including interleukin 1, 6, 8, 10, and thrombomodulin in H. pylori-infected patients with PUD and gastric cancer. Patients: This cross-sectional study was conducted in Taleghani Hospital on 111 patients with H. pylori infection. Materials and Methods: Patients were divided into three groups of PUD, cancer, and control (normal on endoscopy), according to the results of endoscopy. The serum levels of interleukins 1, 6, 8, and 10 and thrombomodulin was determined using enzyme-linked immunosorbent assay (ELISA) technique. H. pylori infection was diagnosed by histological examination of the endoscopic biopsy. Results: One hundred eleven patients were included in the study; 30 as PUD group, 30 as gastric cancer group, and 51 as controls. There was no significant difference between the means of IL-1 and IL-10 levels among the three groups (P = 0.744 and 0.383, respectively). IL-6, IL-8, and thrombomodulin levels were found to be statically different among the three groups (P < 0.05). The level of IL-6, IL-8, and thrombomodulin in cancer group was significantly higher than PUD and control groups (P < 0.05). Conclusion: There is a significant association between H. pylori infection and serum IL-6, IL-8, and thrombomodulin but such relation is not present between H. pylori and IL-1 and IL-10. Immunity response (IL-6, IL-8 and thrombomodulin) is more severe in cancer patient than PUD

Third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia

<p>Abstract</p> <p>Background</p> <p>The burden of non-communicable diseases is rising globally. This trend seems to be faster in developing countries of the Middle East. In this study, we presented the latest prevalence rates of a number of important non-communicable diseases and their risk factors in the Iranian population.</p> <p>Methods</p> <p>The results of this study are extracted from the third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007), conducted in 2007. A total of 5,287 Iranian citizens, aged 15–64 years, were included in this survey. Interviewer-administered questionnaires were applied to collect the data of participants including the demographics, diet, physical activity, smoking, history of hypertension, and history of diabetes. Anthropometric characteristics were measured and serum biochemistry profiles were determined on venous blood samples. Diabetes (fasting plasma glucose ≥ 126 mg/dl), hypertension (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or use of anti-hypertensive drugs), dyslipidemia (hypertriglyceridemia: triglycerides ≥ 150 mg/dl, hypercholesterolemia: total cholesterol ≥ 200 mg/dl), obesity (body mass index ≥ 30 kg/m²), and central obesity (waist circumference ≥ 80 cm in females and ≥ 94 cm in males) were identified and the national prevalence rates were estimated.</p> <p>Results</p> <p>The prevalence of diabetes, hypertension, obesity, and central obesity was 8.7% (95%CI = 7.4–10.2%), 26.6% (95%CI = 24.4–28.9%), 22.3% (95%CI = 20.2–24.5%), and 53.6% (95%CI = 50.4–56.8%), respectively. The prevalence of hypertriglyceridemia and hypercholesterolemia was 36.4% (95%CI = 34.1–38.9%) and 42.9% (95%CI = 40.4–45.4%), respectively. All of the mentioned prevalence rates were higher among females (except hypertriglyceridemia) and urban residents.</p> <p>Conclusion</p> <p>We documented a strikingly high prevalence of a number of chronic non-communicable diseases and their risk factors among Iranian adults. Urgent preventive interventions should be implemented to combat the growing public health problems in Iran.</p

Changes in Liver Enzymes in the Patients Undergoing Open Cardiac Surgery and Related Factors

One of the most important gastrointestinal complications following cardiac surgery is hepatic dysfunction. This prospective study was evaluated the incidence and significance of liver dysfunction after open cardiac surgery. This study was conducted on 150 patients who were candidates for heart surgery. Liver tests including bilirubin (total and direct), alkaline phosphatase, AST, ALT were measured before the operation and on the first, third, and seventh postoperative days. Out of 150 patients, 80 were men (53.3) and 70 were women (46.7) with mean age of 62 +/- 12.5. Level of AST, ALT and bilirubin total has increased significantly after surgery (P<0.05). There were significant relationship between AST, ALT and alkaline phosphatase on first day after surgery and hypothermia less than 32 degrees C (P<0.05), blood transfusion more than 6 units (P<0.05), intraoperative hypotension (P <0.001), duration of the pump over 100 minutes (P < 0.001) and smoking (P<0.05). There was significant difference between two groups in length of ICU stay (7.14 +/- 9.17 days in patients with liver enzyme changes VS. 4.11 +/- 2.17 days in patients without liver enzyme changes, p-value<0. 05). Patients with changes in liver enzyme had a longer hospital stay (25.2 +/- 6.48 in patients with liver enzyme changes VS. 9.23 +/- 5.3 in patients without liver enzyme changes, p-value<0. 05). Four deaths occurred among patients with changes in liver enzyme level but there was no death in patients without changes in liver enzyme levels that this difference in mortality rate was statistically significant (<0.005). The results of this study showed that there is a significant relationship between and changes in liver enzymes and hypotension during the, hypothermia, the pump duration, blood transfusion, and the type of the pump

Non-Communicable Diseases Risk Factors Surveillance in Iran

&quot;nBackground: Non-communicable diseases cause more than 60% of disease burden and 70% death by 2020. NCD risk fac&amp;shy;tors surveillance system is a global strategy to combat with this problem in the world. It has been established since 2004 in Iran.&quot;nMethods: The first national surveillance risk factors of Non-communicable disease (SURFNCD) run as a cross sectional study on 89000 populations by applying who stepwise approach in January and February 2005.&quot;nResult: The prevalence of common risk factors were 14.2 current smokers, 32.5% did exercise at least 10 minutes in their free time in ages 15-64 yr, 7.7 diabetics and 25.2 hypertensive in ages 25-64 yr. Obesity, overweight and hypercholes&amp;shy;terolemia were 14.8, 28.6 and 15.1, respectively in ages 15-64 yr.&quot;nConclusion: Implementation of this system is one of the main concerns of Iranian prototype surveillance system and interna&amp;shy;tional concerned bodies such as World Health Organization. Multi-pronged policy and programmatic interventions promot&amp;shy;ing for maximum effectiveness are needed to conduct

Hypertension Prevention and Control Program

&quot;nTo control hypertension in Iran, one of the most preventable diseases, a program was established in rural areas of the coun&amp;shy;try, employing the main strategy of people screening aged 30 years old and above, confirmation of suspected cases, offering ca&amp;shy;res and follows up. This program is integrated in the primary health care system at rural areas. An evaluation system embed&amp;shy;ded in the program, helps collecting data on main variable defined, including new cases and care taken. According to the results, the defects of the program are mainly categorized as education and referral system accessibility

Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007)

Abstract Aim We have recently determined the optimal cut-off of the homeostatic model assessment of insulin resistance for the diagnosis of insulin resistance (IR) and metabolic syndrome (MetS) in non-diabetic residents of Tehran, the capital of Iran. The aim of the present study is to establish the optimal cut-off at the national level in the Iranian population with and without diabetes. Methods Data of the third National Surveillance of Risk Factors of Non-Communicable Diseases, available for 3,071 adult Iranian individuals aging 25-64 years were analyzed. MetS was defined according to the Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) criteria. HOMA-IR cut-offs from the 50th to the 95th percentile were calculated and sensitivity, specificity, and positive likelihood ratio for MetS diagnosis were determined. The receiver operating characteristic (ROC) curves of HOMA-IR for MetS diagnosis were depicted, and the optimal cut-offs were determined by two different methods: Youden index, and the shortest distance from the top left corner of the curve. Results The area under the curve (AUC) (95%CI) was 0.650 (0.631-0.670) for IDF-defined MetS and 0.683 (0.664-0.703) with the ATPIII definition. The optimal HOMA-IR cut-off for the diagnosis of IDF- and ATPIII-defined MetS in non-diabetic individuals was 1.775 (sensitivity: 57.3%, specificity: 65.3%, with ATPIII; sensitivity: 55.9%, specificity: 64.7%, with IDF). The optimal cut-offs in diabetic individuals were 3.875 (sensitivity: 49.7%, specificity: 69.6%) and 4.325 (sensitivity: 45.4%, specificity: 69.0%) for ATPIII- and IDF-defined MetS, respectively. Conclusion We determined the optimal HOMA-IR cut-off points for the diagnosis of MetS in the Iranian population with and without diabetes.</p

Eight Years Experience of Transanal Endoscopic Microsurgery

Background Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications