Mutation analysis of KRAS and BRAF genes in metastatic colorectal cancer: A first large scale study from Iran

Background: The investigation of mutation patterns in oncogenes potentially can make available a reliable mechanism for management and treatment decisions for patients with colorectal cancer (CRC). This study concerns the rate of KRAS and BRAF genes mutations in Iranian metastatic colorectal cancer (mCRC) patients, as well as associations of genotypes with clinicopathological features. Materials and Methods: A total of 1,000 mCRC specimens collected from 2008 to 2012 that referred to the Mehr Hospital and Partolab center, Tehran, Iran enrolled in this cross sectional study. Using HRM, Dxs Therascreen and Pyrosequencing methods, we analyzed the mutational status of KRAS and BRAF genes in these. Results: KRAS mutations were present in 33.6 cases (n=336). Of KRAS mutation positive cases, 85.1 were in codon 12 and 14.9 were in codon 13. The most frequent mutation at KRAS codon 12 was Gly12Asp; BRAF mutations were not found in any mCRC patients (n=242). In addition, we observed a strong correlation of KRAS mutations with some clinicopathological characteristics. Conclusions: KRAS mutations are frequent in mCRCs while presence of BRAF mutations in these patients is rare. Moreover, associations of KRAS genotypes with non-mucinous adenocarcinoma and depth of invasion (pT3) were remarkable

REFERQUAL: A pilot study of a new service quality assessment instrument in the GP Exercise Referral scheme setting

Background The development of an instrument accurately assessing service quality in the GP Exercise Referral Scheme (ERS) industry could potentially inform scheme organisers of the factors that affect adherence rates leading to the implementation of strategic interventions aimed at reducing client drop-out. Methods A modified version of the SERVQUAL instrument was designed for use in the ERS setting and subsequently piloted amongst 27 ERS clients. Results Test re-test correlations were calculated via Pearson's 'r' or Spearman's 'rho', depending on whether the variables were Normally Distributed, to show a significant (mean r = 0.957, SD = 0.02, p < 0.05; mean rho = 0.934, SD = 0.03, p < 0.05) relationship between all items within the questionnaire. In addition, satisfactory internal consistency was demonstrated via Cronbach's 'α'. Furthermore, clients responded favourably towards the usability, wording and applicability of the instrument's items. Conclusion REFERQUAL is considered to represent promise as a suitable tool for future evaluation of service quality within the ERS community. Future research should further assess the validity and reliability of this instrument through the use of a confirmatory factor analysis to scrutinise the proposed dimensional structure

Fatty liver index vs waist circumference for predicting non-alcoholic fatty liver disease

AIM: To determine the discriminatory performance of fatty liver index (FLI) for non-alcoholic fatty liver disease (NAFLD). METHODS: The data of 5052 subjects aged over 18 years were analyzed. FLI was calculated from body mass index, waist circumference (WC), triglyceride, and gamma glutamyl transferase data. Logistic regression analysis was conducted to determine the association between FLI and NAFLD. The discriminatory performance of FLI in the diagnosis of NAFLD was evaluated by receiver operating characteristic analysis. Area under the curves (AUCs) and related confidence intervals were estimated. Optimal cutoff points of FLI in the diagnosis of NAFLD were determined based on the maximum values of Youden's index. RESULTS: The mean age of men and women in the study population were 44.8 ± 16.8 and 43.78 ± 15.43, respectively (P = 0.0216). The prevalence of NAFLD was 40.1 in men and 44.2 in women (P < 0.0017). FLI was strongly associated with NAFLD, so that even a one unit increase in FLI increased the chance of developing NAFLD by 5.8 (OR = 1.058, 95CI: 1.054-1.063, P < 0.0001). Although FLI showed good performance in the diagnosis of NAFLD (AUC = 0.8656 (95CI: 0.8548-0.8764), there was no significant difference with regards to WC (AUC = 0.8533, 95CI: 0.8419-0.8646). The performance of FLI was not significantly different between men (AUC = 0.8648, 95CI: 0.8505-0.8791) and women (AUC = 0.8682, 95CI: 0.8513-0.8851). The highest performance with regards to age was related to the 18-39 age group (AUC = 0.8930, 95CI: 0.8766-0.9093). The optimal cutoff points of FLI were 46.9 in men (sensitivity = 0.8242, specificity = 0.7687, Youden's index = 0.5929) and 53.8 in women (sensitivity = 0.8233, specificity = 0.7655, Youden's index = 0.5888). CONCLUSION: Although FLI had acceptable discriminatory power in the diagnosis of NAFLD, WC was a simpler and more accessible index with a similar performance. © 2016 Baishideng Publishing Group Inc. All rights reserved

Prevalence and risk factors of hepatitis C virus infection in Amol city, north of Iran: A population-Based study (2008-2011)

Background: Hepatitis C Virus (HCV) infection is one of the most important causes of chronic liver disease and related problems in the world.There are few population-based studies on the prevalence and risk factors of hepatitis C infection in Iran, which could not provide enough information. Moreover, the prevalence and risk factors of hepatitis C infection are not similar in all parts of Iran. Objectives: The aim of this survey was to determine the prevalence and risk factors of HCV infection in the general population of the city of Amol, north of Iran. Patients and Methods: This was a population-based study. Using a cluster sampling approach, 6145 individuals of both genders and different ages were involved from general population of urban and rural areas of Amol, The inclusion criteria were Iranian nationality, willing to participate in the study, and lifelong residence in Amol city and surrounding areas. Anti-hepatitis C antibody was measured by a third generation of ELISA. The positive results were confirmed by Recombinant Immuno Blot Assay (RIBA) and quantitative HCV-RNA polymerase chain reaction (PCR) tests. Potential risk factors of HCV transmission were recorded. Results: The mean age of participants was 42.70 ± 17.10 years. Of these participants, 57.2 (n = 3483) were male. Anti-HCV antibody was positive in 12 individuals from which five were RIBA positive. Three of these subjects were PCR positive. The prevalence of HCV was more predominant among males than females. The common risk factors among the study subjects included history of minor or major surgery (34.7), unsterile punctures (21.2), history of traditional phlebotomy (5.8), and history of hepatitis among close relatives (5.7). In univariate regression analysis, unsterile punctures and history of infection in family members were associated with HCV infection. Conclusions: We confirm that in Amol city and surrounding areas, the prevalence of true HCV infection is 0.05, which is lower than that previously reported from Iran. © 2013, Kowsar Corp.; Published by Kowsar Corp

Redrawing the Map of Great Britain from a Network of Human Interactions

Do regional boundaries defined by governments respect the more natural ways that people interact across space? This paper proposes a novel, fine-grained approach to regional delineation, based on analyzing networks of billions of individual human transactions. Given a geographical area and some measure of the strength of links between its inhabitants, we show how to partition the area into smaller, non-overlapping regions while minimizing the disruption to each person's links. We tested our method on the largest non-Internet human network, inferred from a large telecommunications database in Great Britain. Our partitioning algorithm yields geographically cohesive regions that correspond remarkably well with administrative regions, while unveiling unexpected spatial structures that had previously only been hypothesized in the literature. We also quantify the effects of partitioning, showing for instance that the effects of a possible secession of Wales from Great Britain would be twice as disruptive for the human network than that of Scotland.National Science Foundation (U.S.)AT & TAudi AGUnited States. Dept. of Defense (National Defense Science and Engineering Fellowship Program

Lipid accumulation product and metabolic syndrome: A population-based study in northern Iran, Amol

Purpose: Lipid accumulation product (LAP) demonstrated a strong predictive accuracy for metabolic syndrome (MetS) in previous studies. This study was conducted to determine the predictive performance of LAP compared to obesity indexes. Moreover, the optimal cutoff point of LAP based on the study population waist circumference threshold was estimated in both men and women. Methods: 5797 subjects with an average age of 44.77 ± 16.77 years for men and 43.78 ± 15.43 years for women were included in the present study. The ROC analysis was performed to assess the predictive accuracy of LAP in the diagnosis of MetS. The optimal cutoff point of LAP was determined according to maximal Youden index in both men and women. Results: The optimal cutoff points determined for LAP were 49.71 (sensitivity = 85.2 , specificity = 82.3 ) for women and 39.89 (sensitivity = 86 , specificity = 79.6 ) for men. Based on the assigned cutoff points, the prevalence of high LAP was obtained 44.1 in men and 45.1 in women. LAP also showed a significantly higher predictive performance for MetS compared to obesity measures and also TG. Conclusion: LAP has a strong and reliable diagnostic accuracy for MetS in Iranian population in the north of Iran. LAP showed a better predictability than other obesity indexes assessed in the present study. © 2015 Italian Society of Endocrinology (SIE)

Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars: Multi-center experience in Iran

Aim: The current study aimed to investigate the risk factors, endoscopic findings, and treatments of upper gastrointestinal bezoars. Background: Bezoars are compact masses formed by the accumulation of dietary fiber, undigested food, hair, or medications. The majority of bezoars are asymptomatic, but they may cause serious symptoms or even life-threatening events such as bleeding, obstruction, or perforation Methods: This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019. Bezoars were detected in 109 of 15,830 endoscopy records (0.68). Results A total of 103 patients (52.4 male) were enrolled in this study. Mean patient age was 60.5±11.3 years. The most frequent risk factors were history of gastric surgery (25.2), diabetes mellitus (21.3), hypothyroidism (15.5), trichophagia (5.8), and anxiety disorders (2.9), respectively. The most common endoscopic findings were peptic ulcers (34.9), erosive gastritis/duodenitis (12.6), and reflux esophagitis (10.6). While bezoars were most commonly observed in the stomach (84.4), the majority of them were phytobezoars (92.2). The mean number of endoscopic interventions for each patient was 1.5 (range, 1-4). Endoscopy was successful in removing bezoars in 85.4. Conclusion: The synergistic effect of multiple factors for a long time, such as gastrointestinal surgery, diabetes mellitus or psychiatric disorders, may lead to bezoar formation. These risk factors should be avoided or treated in order to prevent bezoar formation and subsequent life-threatening complications. © 2021 RIGLD, Research Institute for Gastroenterology and Liver Diseases

Obesity measures and elevated levels of alanine aminotransferase: A population based study

Background: Obesity may lead to various morbidity including liver diseases. The present study was done to determine which obesity indices, including body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), and waist to height ratio (WHtR) have the stronger association with rising levels of alanine aminotransferase (ALT). Materials and Methods: Of 6143 subjects aged � 10 years of a cohort study in northern Iran, the data of 5052 subjects were analyzed. We performed multivariate logistic regression analyses for data of men and women, separately. In multivariate analyses the obesity measures were separately included in model in addition to other potential confounders. A high value of ALT was considered as outcome. The capability of obesity indices to discriminate an elevated level of ALT was evaluated using receiver operating characteristic (ROC). Results: Based on our results, men and women with obesity showed significantly higher values of liver enzymes for all obesity indices. In multivariate analysis, while WHtR showed the strongest association with a high value of ALT in men Wald=91.44; OR=3.348, 95%CI (2.613-4.289); P<0.001, WC showed the strongest association in women Wald=26.76; OR=1.724, 95%CI (1.402-2.119). Conclusion: WHtR in men and WC in women have more independent association with elevated levels of ALT

Prevalence of colorectal adenoma in an average-risk population aged 40-50 versus 50-60 years

According to current guidelines, screening colonoscopy begins at 50 years for the average-risk population, although there are not enough data on the incidence of precancerous lesions of individuals in the preceding decades. To evaluate the prevalence of colorectal polyps including potentially premalignant lesions in asymptomatic, average-risk individuals aged 40-49 versus 50-59 years, we offered total colonoscopy screening to individuals without any lower gastrointestinal symptoms. The primary end point was the prevalence of colorectal adenoma in two age groups. Of a total of 737 studies, 333 participants were 40-49 years old and 407 participants were 50-59 years old. The overall prevalence of adenomas was 11.2 and 16.4 in the group of 40-49 and 50-59 year olds, respectively. Advanced adenoma was more common in 50-59 year olds (1.2 vs. 2.9). Malignancy was not reported in these groups. Furthermore, 77.5 and 68.6 of adenomas were observed in the distal colon in the groups of 40-49 year olds and 50-59 year olds, whereas in the proximal colon, 22.2 and 57.1 of adenomas in the groups of 40-49 year olds and 50-59 year olds, respectively, were advanced adenomas. In our study, male sex showed an association with adenoma. However, importantly, there was no significant association between age and colorectal adenoma. Although the prevalence of colorectal adenoma was similar in the two age groups investigated, the rate of advanced adenoma was higher in the group of individuals who were 50-59 years old, suggesting that colorectal cancer screening could be recommended at an age younger than 50 years. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved