Healthcare utilization in patients with esophageal cancer in a high risk area in northeast of Iran

Introduction: Golestan, a province located north of Persian Gulf in northeastern part of Iran is a well known area for high risk of esophageal cancer (EC) in the world. There is no information about healthcare utilization in populations residing in the area. This study was conducted to assess utilization of healthcare and its associated factors among esophageal cancer patients in this region as well as to address ethical implication of this utilization. Methods: All new cases of EC in Golestan province during year of 2007 were recruited. Seven diagnostic and five therapeutic services were used to assess diagnostic utilization index (DUI), and therapeutic utilization index (TUI), respectively. Multivariate regression analysis was used to assess the relationship between variables and DUI or TUI. P-value of less than 0.05 was considered as statistically significant. Results: Tow hundred twenty three, patients were enrolled with mean (Standard Deviation) age of 64.3 (12.5) years with 57.8% male. We observed that occupation (P<0.01), ethnicity (P<0.01) and sex (P=0.03) were strongly associated with DUI. Insurance coverage (P<0.01), place of residency (P<0.01), and occupation (P=0.01) were associated with TUI. Conclusion: We concluded that several factors contribute to disparity in healthcare utilization in the studied population

Glycated hemoglobin measurements from dried blood spots: Reliability and relation to results obtained from whole blood samples

Background: Main objective was to measure glycated hemoglobin (HbA1c) in dried blood spots on paper filter and in whole blood samples in diabetic patients to evaluate relationship between two methods and their respective reliability. Methods: The 20�10 μl of venous blood samples of 33 diabetics were blotted onto the filter paper allowed to dry at room temperature and then stored at 25°C and 4°C. HbA1c was measured via the Turbidimetric Inhibition Immunoassay Technique. The relation was evaluated with correlation and linear regression tests using STATA software and SPSS. Agreement between the results obtained from the dried blood spots and others was evaluated using the Bland and Altman. The pitman's permutation test was also employed to compare the difference in variance. Results: A high positive correlation was detected between whole blood samples and dried blood spots stored at 4°C (r2 =0.90) and at 25°C (r2 = 0.95). The Bland and Altman graphs, as well as the Pitman tests, showed statistically significant differences in variability between the values obtained from whole blood samples and those derived from dried spots stored at 4°C (p=0.05) or 25°C (p=0.004). Conclusion: HbA1c measurements from dried blood spots on the filter paper yielded reliable results. That the Hitachi autoanalyzer is available in most countries renders this assay less costly than the High Performance Liquid Chromatography Method (HPLC). In addition, the filter paper method for Immuno-turbidimetric estimations of HbA1c at different temperatures is reliable and may be particularly useful in outpatient diabetes clinic

Lymphomas in Golestan province of Iran: Results of a population-based cancer registry

Introduction: Malignancies of lymphoid cells can be divided into Hodgkin and non-Hodgkin lymphomas (NHL) on the basis of pathologic features, clinical manifestations and treatment. In this paper we present data on lymphomas in Golestan province, in the northeast of Iran, during 2004-2006, using three years results of the Golestan population-based cancer registry (GPCR), a voting member of the International Association of Cancer Registries (IACR). Methods: GPCR started collecting data on all cancers from all public and private diagnostic and therapeutic centers (hospitals, specialist physicians' offices, pathology, laboratory, and imaging centers) of Golestan province in 2004. Here, we used the Iranian national census data to identify the population characteristics of this geographical area. The last census was done in 2006 and the next one will be done in 2011. The population data for years between the national census intervals are retrieved from provincial census done annually by health deputy of Golestan University of Medical Sciences (GOUMS). Results: A total of 5,076 cancer cases were diagnosed in the GPCR between 2004 and 2006. Of these, 237 (4.67 %) were lymphomas, among the ten top cancers of this area, the patients having a mean (±SD) age of 45.2 (±20.9) years. The number of cases, frequency, age specific rates, crude rates and age standardized incidence rates (ASR) (per 100,000 personyears) for lymphomas in males and females are presented. Conclusion: It could be concluded that according to available therapies for HL and NHL, the outcome of the patients could be improved in this area, due to the better diagnostic and therapeutic methods now available

Gastrointestinal malformations in Gorgan, North of Iran: Epidemiology and associated malformations

The aim of this prospective study was to evaluate the prevalence and pattern of gastrointestinal malformations (GIM) among Iranian newborns in Gorgan, North of Iran. From 1998 through 2003, 37,951 live births in Dezyani hospital in Gorgan, North of Iran, were screened for gastrointestinal malformations. Clinical and demographic factors of diagnosed cases were recorded in a pre-designed questionnaire for analysis; sex, ethnicity, type of GIM and associated anomalies. The overall prevalence rate of gastrointestinal malformations was 10 per 10,000 births. The imperforate anus (5 per 10,000) was the commonest birth defect in gastrointestinal tract. The prevalence rate of GIM was 8.2 per 10,000 in males and 10.7 per 10,000 in females. According to the parental ethnicity, the prevalence rates of GIM were 6.7, 15.8 and 17.6 per 10,000 in Fars, Turkman, and Sistani, respectively. There were eight cases (21%) with associated anomalies. The prevalence rate of GIM in North of Iran is not similar to the previous studies in Iran and Middle East and ethnic background may be a causative factor in the rate of GIM in this area. © 2006 Springer-Verlag

Goiter frequency is more strongly associated with gastric adenocarcinoma than urine iodine level

Purpose: We designed our study to evaluate the hypothesis that gastric cancer is correlated with iodine deficiency or thyroid dysfunction. Materials and Methods: We investigated the total body iodine reserve, thyroid function status and autoimmune disorder in 40 recently diagnosed gastric adenocarcinoma cases versus 80 healthy controls. The participants came from a region with high gastric cancer rate but sufficient iodine supply due to salt iodination. The investigation included urine iodine level, thyroid gland clinical and ultrasonograph-ic examination, and thyroid function tests. Results: Goiter was detected more frequently in the case group (P=0.001); such a finding, however, was not true for lower than normal urine iodine levels. The free T3 mean level was significantly lower in the case group compared to the control group (P=0.005). Conclusions: The higher prevalence of goiter rather than low levels of urinary iodine in gastric adenocarcinoma cases suggests that goi-ter, perhaps due to protracted but currently adjusted iodine deficiency, is more likely to be associated with gastric adenocarcinoma com-pared to the existing iodine deficiency itself. © 2013 by The Korean Gastric Cancer Association

Hepatitis B/C virus co-infection in Iran: A seroepidemiological study

Background/aims: As hepatitis B and C virus have the same transmission routes, dual infection may occur. The aim of this study was to determine the seroprevalence of HCV in HBsAg-positive subjects. Methods: 139 HBsAg-positive subjects were enrolled in the study. Serum samples were tested using ELISA method for anti-HCV antibodies. Chi-square and Fisher's exact tests were used to compare the proportions. Results: There were 68 (48.9%) males and 71 (51.1%) females. The mean age was 41.89±11.30 years. One case was excluded because of inadequate blood sampling. Anti-HCV antibody was positive in 17 (12.3%) of the 138 remaining subjects. Seropositivity of HCV was similar between female and male patients (p=0.69). Conclusion: The seroprevalence of co-infection with hepatitis B virus and hepatitis C virus in our study was higher than such reports from some countries (Italy), but was in line with worldwide prevalence (>10%)

Irritable bowel syndrome in Iranian young adults: A survey among medical students

A cross-sectional study on medical students at the Golestan University of Medical Sciences in Iran was conducted to determine the prevalence of IBS and to assess the symptom subgroups based on the predominant bowel habit. A vaild self report questionnaries based on ROM II criteria was administered to all the medical students. Comparison between groups was assessed using the Chi-square and Fishers Exatct analytical tests. Of 708 questionnaires, 513 complete responses were received (response rate of 87.4%). Fifty (10.6%) subjects reported symptoms consistent with the diagnosis of IBS, predominantly in women. Forty (77.4%) and three (7.1%) were of the constipation-predominant and diarrhea-predominant subgroups, respectively. Six (12.2%) subjects fell into the non-specific IBS subgroup. The mean age of the IBS group was 22.6±2 years. IBS rate was higher in married students (15.2%) than singles (9.7%). There were no significant differences regarding sex, age, marital status and place of residence in the IBS and non-IBS groups. 57.1% (n = 28) of the medical students had consulted their healthcare practitioner for their symptoms. Hospitalization and endoscopic procedures were reported in 3 (6.1%) of cases. Self-medication was reported in 55.1% (n = 27) of subjects. Based on this study, the prevalence of IBS in young Iranian population are higher than previously expected that deserves greater care and further investigation

A suggested prototype for assessing bone health

Background- Osteoporosis is becoming a health concern worldwide. Considering the fact that prevention plays an important role in reducing the burden of this silent disease and in view of the limited resources available, many countries have adopted certain programs to fight osteoporosis through shifting their attention towards at-risk individuals. The Iranian Multicenter Osteoporosis Study (IMOS) is one of these programs. The program aims to assess bone health and the prevalence of vitamin D deficiency in different parts of Iran with various altitudes, latitudes and lifestyle habits in a way that the results could be generalized to the country. Method- The present article presents the protocol used in the third phase of the study. It was designed based on the experiences gathered in the previous phases to overcome the shortcomings particularly subject loss. The questionnaire applied in this study was developed based on a thorough literature review of the risk factors and secondary causes of osteoporosis and was approved by an expert panel. It should be added that while the majority of the existing studies aim to study a certain aspect of osteoporosis, the present protocol provides the information needed for policy makers and researchers to study different osteoporosis-related issues. Conclusion- The authors believe the protocol, to be implemented with small modifications, can help policymakers in different parts of the world, particularly developing countries, gather accurate information on different aspects of bone health at the national level. © 2015, Academy of Medical Sciences of I.R. Iran. All rights reserved

HBV/HCV co-infection in Iran: A seroepidemiological based study

The aim of this study was to determine the seroprevalence of HCV in HBsAg positive subjects. In a population based single stage cluster sampling in Golestan province of Iran, 139 HBsAg positive subjects were detected and enrolled in the study. Serum samples were tested using ELISA method for anti-HCV antibodies. Chi-square and Fishers exact tests were used to compare the proportions. There were 68(48.9%) male and 71(51.1 %) female. The mean age was 41.89±11.30 years (25-64 years). One case was excluded because of inadequate blood sampling. Anti-HCV antibody was positive in 17(12.3%) of 138 remaining subjects. Seropositivity of HCV in female was higher than male (14.1% versus 10.4%, respectively) but the difference was not statistically significant (p = 0.52). No significant relationship was seen between Anti-HCV seroprevalence and demographic factors such as age, place of residence and marital status. The seroprevalence of co-infection with HBV and HCV in our study was higher than such reports from some countries (Italy); but it was in line with worldwide prevalence (>10%). A careful longitudinal evaluation of the viremia levels of both HBV/HCV viruses is essential for making a correct diagnosis and tailoring the appropriate therapeutic schedule in co-infected patients. © 2006 Asian Network for Scientific Information

Prevalence of hepatitis D virus infection in HBsAg positive subjects in Iran

Abstract This study was carried out to determine the seroprevalence of hepatitis D virus among HBsAg positive individuals in the northeast part of Iran. One hundred thirty nine HBsAg positive subjects detected from a population based single stage cluster sampling in Golestan province of Iran were enrolled. All cases were evaluated for the presence of anti-HDV antibodies using commercially available ELISA kits. Logistic regression was used to determine the relationship between independent variables and HDV seropositivity. Of 139 cases, 68(48.9%) were males and 71(51.1%) were females. The mean age was 41.89±11.30 years (25-64 years). Anti-HDV antibody was positive in 8 (5.8%) subjects with female predominance (9.9% versus 1.5%, p = 0.06; odds ratio = 7.32, 95%CI: 0.87-61.23). No significant relationship was seen between anti-HDV seropositivity and demographic factors such as age, place of residence and marital status. These findings showed that HDV infection was endemic in Golestan province (northeast) of Iran. Seroprevalence of Anti-HDV in the present study was higher than some previous studies from other parts of Iran. Our results suggest that the prevalence of HBV/HDV co-infection in Iran has increased during the last decade. Therefore, practitioners and all health care managers should be made aware of the risk of dual infection with HBV and HDV. © 2007 Asian Network for Scientific Information