Normal limit for serum alanine aminotransferase level and distribution of metabolic factors in old population of Kalaleh, Iran

Backgrounds: Normal or elevated values of serum alanine aminotransferase level (ALT) vary in different studies mostly related to characteristics of reference population including age, gender, body mass index, nonalcoholic fatty liver disease (NAFLD), and metabolic syndrome prevalence. Objectives: To measure upper normal limit (UNL) for serum ALT in an apparently healthy Iranian old population (which we had not sufficient data before this study), and its modulating factors. Patients and Methods: All inhabitants (> 50 years old) of Kalaleh, Golestan, Iran (N = 1986) were invited to the study. ALT measurements were performed for all subjects using the same laboratory method. Upper limit of normal (ULN) ALT was calculated based on its 95th percentile in normal weight subjects. Modulating factors of ALT were determined by multivariate analysis. Results: A total of 1309 subjects, with the mean age of 61.5 ± 7.5 years were included. UNL of ALT was 18.8 U/L and 21.4 U/L in women and men, respectively. Based on univariate analysis, waist circumference (r = 0.124, P = 0.01), body mass index (r = 0.118, P = 0.01), triglyceride (r = 0.143, P = 0.01), and having metabolic syndrome (OR = 2.04) modulate ALT levels in men. Also triglyceride (r = 0.119, P = 0.01) modulates ALT levels in women. Conclusions: The calculated level for UNL of ALT is considerably far lower than previous accepted value. Age, gender, ethnicity, and metabolic factors should be accounted in future studies to determine normal ALT level. © 2013, Kowsar Corp.; Published by Kowsar Corp

Prevalence of chronic kidney disease and its associated risk factors: The first report from Iran using both microalbuminuria and urine sediment

Background: The incidence of major risk factors of chronic kidney disease (CKD) in the world is on the rise, and it is expected that this incidence and prevalence, particularly in developing countries, will continue to increase. Using data on urinary sediment and microalbuminuria, we aimed to estimate the prevalence of CKD in northeast Iran. Methods: In a cross-sectional study, the prevalence of CKD in a sample of 1557 regionally representative people, aged � 18 years, was analyzed. CKD was determined based on glomerular filtration rate (GFR) and microalbuminuria. Life style data, urine and blood samples were collected. Urine samples without any proteinuria in the initial dipstick test were checked for qualitative microalbuminuria. If the latter was positive, quantitative microalbuminuria was evaluated. Results: 1557 subjects with a mean age of 56.76 ± 12.04 years were enrolled in this study. Based on the modifcation of diet in renal disease (MDRD) equation, 137 subjects (8.89%) were categorized as CKD stages III-V. Based on urine abnormalities, the prevalence of combined CKD stages I and II was 10.63%, and based on macro- and microalbuminuria it was 14.53%. The prevalence of CKD was significantly associated with sex, age, marital status, education, diabetes mellitus (DM), hypertension (HTN), ischemic heart disease (IHD), waist to hip ratio, myocardial infarction (MI), and cerebrovascular accident (CVA). Conclusion: CKD and its main risk factors are common and represent a definite health threat in this region of Iran. Using and standardizing less expensive screening tests in low resource countries could be a good alternative that may improve the outcome through early detection of CKD

Laboratory evaluation of electrokinetic dewatering of dredged marine sediment as an option for climate change adaption

The climate change affects the coastal infrastructure including ports. This effect is through changes in the tides, waves, wind and coastal erosion. As a result, sedimentation in harbours and coastal area increases and therefore there is a need for more regular dredging as well as adaption to climate change to reduce the vulnerability. More frequent dredging means higher amount of dredging sediments need to be disposed or treated. One of the methods to be proposed to reduce the impact of high amount of dredging and reducing the environmental wastes as a by-product of dredging is to reuse or reproduce the dredged sediments. Electrokinetic stabilization is one of the environmentally friendly methods to dewater and strengthen the engineering properties of the soils and dredged sediments. This study investigates the effect of electrokinetic stabilization to improve the engineering properties of the dredged mud as an alternative option to reduce the environmental impact and use of a sustainable method for climate change adaption. Two laboratory designs are tested to determine the most efficient electrokinetic dewatering configuration and to examine the potential use of this method for dewatering and improving dredged mud. Electrokinetic stabilization is a promising method to dewater and expedite the settlement of the dredged marine sediments. However, the placement of electrodes can affect the power consumption and the efficiency of the technique and the resistivity of the soil. Some studies in the literature determine the best electrode configuration to optimize the electrokinetic stabilization. However, a few studies examined the electrode placement for electrokinetic dewatering and sedimentation. This study investigates the effect of electrode placement based on the efficiency of the method depending on power consumption versus dewatering, soil electrical resistivity, the settlement of the sediments, and treatment time. To reduce the energy expenditure first a constant voltage of 20 V is applied and the variation of electric current during the electrokinetic stabilization is monitored. Once the electric current approached zero, the voltage is increased to 30 V. Using constant voltage for both cases of electrode placement (anode on top, cathode at the bottom; anode at the bottom, cathode on top), it was observed that higher efficiency based on dewatering and power consumption is obtained when the cathode is placed on top

A case-control study of the relationship between gastric cancer and meat consumption in Iran

Background: Despite the descending trends of gastric cancer in many parts of the world, its mortality rate has still remained high globally. Meat, red and processed meat in particular, may induce gastric carcinogenesis through potential mechanisms. However, the role of this dietary aspect in the risk of gastric cancer has not well been investigated so far. Therefore, we designed a study to assess the relation between meat consumption and the risk of gastric cancer in Golestan Province, a high- risk area for gastric malignancies in Iran. Methods: Subjects of this population-based case-control study included 190 histologically confirmed case so fgastric cancer and 647 controls. Meat consumption was evaluated using a 116-item semi-quantitative food frequency questionnaire. A lifestyle questionnaire also collected data concerning demographic features, anthropometric measures, and other known risk factors of gastric cancer. We estimated crude and adjust edoddsratios(ORs) and 95 confidence intervals (CIs) for the relation between meat intake and gastric cancer. Results: After being adjusted for potential confounders, red meat intake was positively associated with gastric cancer which reached statistical significance (OR=1.87, 95 CI: 1.01-3.47, Ptrend = 0.07). On the other hand, individuals in the highest quartile of white meat consumption had astatistically significant reduced risk of gastric cancer compared to those in the lowest quartile (OR = 0.36, 95 CI: 0.19-0.68, Ptrend = 0.005). Conclusions: We observed a positive association between red meat consumption and the risk of gastric cancer, and a reverse relationship regarding white meat intake and the risk of this malignancy

Marked increase in the incidence rate of esophageal adenocarcinoma in a high-risk area for esophageal cancer

BACKGROUND: Esophageal cancer (EC) is the eighth common cancer worldwide. Esophageal squamous cell carcinoma (ESCC) and adenocarcinoma (EAD) are the most common histologic types of EC. Many recent reports showed an increasing trend in EAD and a decreasing trend in ESCC in many Western countries. Golestan Province in northeastern Iran has been known as a high-risk area for EC. The aim of this study was to describe the time trend of EAD in this area between 2000-2009. METHODS: Data on cancer cases were obtained from Golestan Population-based Cancer Registry. Analysis was done using Joinpoint software. To examine the incidence trends, the annual percent change was calculated. The possibilities of anatomic and histologic misclassification were considered by assessing the trend of ESCC and gastric adenocarcinoma. RESULTS: A total number of 1186 histologically-confirmed EC cases were recruited. The incidence rate of EAD showed a significant increasing trend. There was no significant trend in the incidence of ESCC during the study period. A significant increase in the incidence rate of gastric adenocarcinoma was observed during the period of 2000-2005, followed by a plateau during the period of 2005-2009. CONCLUSIONS: We found a significant increasing trend in the incidence rate of EAD. We find no evidence to support an alternative explanation including anatomic and histologic misclassification. So, the observed rise in the incidence of EAD seems to be real. Therefore, designing and implementation of control programs, including control of preventable risk factors of EAD, should be considered in this high- risk area

Cancer incidence in Golestan province: Report of an ongoing population-based cancer registry in Iran between 2004 and 2008

Background: Golestan Province, at the western end of the Asian esophageal cancer (EC) belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry (GPCR). Methods: The GPCR collected data from newly diagnosed (incident) cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer (IARC). Age-standardized incidence rates (ASR) of cancers were calculated using the 2000 world standard population. Results: From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean (SD) age was 55.5 (18.6) years, and 54 were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach (ASR:30.7), esophagus (24.3), and lung (15.4) were the most common cancers in males. In females, breast cancer (ASR:26.9) was followed by malignancies of the esophagus (19.1) and stomach (12.4). The diagnosis of cancer was based on histopatho- logical reports in 71 and on death certificate only in 9 ofcases. Conclusions: The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase

Declining incidence of esophageal cancer in the Turkmen Plain, eastern part of the Caspian Littoral of Iran: A retrospective cancer surveillance

Background: Previous studies have shown that upper gastrointestinal cancers are the most common cancers in Caspian Littoral, and rate of esophageal cancer (EC) in Iranian Turkmens residing in the Eastern part of littoral are among the highest in the world. Our aim was to reassess the rate 30 years later and following socioeconomic changes in the region. Methods: A comprehensive retrospective search was undertaken to find all new cancer cases during the 1996-2000 period. Diagnosis of cancer was based on histopathological reports in 68.2, clinical and/or radiological evidence in 29.7 and death certificate only (DCO) in 2.1 of the cases. Results: A total of 5143 new cancer cases were registered of whom 3063 (59.6) were males. The median (IQR) age was 60 (44-69) years. Age-standardized rates (ASR) for all cancers in males and females were 134.7 and 104.5 per 100,000, respectively. Based on ASR, the top five common cancers in males (excluding skin cancer) were cancers of esophagus (43.4), stomach (27.8), colorectal (10.7), bladder (7.8) and oral cavity (6.3), while in females cancer of esophagus (36.3) was followed by cancers of breast (15.7), stomach (8.3) colorectal (6.6) and cervix (3.6). Conclusion: We conclude that EC incidence rate has decreased to less than half the rate reported 30 years ago, while the incidence rates of colorectal and breast cancers have increased significantly. © 2006 International Society for Preventive Oncology. Published by Elsevier Ltd. All rights reserved

Simulation‐based otorhinolaryngology emergencies boot camp: Part 1: Curriculum design and airway skills

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107579/1/lary24572.pd

Simulation‐based otorhinolaryngology emergencies boot camp: Part 2: Special skills using task trainers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107500/1/lary24571.pd

Serum hyaluronate as a non-invasive marker of hepatic fibrosis and inflammation in HBeAg-negative chronic hepatitis B

Background: HBV infection is a serious global heath problem. It is crucial to monitor this disease more closely with a non-invasive marker in clinical trials. We aimed to evaluate the predictive value of serum hyaluronate for the presence of extensive liver fibrosis and inflammation. Methods: 28 healthy volunteers and 65 patients with HBeAg negative chronic hepatitis B were enrolled. Liver biopsies scored according to Ishak system. Association of serum hyaloronate with liver fibrosis and inflammation were assessed, and cut off points for serum hyaluronate levels were identified by receiver operating characteristics (ROC) curves and their values for prediction of fibrosis and inflammation were assessed. Results: In patients with CHB serum hyaluronate had the most significant correlation and predictive values for the liver fibrosis and inflammation comparing to the other variables. At the cut off point of 126.4 ngm/ml it could discriminate extensive fibrosis from milder ones with sensitivity of 90.9% and specificity of 98.1%. With the same value it could discriminate extensive inflammation from their milder counterparts with sensitivity of 63.6% and specificity of 92.6%. Conclusion: Serum hyaluronate was the best predictor of extensive liver fibrosis and inflammation and it could discriminate subgroups of patients with chronic hepatitis B. It could be used as a non-invasive test to monitor these patients more closely with developing anti viral agents in clinical trials