Clinicopathological Characteristics of Gastric Cancer in Iranian Patients Referred to Imam Reza Hospital During 2008 to 2017

Background and Aim: There are a limited number of studies regarding the clinicopathological features of gastric cancer. Here, the clinicopathological features of gastric cancer including tumor type and size, degree of differentiation, tumor operability, and immunohistochemically results of E-cadherin and P53 expression was investigated in Iranian patients. Methods: This retrospective study was performed on patients who were admitted at Imam Reza Hospital in Tehran-Iran from 2008 to 2017 with a diagnosis of gastric cancer. Required information including age, sex, type of cancer, pathology, and immunohistochemistry (IHC) results and treatment were extracted from the hospital archive. Results: Out of 264 enrolled patients (with the mean age of 70.03±14.01 years), 180 cases were men. The frequency of intestinal-type, Diffuse-type, lymphoma and GIST tumor were 54.5%, 27.7%, 12.25% and 5.92% respectively. In addition, 67.58% and 13.83% of the tumors were undifferentiated and poorly differentiated respectively. Surgery was less probable in less differentiated tumors (r=0.582 P=0.001). The surgery rate in GIST, intestinal-type, and Diffuse-type tumors were 100%, 57%, and 14.4%, respectively. IHC results showed that E-cadherin expression was present in 78.6, of which 50.9% were weakly positive (+1). Also, the high expression of P53 was observed in 60.7% of patients. Conclusion: According to the data, we can conclude that poorly differentiated tumors, decreased expression of E-cadherin, and increased expression of P53 is linked to poor prognosis in Iranian patients with gastric cancer. In this regard, further clinical trials and multicenter studies should be done to evaluate the possible factors for improving the prognosis and survival rates of Iranian patients with gastric cancer. *Corresponding Author: Shahrokh Iravani; Email: [email protected] Please cite this article as: Sattartabar B, Nourian M, Samizadeh E, Mehrvar N, Jalaeikhoo H, Mehrvar A, Iravani S. Clinicopathological Characteristics of Gastric Cancer in Iranian Patients Referred to Imam Reza Hospital During 2008 to 2017. Arch Med Lab Sci. 2020;6:1-6 (e18). https://doi.org/10.22037/amls.v6.3330

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Successful Treatment with Intravenous and Intravascular Cidofovir for BK Virus-Associated Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report

BK virus rarely causes disease but is typically associated with patients who have had a transplant. The cornerstone of therapy is reduction in immunosuppression. A recent surge in BKVAN correlates with use of potent immunosuppressant drugs, such as tacrolimus and mycophenolate mofetil. Studies have not shown any correlation between BKVAN and a single immunosuppressive agent but rather the overall immunosuppressive load. A 12-year-old male with recurrent acute myeloblastic leukemia (M4) was undergoing chemotherapy regimen at MAHAK Pediatric Cancer Treatment and Research Center. Following 28 days of allogenic transplantation with protocol BU/CY/Mel from his brother, he had severe hematuria in urine. So he was screened for the reason of hematuria. The results of screening showed that he had positive BK virus in urine (viral load PCR tests: 7128037228 IU/ML). According to grade IV hemorrhagic cystic, cidofovir was administered for the first time as IV and then 2 times as intravesical. After the administration of cidofovir, the symptoms of hematuria improved and the load of BK virus decreased that finally accounted as zero. Cidofovir could be the target issue in patients’ recovery. Authors suggest further evaluations of cidofovir both in allogeneic stem cell transplantation setting and in renal allograft patients to consider its impact on BKV and nephropathy

An mHealth Self-management System for Support Children With Acute Lymphocytic Leukemia and Their Caregivers: Qualitative Co-design Study

BackgroundThe unique features of smartphones have extended their use in different fields, especially in the health care domain. These features offer new opportunities to support patients with chronic conditions by providing them with information, education, and self-management skills. We developed a digital self-management system to support children with cancer and their caregivers in Iran (low- and middle-income country). ObjectiveThis study is aimed at the development and preliminary evaluation of a cancer self-management system (CanSelfMan) tailored to the needs of children with cancer and their parents or caregivers. MethodsThis study was conducted in collaboration with a multidisciplinary team between January and February 2020 at MAHAK’s Pediatric Cancer Treatment and Research Center. We developed a self-management system in six stages: requirement analysis, conformity assessment, preparation of educational content, app prototyping, preliminary evaluation, and developing the final version. ResultsA total of 35 people (n=24, 69% parents and n=11, 31% children) volunteered to participate in the study. However, only 63% (15/24) of parents and 73% (8/11) of children were eligible to participate. By adopting a user-centered design approach, we developed a mobile app, CanSelfMan, that includes five main modules (knowledge base, self-management tips, self-assessment report, ask a question, and reminders) that provide access to reliable information about acute lymphocytic leukemia and the self-management skills required for side effect measurement and reporting. A web-based dashboard was also developed for oncologists and included a dashboard to monitor users’ symptoms and answer their questions. ConclusionsThe CanSelfMan app can support these groups by providing access to reliable information about cancer, facilitating communication between children or parents and health care providers, and helping promote medication adherence through a reminder function. The active participation of the target group can help identify their needs. Therefore, through the involvement of stakeholders such as patients, caregivers, and oncologists in the design process, we improved usability and ensured that the final product was useful. This app is now ready to proceed with feasibility studies

Cost-analysis of Treatment of Pediatrics Acute Lymphoblastic Leukemia based on ALL-BFM Protocol

Background Among all pediatric cancers acute lymphoblastic leukemia (ALL) is highly prevalent, butthe overall cost of ALL management is not well-known, there is a need to assess the Berlin-Frankfurt-Munster (BFM) protocol commonly used in ALL management in Iran. So, the aim of this study was to estimate direct and indirect costs of ALL treatment among children based on the ALL-BFM protocol from the societal perspective in Iran. Materials and Methods A retrospective study was conducted. All pediatric patients newly diagnosed with ALL and managed by the BFM protocol from 2010-2015 were included. Finally, total costs, including direct medical costs, direct non-medical costs and indirect costs were calculated. Results The total direct medical cost per patient for a complete treatment period was 15,026.6US dollars, the direct non-medical cost incurred was 1,688.9 USD and the indirect cost due to productivity loss was 932.3 USD. Conclusion Treatment of pediatrics ALL is less costly in Iran comparing other countries. So, physicians and policy makers and health care system administrators should devise an appropriate strategy to reduce the direct medical costs which have more economic burden special for hospitalization days and chemotherapy costs based on the findings

Features of Childhood Acute Myeloid Leukemia in Iran: a Report from Double Center Study

Acute Myeloblastic Leukemia is one of the important malignancies in children. For better managing the prognosis of this disease, there should be enough information about common features of this malignancy. The aim of this study was to evaluate these common features in children with Acute Myeloblastic Leukemia. A total of 104 eligible children less than 15-year-old have been referred from 2007-2011 to two referral centers for childhood malignancies. Basic epidemiological information recorded in checklists for each individual. Analyzes have been done by SPSS version 22. Out of patients, 57 cases were males (54.8%). The male/female ratio was 1.2. The mean age of patients was 6.5 ± 4.3 years. The majority subtypes of patients were M3, M4, non-M3, and M2, respectively. The common molecular abnormalities were t (15;17) and inv (16). Of patients, 19.2% had an early relapse. The mean age of relapse in patients was 6.7 ± 3.9 years. Sixty patients (57.7%) were alive, and 44 cases (42.3%) died during or after therapy. The three years overall survival rate of patients was 42% in this study. According to our data, AML has the same frequency as compared with data from developing countries. But different epidemiological characteristic was a lower rate of three years overall survival in patients. These data may serve the health authorities for more effective environmental and preventive measurements, purposeful allocation of resources for facilitating up-to-date diagnostic and treatment modalities, psychological support programs for respective family members and educational purposes

Classifying Pediatric Central Nervous System Tumors through near Optimal Feature Selection and Mutual Information: A Single Center Cohort

Background: Labeling, gathering mutual information, clustering and classificationof central nervous system tumors may assist in predicting not only distinct diagnosesbased on tumor-specific features but also prognosis. This study evaluates the epidemi-ological features of central nervous system tumors in children who referred to Mahak’sPediatric Cancer Treatment and Research Center in Tehran, Iran.Methods: This cohort (convenience sample) study comprised 198 children (≤15years old) with central nervous system tumors who referred to Mahak's PediatricCancer Treatment and Research Center from 2007 to 2010. In addition to the descriptiveanalyses on epidemiological features and mutual information, we used the LeastSquares Support Vector Machines method in MATLAB software to propose apreliminary predictive model of pediatric central nervous system tumor feature-labelanalysis. Results:Of patients, there were 63.1% males and 36.9% females. Patients' mean±SDage was 6.11±3.65 years. Tumor location was as follows: supra-tentorial (30.3%), infra-tentorial (67.7%) and 2% (spinal). The most frequent tumors registered were: high-gradeglioma (supra-tentorial) in 36 (59.99%) patients and medulloblastoma (infra-tentorial)in 65 (48.51%) patients. The most prevalent clinical findings included vomiting,headache and impaired vision. Gender, age, ethnicity, tumor stage and the presence ofmetastasis were the features predictive of supra-tentorial tumor histology.Conclusion: Our data agreed with previous reports on the epidemiology of centralnervous system tumors. Our feature-label analysis has shown how presenting features maypartially predict diagnosis. Timely diagnosis and management of central nervous systemtumors can lead to decreased disease burden and improved survival. This may be furtherfacilitated through development of partitioning, risk prediction and prognostic models

Assessment of health related quality of life in children and adolescents suffering from cancer on chemotherapy and off treatment

Introduction: Better perception of Quality of Life in children suffering from cancer and their common complications help us to apply supportive and psychological interventions. The current study assessed Health Related Quality of Life in children with cancer on chemotherapy and off treatment and compared children’s report with their parents’ proxy report.Materials and Methods: 100 children aged 8 to 18 years on chemotherapy including 58 males and 42 females, with the mean age of 12.02 years (SD=2.54) and 51 off treatment children including 23 males and 28 females, with the mean age of 13.01 years (SD=3.26) and their parents completed PedsQL Cancer Module questionnaire. The mean total score and Health Related Quality Of Life subscales were calculated and compared within study groups.Results: Parents reported their children’s Quality Of Life and most of its subscales statically lower than children themselves both on and off chemotherapy (P <0.05). The females had a lower Quality Of Life by self report on Procedural Anxiety and by parents’ report on Procedural Anxiety, Physical Appearance Perception and Communication subscales (P <0.05). On chemotherapy children had significant lower Quality Of Life in Pain & Hurt and Nausea subscales by self report (p: 0.015 and <0.001, respectively) and lower Quality Of Life in Pain and Hurt, Nausea, Worry and Communication subscales by parent’s proxy report (P <0.05).Conclusion: Parents’ report of their children’s Quality Of Life could not be substituted their self report. On chemotherapy and off treatment Children have their specific complications. Considering gender differences of children’s problems suffering from cancer, their psychological and supportive interventions should be designed and applied considering their gende