Diffuse Large B-cell Lymphoma during Pregnancy

Introduction:Non-Hodgkin Lymphoma (NHL) during pregnancy are very uncommon, and primary symptoms of NHL are similar to pregnancy physiologic changes.Case presentation:We report a case of NHL during pregnancy that didn’t have any peripheral lymphadenopathy, with mediastinal involvement. Chemotherapy began during pregnancy and after delivery treatment continued with chemotherapy and radiotherapy, and mother and baby were both healthy.Conclusion: Early diagnosis of NHL cause to better prognosis of disease andmaking a chance for mother to make a decision about continue pregnancy or not and about her treatments

Staple Food Fortification with Folic Acid and Iron and Gastrointestinal Cancers:Critical Appraisal of Long-Term National Fortification

The co-occurrence of wheat flour fortification with folic acid and iron and gastrointestinal cancer incidences were critically assessed in the East Azerbaijan province in Northwest of Iran. In an ecological design, overall gastrointestinal cancer rate ratios and their 95% confidence intervals (95% CI) were calculated as primary outcome before (2004-2006) and after (2007-2015) the introduction of fortification. No consistent changes were observed in esophageal and gastric cancer, but the rate ratios of colorectal cancer increased significantly after fortification in the 35-54 years age group (women: 2.07, 95% CI: 1.79-2.49; men: 1.59, 95% CI: 1.33-1.89) and the 55-74 years age group (women 1.50, 95% CI: 1.27-1.76; men: 2.51, 95% CI: 2.13-2.95). The increased incidence of colorectal cancer was contemporary with long-term fortification; further investigation is required to establish the associations

Folic Acid Supplement Intake and Risk of Colorectal Cancer in Women; A Case Control Study

Background: An ongoing controversy exists on the role of folic acid supplementation in colorectal cancer risk among epidemiological studies. Objective: To assess the association between maternal folic acid supplementation and colorectal cancer risk. Methods: A paired matched case control study of 405 subjects was performed, including women residing in 135 villages of East Azerbaijan, Iran. Per area, subjects were followed regularly in local healthcare centers, where health- and social-related information have been collected prospectively in face to face interviews by well-trained health workers. We extracted folic acid supplement intake, baseline characteristics, and confounders from healthcare records. The data for study participants were linked to national cancer registry repositories, from which we retrieved the data of 135 women diagnosed with colorectal cancer between 2005 to 2015. Two hundred seventy controls were individually matched with cases in terms of residing village, age, and gender. We applied multivariate conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Findings: There was no significant association between folic acid supplementation and colorectal cancer risk in those with history of folic acid intake compared to those with no history of intake (OR 0.95; 95% CI 0.59 to 1.53), in those with less than five years of folic acid (0.79; 0.45 to 1.39) or in those with ≥5 years intake (1.09; 0.52 to 2.26). This risk did not change after adjustment for covariates or further stratification. Conclusions: Maternal folic acid supplementation did not affect colorectal cancer risk in a population where supplemental folic acid is prescribed with regular intervals for women of child-bearing age

Acceptability and compliance with a breast cancer prevention campaign in the Northwest Region, Iran

Aim: Breast cancer screening intended to improve survival and treatment outcomes. This study aimed to document the acceptability and compliance of the breast cancer prevention campaigns.Materials &amp; methods: Healthy women aged 35-65 years were recruited from various regions of the Northwest of Iran. All women were invited to participate in self-examination training for the breast and then re-Assessed by clinical examination and mammography.Results: A total of 321 healthy women were recruited, and volunteered to undergo at least one breast self-examination. The first and second clinical examinations were conducted on all women. Ultimately, 272 women (84.7%) underwent mammography. The most common barriers to screening were found to be fear of positive results, fear of cancer, lack of knowledge, fear of the mammography procedure and pain, travel distance and costs.Conclusion: The most critical challenge for implementing a breast cancer prevention program was the lack of knowledge and attitude. </p

Evaluation of iron overload by cardiac and liver T2* in β-thalassemia: Correlation with serum ferritin, heart function and liver enzymes

Introduction: In this study, we aimed to assess the relationship of cardiac and hepatic T2* magnetic resonance imaging (MRI) values as a gold standard for detecting iron overload with serum ferritin level, heart function, and liver enzymes as alternative diagnostic methods. Methods: A total 58 patients with beta-thalassemia major who were all transfusion dependent were evaluated for the study. T2* MRI of heart and liver, echocardiography, serum ferritin level, and liver enzymes measurement were performed. The relationship between T2* MRI findings and other assessments were examined. Cardiac and hepatic T2* findings were categorized as normal, mild, moderate, and severe iron overload. Results: 22% and 11% of the patients were suffering from severe iron overload in heart and liver, respectively. The echocardiographic findings were not significantly different among different iron load categories in heart or liver. ALT level was significantly higher in patient with severe iron overload than those with normal iron load in heart (P=0.005). Also, AST level was significantly lower in normal iron load group than mild, moderate, and severe iron load groups in liver (P&lt;0.05). The serum ferritin level was significantly inversely correlated with cardiac T2* values (r = -0.34, P=0.035) and hepatic T2* values (r = -0.52, P=0.001). Conclusion: Cardiac and hepatic T2* MRI indicated significant correlation with serum ferritin level

Colorectal Cancer in Iran: Molecular Epidemiology and Screening Strategies

Purpose. The increasing incidence of colorectal cancer (CRC) in the past three decades in Iran has made it a major public health burden. This study aimed to report its epidemiologic features, molecular genetic aspects, survival, heredity, and screening pattern in Iran. Methods. A comprehensive literature review was conducted to identify the relevant published articles. We used medical subject headings, including colorectal cancer, molecular genetics, KRAS and BRAF mutations, screening, survival, epidemiologic study, and Iran. Results. Age standardized incidence rate of Iranian CRCs was 11.6 and 10.5 for men and women, respectively. Overall five-year survival rate was 41%, and the proportion of CRC among the younger age group was higher than that of western countries. Depending on ethnicity, geographical region, dietary, and genetic predisposition, mutation genes were considerably diverse and distinct among CRCs across Iran. The high occurrence of CRC in records of relatives of CRC patients showed that family history of CRC was more common among young CRCs. Conclusion. Appropriate screening strategies for CRC which is amenable to early detection through screening, especially in relatives of CRCs, should be considered as the first step in CRC screening programs

Impact of RAS/RAF mutations on clinical and prognostic outcomes in metastatic colorectal cancer

Introduction: Early-activated RAS/RAF mutation status is a key molecular finding in colorectal cancer (CRC), while these mutations have been proposed as predictive and prognostic biomarkers. The present study has been designed as a longitudinal study to evaluate and summarize the different genotypes of metastatic CRC (mCRC), and assessing any association with the disease prognosis and clinicopathological characteristics. This study was performed in two main referral hospitals of Tabriz University of Medical Sciences, over three years (2016-2018). Methods: Mutations were detected by Idylla tests of KRAS/NRAS/BRAF among a total of 173 mCRCs, using surgically-resected specimens or biopsied samples. To evaluate the factors associated with overall survival (OS) and prognosis, the Cox proportional hazards model was used in two steps to estimate the outcome measures (hazard ratio, or HR) with a 95% confidence interval (CI). Results: The nominal 1 to 5-year OS rates were 78%, 65%, 55%, 46%, and 42%, respectively. KRAS mutations in codon 12 was an independent significant prognostic factor, as the patients with codon 12 mutations had a significantly lower OS (P Log-rank=0.049) and a higher hazard of mortality (HR=2.30; 95% CI: 0.95-5.58; P=0.066). Also, the mCRC patients with liver metastasis (HR=2.49; 95% CI: 1.49-12.52; P=0.002) and tumors of the distal colon (HR=3.36; 95% CI: 1.07-10.49; P=0.037) had a significantly worse prognosis. Conclusion: KRAS mutation in codon 12 was an independent significant poor prognostic factor, and patients with liver metastasis had a significantly worse prognosis. Routinely performing specific oncogenic tests may help improve the patients’ prognosis and life expectancy

Relationship between thyroid hormone levels in euthyroid patients before HSCT and time to achieve neutrophil and platelet engraftment: an analytical cross-sectional study

Introduction. The time to reach neutrophil (NE) and platelet engraftment (PE) in hematopoietic stem cell transplantation (HSCT) is one of the most important factors indicating transplantation survival. The aim of this study was to investigate the relationship between thyroid hormone levels before HSCT and the time to achieve NE and PE. Material and methods. The relationship between thyroid hormone levels before HSCT, age, gender, type of HSCT, type of disease and cluster of differentiation 34+ (CD34+) cell count and the number of days to reach NE and PE was examined in 37 clinically and laboratorially euthyroid patients. Results. An odds ratio (OR) of &gt; 6 was observed in the probability of time to NE &gt; 10 days in patients with thyroid-stimulating hormone (TSH) &gt; 2.89 mU/L in the upper normal range (UNR) and male patients, also in the probability of time to PE &gt; 15 days in patients with TSH &gt; 2.89 mU/L in the UNR. Statistically significant p-value and confidence interval were found in the probability of time to NE &gt; 10 days in male patients (OR = 8.58, p-value = 0.036) and time to PE &gt; 15 days in patients with TSH &gt; 2.89 mU/L in the UNR (OR = 14.32, p-value = 0.041). Conclusions. Treatment with low dose levothyroxine can be cautiously recommended to achieve TSH to ≤2.8 mU/L in the lower normal range before performing HSCT in euthyroid patients, which will reduce the times to NE and PE and help earlier discharge of patients

Epidemiologic profile of breast cancer in Iran: A systematic review and meta-analysis

Background: In Iran, the latest reports from different regions indicate that incidence and mortality rates of breast cancer have significantly increased. Methods: All manuscripts were screened for eligibility according to inclusion criteria. Epidemiological, analytical, cross-sectional, descriptive, and population-based studies were recruited. Results: Pooled estimated results were ASIR = 32.10, CIR = 28.99, and APC = 7.54%. However, the results indicated an increasing trend of all incidence indexes including ASIR, CIR, and APCs. Conclusion: This is noteworthy that there has been a rapid increase in the incidence of breast cancer. The estimated results were in accordance with the last reported results of Iran

How the COVID-19 outbreak affected physician-patient relationship

Physician-patient communication is the most basic element and vital skill of physicians in the diagnosis, treatment, and establishing diagnostic protocols. As the risks of contagion and viral infection are higher in physicians and health workers, front line soldiers inpatient care units, so they should establish strict protective measures. However, patients value greatly face to face and close relationships with their doctors, including facial interviews and physical examinations. So social and physical distancing between physician and their patients can be remarked as a bigger toll than the risk of COVID-19 contagious