[Show abstract][Hide abstract] ABSTRACT: The efficacy of first- and second-line Helicobacter pylori (H. pylori) eradication regimens varies considerably in West Asian countries, mainly due to the variable prevalence of resistant organisms. However, no review article has yet evaluated and compared the efficacy of different regimens among different countries of this region. Therefore, we conducted a review to select the best options and provide recommendations for H. pylori treatment in this geographic region. A search through PubMed was carried out to obtain relevant randomized clinical trials published in English language up to June 2013. According to the results, among different therapeutic regimens used as the first-line protocols, 10-d Bismuth-Furazolidone/Metronidazole quadruple therapy, 14-d Clarithromycin-containing hybrid therapy and 14-d quadruple therapy including a proton pump inhibitor + Bismuth + Tetracycline (500 mg QID) + Metronidazole (500 mg TDS) seemed to be appropriate options. Among second-line therapeutic regimens, Bismuth-based quadruple therapies containing Tetracycline and Furazolidone/Metronidazole, triple therapy containing Amoxicillin and Gatifloxacin and Quadruple therapy including Bismuth + Azithromycin and Ofloxacin seemed to be effective options. Third-line therapies were not evaluated in West Asia; most guidelines, however, recommend choosing optimal eradication regimen according to the pattern of antibiotic susceptibility of H. pylori. Although we limited our investigation to H. pylori eradication regimens in West Asia, the clinical significance of the results goes beyond the countries situated in this geographic region. In fact, the results are transferrable to any region as long as the patterns of resistance are the same.
[Show abstract][Hide abstract] ABSTRACT: We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran.
We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates.
Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model.
Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs.
[Show abstract][Hide abstract] ABSTRACT: Background:
Golestan province in northeastern Iran has been known as a high-risk area for esophageal cancer (EC). This study was conducted to assess aflatoxin (AF) contamination of wheat flour (WF) samples in high and low EC-risk areas of Golestan province.
Four WF samples were collected randomly from each of 25 active silos throughout the province in 2009. The levels of AFs were measured using the High-performance liquid chromatography method. Using the data of EC rates obtained from Golestan population-based cancer registry, the province was divided into high and low risk areas for EC. Student t-test and multivariate regression analysis were used to compare the levels of aflatoxins as well as the condition of silos between the two areas.
One hundred WF samples were collected. The mean levels of total aflatoxin and aflatoxin B1 was 1.99 and 0.53 ng g(-1), respectively. The levels of total AF (p = 0.03), AFG2 (p = 0.02) and AFB1 (p = 0.003) were significantly higher in samples obtained from high risk area. Multivariate regression analysis showed that humidity of silo was the most important source of difference between silos of the two areas (p = 0.04).
We found a positive relationship between AF level of WF samples and the risk of EC. So, AF contamination may be a possible risk factor for EC in our region. We also found that humidity of silos was the most important determinant of AF contamination of WF. Intensive control of silos conditions including humidity and temperature are needed especially in high EC-risk areas.
[Show abstract][Hide abstract] ABSTRACT: Cognitive dysfunction increasingly has been recognized as a complication after cardiac surgery. Different methods have been considered for the reduction of cognitive dysfunction after cardiac surgery. One of these methods is by using lidocaine during surgery. The aim of this study was to determine the effects of adding lidocaine to the cardioplegia solution on cognitive impairment after coronary artery surgery. Design and methods: In a prospective, randomized, double-blind trial, 110 patients aged between 20-70 years, scheduled for elective CABG surgery using cardiopulmonary bypass, were recruited into the study. They were randomized into two groups who received either cardioplegia solution containing lidocaine 2 mg/kg or procaine hydrochloride 5 mg/kg. The neurocognitive test used in this study was the Mini Mental State Examination (MMSE) or Folstein test. The test was done on the day before and 10 days and 2 months after the operation.
In the procaine group, the total score after 10 days decreased significantly compared to the preoperative score (mean difference 0.68; 95% CI: 0.20 to 1.17, p=0.006). Comparison between mean differences after 10 and 60 days of operation between the lidocaine and procaine groups were statistically significant, p-value 0.017 and 0.013, respectively. There was no cognitive impairment in the lidocaine group, but, in the procaine group, four patients (7.7%) after 10 days and one patient (1.9%) after both 10 and 60 days had cognitive impairment, p=0.051.
Administration of lidocaine compared to that of procaine through the cardioplegia solution had a better effect on cognitive function after coronary artery bypass graft surgery.
[Show abstract][Hide abstract] ABSTRACT: BACKROUND: 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).
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.
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 histopathological reports in 71% and on death certificate only in 9% of cases.
The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase.
Archives of Iranian medicine 04/2012; 15(4):196-200. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing Coronary Artery Bypass Graft (CABG) surgery and there is a direct relation between postoperative hyperglycemia and mortality rate in these patients. The aim of the present study is to determine the efficacy of metformin on glycemic control in diabetic patients after CABG surgery. In a randomized double blind clinical trial, 100 patients with type 2 diabetes admitted in open heart ICU after CABG surgery in Mazandaran Heart Center were enrolled. They were randomly assigned to two intervention and control groups. Three hours after extubation, therapeutic antiglycemic regimens were applied in these two groups and continued for three days. Intervention group received regular insulin infusion along with two metformin 500 mg tablets per twelve hours while control group received regular insulin infusion with two placebo tablets per twelve hours. Blood glucose level and other parameters were measured and recorded in determined intervals. To analyze the data, independent T-test, paired T-test, Mann-Whitney and repeated measure ANOVA tests were employed. Mean blood glucose level was not significantly different in the two groups at the beginning of the ICU admission; however, mean glucose level in insulin-metformin group, twelve hours after the initiation of the study, was significantly lower than insulin group (p < 0.05). In addition, mean doses of potassium and insulin demand as well as mean number of episodes of hyperglycemia, hypoglycemia and glucose levels out of the accepted range were significantly lower in insulin-metformin group (p < 0.05). Alterations in mean levels of lactate, BE, pH and creatinine were not statistically significant in these two groups. It seems that adding metformin to insulin leads to a better glycemic control in type two diabetic patients undergoing CABG surgery without causing metabolic acidosis. Therefore, it might be a potential option in blood glucose control protocol in this group of patients.
Pakistan Journal of Biological Sciences 12/2011; 14(23):1047-54. DOI:10.3923/pjbs.2011.1047.1054
[Show abstract][Hide abstract] ABSTRACT: The majority of hemodialysis patients are hyperphosphatemic. Hyperphosphatemia in these patients can lead to renal osteodystrophy, vascular calcification, cardiovascular events, and is independently associated with mortality risk. The aim of this study was to evaluate the effect of intravenous vitamin C on phosphorus level in hemodialysis patients.
Using a double blind randomized clinical trial, a total of 60 qualified hemodialysis patients were randomly allocated in two intervention and control groups and serum phosphorus, CRP, calcium, albumin and PTH levels were measured. At the end of each hemodialysis session, intervention group received vitamin C vial (500 mg/5 cc) intravenously three times a week for 8 weeks and control group received normal saline in the same way. Data were collected before and after two months of treatment. Data were analyzed using independent t-test, paired t-test and chi-square test.
Vitamin C treated group had a significant decrease in phosphorus (p=0.01), CRP level (p=0.01) and Ca×P product (p=0.03). In contrast, there was no significant difference in phosphorous (p= 0.5) and CRP levels (p= 0.6) and Ca×P product (p=0.7) in the control group. In addition, there was no statistically significant change in calcium (p=0.1), PTH (p=0.4) and albumin (p=0.4) levels in both groups.
Intravenous vitamin C can significantly decrease phosphorus level in hemodialysis patients.
[Show abstract][Hide abstract] ABSTRACT: Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used.
There was no significant difference between the 2 groups regarding pH, base excess, or bicarbonate intake (P>0.05). No patient showed lactic acidosis in either group. Lactate levels were 23.0 vs 23.4 in the insulin-metformin and insulin only groups when the study was started, respectively. At the end of the study, those levels were 18.7 vs 18.9, respectively. In addition, the ANOVA repeated measurement test did not show a significant difference in terms of changes in the amount of lactate level between the 2 groups during the five measurement tests of the study period (P>0.05).
High-dose metformin (1,000 mg twice daily with insulin) does not cause lactic acidosis in type 2 diabetic patients after coronary artery bypass surgery.
Heart International 06/2011; 6(1):e8. DOI:10.4081/hi.2011.e8
[Show abstract][Hide abstract] ABSTRACT: We investigated polymorphisms of plasminogen activator inhibitor-1 (PAI-1), angiotensin converting enzyme (ACE ) and coagulation factor XIII (FXIII) genes and their association with recurrent spontaneous abortion (RSA) in Iranian patients and normal healthy controls. Ten (18.5%) patients were homozygote (4G/4G) for PAI-1 polymorphism, in contrast with two (2%) controls (p = 0.001). Patients with homozygote 4G mutation were significantly more prone to RSA in contrast to others (odds ratio: 11.0, 95% CI: 2.3-52.4). Nineteen (30.2%) patients and 25 (26.6%) controls were homozygote (DD) for ACE polymorphism. We observed only two patients and one control with homozygosity (34leu) for FXIII polymorphism. 4G/4G polymorphism for PAI-1 gene could be a thrombophilic mutation leading to abortion in Iranian population.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 03/2011; 24(3):545-8. DOI:10.3109/14767058.2010.511331 · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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).
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).
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 person-years) for lymphomas in males and females are presented.
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.
Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(1):219-22. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper presents the incidence rates of childhood cancers using the data obtained from Golestan population based cancer registry (GPCR) between 2004 and 2006.
GPCR registers only primary cancers based on standard protocols of the international association of cancer registries (IACR). We collect data on newly diagnosed (incident) cancer cases from all public and private diagnostic and therapeutic centers of the whole province. CanReg-4 software was used for data entry and analysis.
Totally 5076 cancer cases (all ages) were diagnosed in GPCR between 2004 and 2006. Of these, 139 (2.74 %) were children (aged 0-14 years) with mean (±SD) age of 8.06 (±4.48) years. The age standardized incidence rates for childhood cancer were 119.8 and 78.3 per 1000000 person-years in male and female children, respectively. Leukemia was the most common childhood cancer in Golestan province of Iran. Lymphomas and central nervous system tumors were the second and third ones, respectively.
The incidence rates of childhood cancers were relatively high in Golestan province of Iran. So, controlling of childhood cancers should be mentioned as an important issue in health policy making in this area.
Iranian Journal of Pediatrics 09/2010; 20(3):335-42. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine whether interleukin (IL)-6 and IL-8 concentrations, as well as numbers of seminal leukocytes in a population of infertile men, some of whom were Chlamydia trachomatis positive, were related to chlamydial infection. Our patient group included 255 men attending for diagnostic semen analysis as part of infertility investigations. Significantly raised levels of IL-8, but not IL-6, were found in C trachomatis-infected patients but not in uninfected patients. Raised IL-8 levels in semen were also associated with an increase in semen volume. There was a relationship between C trachomatis infection and lower progressive motile sperm, as well as an increase in seminal leukocytes. The overall prevalence rate for C trachomatis was 6.2%, and more infections were detected in semen than in first void urine. This study supports the suggestion that IL-8 might be used as a marker for male genital tract infection, especially when due to C trachomatis. In this study, there was a relationship between the presence of C trachomatis in semen and alterations of some semen parameters. Further investigations should be performed to understand the disparities of first void urine and semen testing for detection of C trachomatis in males.
Journal of Andrology 09/2009; 31(2):114-20. DOI:10.2164/jandrol.109.008300 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Perinuclear antineutrophil cytoplasmic autoantibodies (pANCA) and anti-Saccharomyces Cerevisiae antibody (ASCA) are potential markers for diagnosis of inflammatory bowel disease (IBD). The aim of the present study was to evaluate the diagnostic value of pANCA and ASCA in Iranian patients with IBD.
Serum samples were collected from 144 patients with IBD (113 ulcerative colitis and 31 Crohn's disease) and patients with non-IBD problems were assayed for ASCA by Enzyme-Linked Immunosorbent Assay (ELISA) and for pANCA by indirect immunofluorescence assay.
Sensitivity and specificity of pANCA in UC were 39.8% and 82.1%, respectively. For CD, pASCA test provided the sensitivity of 58% and specificity of 70%. A combination of pANCA+/ASCA- for diagnosis of UC showed a sensitivity of 31.9% and specificity of 89.1%. In addition the combination of pANCA-/ASCA+ showed a sensitivity of 35.5% and specificity of 79.8% for diagnosis of CD.
Due to low sensitivity of pANCA and ASCA alone or in combination, they are not valuable serological markers for diagnosis of UC or CD.
[Show abstract][Hide abstract] ABSTRACT: The importance of patients' involvement in decision-making is because of their right to know the risks and benefits they accept in undertaking treatment and the as yet unproven hope that this will improve compliance. The aim of this study was to establish local people's willingness to receive antihypertensive treatment for primary prevention of cardiovascular disease (CVD) and to explore the role of ethnicity.
In a cross-sectional study with face-to-face interview South Asian and Caucasian men and women aged 35-74, with and without history of CVD, were interviewed. Minimal clinically important differences were measured for three different baseline CVD risks (10, 20, and 40% in 10 years) using a standard method with risks presented both graphically and numerically and expressed in positive and negative terms.
A total of 262 (110 South Asians) participants were interviewed. Overall, South Asians expressed smaller median minimal clinically important differences than Caucasians, 1 and 4%, respectively. Up to 17% of participants in both ethnic groups indicated that they would not take medication regardless of the benefits. The proportion of South Asian men unwilling to take medication regardless of benefit was higher than Caucasian men for all scenarios, 17.2 versus 10.7% for scenario 1 and 12.1 versus 5.6% for scenario 2, respectively. South Asians of both sexes who would consider therapy required less benefit for acceptance in all three scenarios compared with the Caucasians.
South Asian participants were at least likely as Caucasians to accept antihypertensive treatment as the primary prevention therapy and they should be targeted for this type of therapy.
European Journal of Cardiovascular Prevention and Rehabilitation 03/2008; 15(1):59-66. DOI:10.1097/HJR.0b013e3282f07973 · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence of subjects eligible for primary and secondary prevention of coronary heart disease (CHD) among the British South Asian population and to compare that with British Caucasians.
We used the Health Survey for England 1998 and 1999 datasets, holding data on 9950 Caucasians and 1938 South Asians. Thresholds for treatment were a total cholesterol >3.5 mmol/l and either a history of cardiovascular disease or elevated estimated CHD risk, adjusted where necessary for ethnic differences. Separate analyses were performed for primary prevention risk thresholds of >15% and >30% over 10 years. The prevalence of previous myocardial infarction, angina, or stroke was higher in South Asian men than in Caucasian but the reverse was seen in women. More than 93% [95% confidence interval (CI) 88-97] of South Asian men and nearly 68% (95% CI 66-71) of Caucasian men older than 55 years have a CHD risk greater than 15% (equivalent to cardiovascular risk of 20%) and a cholesterol above 3.5 mmol/l and would be eligible for treatment with lipid-lowering drugs. The equivalent proportions in women are 55% (95% CI 46-65) and 18% (95% CI 16-20) in South Asians and Caucasians, respectively.
Treating this proportion of the population will have a societal impact, the majority of older people becoming patients, and although it may well be cost-effective for individuals, it will require substantial new resources.
European Journal of Cardiovascular Prevention and Rehabilitation 04/2007; 14(2):333-9. DOI:10.1097/01.hjr.0000239477.79428.6c · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although people of South Asian descent appear to be at increased risk of cardiovascular disease (CVD) compared to the general population there is no validated tool for predicting risk in this group.
This study was based on an analysis of data from the Health Survey for England (HSE) 1998 and 1999 to identify a simple method for adjusting the Framingham equation to estimate coronary risk in South Asians which could be then applied to existing simple paper-based tools.
The different adjustments investigated were fixed increments to the age, total cholesterol (TC), and TC:high density lipoprotein (HDL) cholesterol ratio and multipliers for the TC:HDL cholesterol ratio. Framingham risk modified according to a factor derived from an earlier overview of prospective studies was used as a standard to estimate sensitivity and specificity of adjustment methods. The receiver-operating characteristic (ROC) plot was used to compare the different adjustments in the primary role of identifying individuals above or below a given risk threshold.
All adjustment methods produced a graded monotonic increase of coronary risk in 4497 eligible subjects from the HSE 1998 dataset. Multiplying TC:HDL cholesterol ratio gave the largest area under the ROC curve. However adding 10 years to the age of South Asian people was the simplest way of calculating coronary heart disease risk using paper-based methods and still provided acceptable accuracy.
Our result should be used to achieve the systematic evaluation of each individual for primary prevention of CHD in South Asians in primary care.
European Journal of Cardiovascular Prevention and Rehabilitation 03/2005; 12(1):46-51. DOI:10.1097/00149831-200502000-00007 · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Studies of South Asian immigrants in different countries have reported an increased predisposition to cardiovascular disease in comparison with the native populations.
This study is a systematic review of longitudinal studies investigating differences in established risk factors for coronary heart disease (CHD) between Caucasians and South Asians. The aim was to develop a practical tool to estimate CHD risk in individuals. Secondarily data from the Health Survey for England 1999 (HSE 1999) were used to explore a possible role of differences in blood glucose in risk variation.
We used a systematic search to find relevant published papers. Data from the HSE 1999 were employed to study ethnic differences in blood glucose and glycosylated haemoglobin.
Only two out of five longitudinal studies reported independent estimates of relative risks of CHD in South Asians compared to Caucasians. Risk in diabetic South Asians was predicted adequately by classical risk factors whilst risk in a non-diabetic study population was 79% greater than predicted. Non-diabetic South Asians have higher fasting blood glucose (FBG) and HbA1c than Caucasians after adjustment for CHD risk factors.
The difference in risk of CHD between non-diabetic South Asian and Caucasians is not explained by differences in the impact of the traditional risk factors. Part may be due to higher blood sugar concentrations in non-diabetic South Asians.
European Journal of Cardiovascular Prevention and Rehabilitation 11/2004; 11(5):389-93. DOI:10.1097/01.hjr.0000140714.79273.c9 · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the effects, both harmful and beneficial of aspirin in the primary prevention of coronary heart disease.
Does aspirin prevent fatal and non-fatal CHD in people without symptomatic vascular disease? Does aspirin reduce all-cause and cardiovascular mortality?
Are the effects of aspirin, be they harmful or beneficial, affected by underlying risk of CHD? Do the major adverse effects of Aspirin ever outweigh its benefit and is this balance affected by underlying CHD risk?