Primary repair with no flaps for lower lip defects (30-80 %) after cancer excision

Reconstruction of the lip is a necessary procedure when lip tumors are excised. Although many good techniques have been described, they often have disadvantages such as necrosis and extensive suture lines. In our approach, we aim to minimize the suture line and avoid tissue necrosis for medium-sized lip defects (30-80 %). This is a surgical technique report from a single center. After tumor resection, we made a bilateral 15 mm horizontal skin and mucosa incision from the angles of the lip to the lateral sides. The mucosa and skin were dissected from the underlying muscle, and the muscle was cut approximately 15 mm on each side. The lip defect was then closed and sutured in four layers. Finally, the released mucosa was sutured to the corner of the incised skin. We followed the patients for 36 months and found that their speech intelligibility, sensation, mobility, and aesthetic satisfaction were preserved. The scars were also less pronounced compared to flaps, and there were no signs of edema or drooling. In conclusion, our technique offers many advantages for moderate defects of lower lip tumors. By avoiding the use of flaps, we eliminate the complications associated with flap surgery while achieving aesthetically satisfactory results. However, further evaluation by other surgeons is necessary to fully examine the technique's benefits.

The effect of rs9930506 FTO gene polymorphism on obesity risk: a meta-analysis

Obesity is associated with polymorphisms of the fat mass and obesity associated gene (FTO). This meta-analysis aimed to investigate the association of the rs9930506 FTO gene polymorphism and obesity. To the best of our knowledge, this study is the first meta-analysis to evaluate the relation between FTO rs9930506 polymorphism and obesity. We searched PubMed, Web of Science, and Embase to identify studies investigating the relations between the rs9930506 FTO gene polymorphism and obesity risk. We pooled adjusted odds ratios (OR) as overall and in continent subgroups. A Fixed-effects model was used to analyze the results of these studies in dominant and recessive models. By examining 3337 obesity cases and 3159 healthy controls, we identified 8 eligible case-control studies. Considering the dominant model of inheritance, there was a relationship between the rs9939506 polymorphism and obesity (OR=1.34 [1.03- 1.74]). The association remained significant in the European subgroup (OR=1.68 [1.2-2.36]), but not in the Asian subgroup. Using the recessive model, we also found a significant relationship when the overall association was investigated (OR=2.47; 95% CI 1.56-3.91). In conclusion, this study identified that the carriers of the risk allele of FTO rs9930506 polymorphism are at higher risk for obesity.

Assessment of Computer Regulation Thermography (CRT) as a Complemetrary Diagnostic tool for Breast Cancer Patient

Background:

Breast cancer is the most common type of cancer in women demanding accurate diagnosis to take remedial measures to treat.

Objective:

Comparing the diagnostic capability of the computer regulation thermography (CRT), as a novel and safe diagnostic procedure, with common methods including sonography, mammography and clinical examinations for diagnosing breast cancer in suspicious patients against pathology as the gold standard.

Material and Methods:

In this prospective clinical trial study, out of 97 referred patients, 44 meeting the inclusion criteria were selected. The selected patients were subjected to mammography, sonography, CRT and clinical examinations. Then, the patients showing suspicious symptoms of breast cancer underwent pathological examinations.

Results:

CRT indicated a higher specificity compared to mammography and sonography (78.9% vs. 71.4% and 47.0%, respectively). However, CRT sensitivity was lower than those of mammography, sonography and clinical examination (52% vs. 70.6%, 82.4% and 84.0%). Furthermore, CRT accuracy was lower than mammography, sonography and clinical examination (63.6% vs. 70.9%, 64.7% and 88.6%). While CRT positive prediction value (PPV) was higher than those of mammography and sonography, it was lower than that of clinical examination (76.5% vs. 75%, 60.9% and 95.5%). The negative prediction value (NPV) of CRT was less than all other modalities (55.5% vs. 66.7%, 72.7% and 81.8% for the clinical examination, mammography and sonography, respectively).

Conclusion:

Although CRT with a lower sensitivity and higher specificity, cannot be recommended to be used as a definitive diagnostic tool for breast cancer patients, it can be used as a complementary method with other methods to increase the diagnostic accuracy of suspicious patients.

Socioeconomic inequalities in metastasis, recurrence, stage and grade of breast cancer: a hospital-based retrospective cohort study

Introduction

This study aims to estimate the Socio-Economic Status (SES) inequality on the metastasis, recurrence, stage and grade in Breast Cancer (BC).

Methods

This retrospective cohort study conducted on 411 BC patients in Arak, Iran. Asset-based questionnaire used to estimate the household SES. For calculate of SES inequality was used from Concentration Index (C). Moreover for investigate the association between recurrence and metastasis with other variables were used from multilevel logistic regression and analysis of variance were used to investigate the relationship between SES and other variables. The data were analyzed with Stata (v.13) software.

Results

Results of analysis of variance showed statistical significant relationship between SES with, insurance, surgery, grade, stage, recurrence and metastasis (p-value < 0.05). Moreover the Odds Ratio (OR) were significant of recurrence with age, academic level of education, supplementary insurance history of BC in first-degree relatives, stage and grade, also, metastasis with age of > 80 years, insurance, supplementary insurance, history of BC in first-degree relatives, chemotherapy, radiotherapy, stage and grade four. The total C index obtained 0.015 (0.002, 0.026), 0.011 (0.003, 0.031), – 0.014 (– 0.034, – 0.001) and – 0.042 (– 0.061, – 0.002) for metastasis, recurrence, stage and grade of BC respectively.

Conclusions

Our results showed evidence of inequality in the metastasis, recurrence, stage and grade in BC patients.

Association between interleukin 4 (IL-4) VNTR, gene polymorphism, and breast cancer susceptibility in Iranian population: experimental and web base analysis

BACKGROUND

Breast cancer (BC) is one of the most common types of cancer and the second leading cause of cancer death among women. Epidemiological studies showed that BC is linked to genetic and environmental factors, and inheritance plays a key role in the pathobiology of this disease. Interleukin 4 (IL-4) is a key differentiation cytokine and is produced by Th2 and activates Th2 development. Hence the current study aimed to assess the possible association between interleukin 4 (IL-4) VNTR polymorphism, and BC susceptibility in a sample of Iranian population.

MATERIAL AND METHODS

IL-4 VNTR polymorphism was evaluated in 150 women with BC and 150 age-matched healthy women by polymerase chain reaction method.

RESULT

Among 3 possible alleles for IL-4 gene, we only observed 2 alleles. Current findings indicate that RP2/RP2 genotypes can be regarded as potent protective factors against breast cancer (OR = 0.929 [95%CI, 0.929-0.995]).

CONCLUSION

Our result showed that the RP2/RP2 genotype of the IL-4 VNTR polymorphism could be a protective factor for BC susceptibility (Tab. 2, Fig. 1, Ref. 46).

FTO Gene Affects Obesity and Breast Cancer Through Similar Mechanisms: A New Insight into the Molecular Therapeutic Targets

OBJECTIVES

This review focused on the possible mediatory role of the FTO in the association between obesity and breast cancer.

METHOD

All articles published in English from June 1990 to January 2017 were studied. The search terms used were FTO gene, FTO polymorphism, breast cancer, and obesity. Inclusion criteria consisted of assessment of the relationship between FTO polymorphisms and/or FTO expression level with obesity and/or breast cancer as a primary outcome.

RESULTS

The FTO gene may have a role in the cellular sensing of macronutrients. Over expression of the FTO gene increases the levels of mammalian target of rapamycin (mTOR) signaling that is a key regulator of cell growth. Moreover, some SNPs in intron locations of the FTO gene exert their effects on body mass index, body composition and breast cancer risk through change of the homeobox transcription factor iriquois 3 (IRX3) gene expression level.

CONCLUSION

The FTO gene may has a critical role in obesity and breast cancer. Similar molecular mechanisms may play a role in the development of breast cancer and obesity. If this result is correct then, it will be interesting to examine the FTO gene as a molecular therapeutics target.

Standardized breast cancer mortality rate compared to the general female population of Iran

INTRODUCTION

Breast cancer is the most common cancer in women. Improvements of early diagnosis modalities have led to longer survival rates. This study aimed to determine the 5, 10 and 15 year mortality rates of breast cancer patients compared to the normal female population.

MATERIALS AND METHODS

The follow up data of a cohort of 615 breast cancer patients referred to Iranian Breast Cancer Research Center (BCRC) from 1986 to 1996 was considered as reference breast cancer dataset. The dataset was divided into 5 year age groups and the 5, 10 and 15 year probability of death for each group was estimated. The annual mortality rate of Iranian women was obtained from the Death Registry system. Standardized mortality ratios (SMRs) of breast cancer patients were calculated using the ratio of the mortality rate in breast cancer patients over the general female population.

RESULTS

The mean age of breast cancer patients at diagnosis time was 45.9 (±10.5) years ranging from 24-74. A total of 73, 32 and 2 deaths were recorded at 5, 10 and 15 years, respectively, after diagnosis. The SMRs for breast cancer patients at 5, 10 and 15 year intervals after diagnosis were 6.74 (95% CI, 5.5- 8.2), 6.55 (95%CI, 5-8.1) and 1.26 (95%CI, 0.65-2.9), respectively.

CONCLUSION

Results showed that the observed mortality rate of breast cancer patients after 15 years from diagnosis was very similar to expected rates in general female population. This finding would be useful for clinicians and health policy makers to adopt a beneficial strategy to improve breast cancer survival. Further follow-up time with larger sample size and a pooled analysis of survival rates of different centres may shed more light on mortality patterns of breast cancer.

Integrating Spirituality into a Group Psychotherapy Program for Women Surviving from Breast Cancer

BACKGROUND

In spite of a significant relation between spirituality and hope, happiness and life satisfaction, the effectiveness of spiritual interventions in the mentioned mental strengths has been less dealt with. The present study is conducted in order to determine the effectiveness of spiritual group intervention on the increase of hope, life satisfaction and happiness in women surviving from breast cancer.

METHODS

Sixty women surviving from Breast Cancer were voluntarily assigned in to case and control groups, and were assessed before and after Islamic perspective spiritual intervention by spiritual experience, hope, happiness and life satisfaction questionnaires. Statistical analysis of data was performed using descriptive and inferential statistics through covariance.

RESULTS

The spiritual intervention resulted in significant increase of hope, happiness and life satisfaction (P < 0.05).

CONCLUSION

Spiritual intervention appears to be a potentially beneficial intervention for increasing mental strengths among those suffering from breast cancer. Therefore, it seems necessary to consider it as an important element incomprehensive treatment, plans, and in palliative and supportive care.

A Novel Scheme for Optimal Control of a Nonlinear Delay Differential Equations Model to Determine Effective and Optimal Administrating Chemotherapy Agents in Breast Cancer

BACKGROUND

Determining the optimal and effective scheme for administrating the chemotherapy agents in breast cancer is the main goal of this scientific research. The most important issue here is the amount of drug or radiation administrated in chemotherapy and radiotherapy for increasing patient's survival. This is because in these cases, the therapy not only kills the tumor cells, but also kills some of the healthy tissues and causes serious damages. In this paper we investigate optimal drug scheduling effect for breast cancer model which consist of nonlinear ordinary differential time-delay equations.

METHODS

In this paper, a mathematical model of breast cancer tumors is discussed and then optimal control theory is applied to find out the optimal drug adjustment as an input control of system. Finally we use Sensitivity Approach (SA) to solve the optimal control problem.

RESULTS

The goal of this paper is to determine optimal and effective scheme for administering the chemotherapy agent, so that the tumor is eradicated, while the immune systems remains above a suitable level. Simulation results confirm the effectiveness of our proposed procedure.

CONCLUSION

In this paper a new scheme is proposed to design a therapy protocol for chemotherapy in Breast Cancer. In contrast to traditional pulse drug delivery, a continuous process is offered and optimized, according to the optimal control theory for time-delay systems.

Incidence rate of ovarian cancer in Iran in comparison with developed countries

BACKGROUND

Ovarian cancer is one of the most common gynecologic malignancies. The present study was designed to compare age-standardized incidence rate (ASR) of ovarian cancer in Iran with that in Australia and some other developed countries.

MATERIALS AND METHODS

Data from the Cancer Registry Program of Iran, as a base, were compared with the cancer registry reports of surveillance, epidemiology and end results program in the USA, considering the population of the USA in the year 2000 as the standard population.

RESULTS

In all the age groups, ASR of ovarian cancer was much lower in Iran. Overall rates of ovarian cancer in Iran and the USA were 3.9 and 16.2 per 100,000, respectively.

CONCLUSION

Age-standardized ovarian cancer rate in Iran was much lower in comparison with high incidence areas in the world. Encouraging oral contraceptive use and reduction in fat intake may be effective in decreasing the rate of ovarian cancer or keeping its rate constant in Iran.

Gastric cancer prevalence, according to survival data in iran (national study-2007)

BACKGROUND

Gastric cancer is a common and lethal disease throughout the world. In Iran with 7300 new cases annually, it is the first cause of cancer related death in both sexes. Regarding the high incidence (10.5/100000 individuals) of gastric cancer and priority of prevalence index in cancer management, in this study we tried to determine 1, 2-3 and 4-5 year point prevalence of the disease according to survival data.

METHOD

Survival and incidence data were used for determination of cancer prevalence. Incidence data were extracted from cancer registry in Iran and survival data were determined in a descriptive study by following up 3439 gastric cancer patients in Cancer Research Center (CRC). 1, 2-3 and 4-5 year prevalence was estimated from incidence rates in different years and the proportion of patients surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years from the time of diagnosis.

RESULTS

patients with survival of 0.5, 1.5, 2.5, 3.5 and 4.5 years from the time of diagnosis were 46.38%, 26 %, 19.36%, 15.47% and 12.8% respectively. The prevalence of 1, 2-3 and 4-5 year was 3392, 3118and 1824 respectively. The cumulative 5 year prevalence was 8334 cases.

CONCLUSION

These estimates of the point prevalence of gastric cancer at 1, 2-3 and 4-5 years are applicable to the evaluation of initial treatment, clinical follow-up, and point of cure. Therefore 1, 2-3 and 4-5 year point prevalence estimates, are necessary in health service planning for gastric cancer management and should be considered by public health managers.

Comparing two treatment methods for post mastectomy lymphedema: complex decongestive therapy alone and in combination with intermittent pneumatic compression

There is no cure for breast cancer related lymphedema. This study was conducted to compare two treatment methods for postmastectomy lymphedema: Complex Decongestive Therapy (CDT) and Modified CDT (MCDT) combined with Intermittent Pneumatic Compression (IPC). One hundred and twelve patients referred to the Lymphedema Clinic of the Iranian Center for Breast Cancer in 2008, were included in a randomized clinical trial. They were randomly allocated into two equal groups receiving daily CDT alone or in combination with IPC. The volume reduction of the upper limb was measured by water displacement volumetry. No statistically significant differences in demographic and clinical variables between the two groups were observed. During the intensive phase (phase I) of treatment, CDT alone yielded a significantly higher mean volume reduction than the combination modality (43.1% vs. 37.5%; p = 0.036). Limb volume measured three months following treatment, showed 16.9% volume reduction by CDT alone, and 7.5% reduction by MCDT plus IPC. This study demonstrated that the use of CDT alone, or in combination with IPC significantly reduced limb volume in patients with post mastectomy lymphedema. CDT alone provided better results in both treatment phases. Further studies will help to define the role of multidisciplinary approaches in the management of postmastectomy lymphedema.

Epidemiology of deaths from injuries in the Islamic Republic of Iran

A 1-year study of fatal injuries was carried out in 10 provinces of the Islamic Republic of Iran based on a population of 16 740 637 in 2000-01. All reported deaths were compared and validated with other sources of death registration. Out of 66 846 deaths, 9733 (58/100 000) resulted from injuries. Overall, 14.9% of all deaths with 26.9% of years of lost life were from injuries. Most fatal injuries were unintentional (48.0/100 000). Deaths from traffic injuries (30.0/100 000) are the highest in the world. Of 1693 intentional fatal injuries, 61% were due to suicide, at a mean age of 29 years.

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience

INTRODUCTION

Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development.

DESCRIPTION OF THE PROJECT

Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities.

LESSON LEARNED

A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.

Public health improvement in Iran—lessons from the last 20 years

INTRODUCTION

Health services are historically based on providers's and policy makers's understanding of population health status. This does not necessarily reflect the real needs of a population. Health needs assessment (HNA) should improve individual or population health and optimize the way that limited resources are utilized.

OBJECTIVES

To review health needs literature and to describe Iranian primary healthcare (PHC) achievements in developing a needs-driven health system.

FINDINGS

The Iranian PHC system was established to meet healthcare needs identified through population health status surveys. Since 1984, the PHC system has become highly organized and efficient, resulting in a dramatic decrease in infant, maternal and neonatal mortality rates, population growth, increasing life span and a marked shift towards non-communicable diseases. Through an organized partnership of the general population, volunteers, health workers and health professionals, a needs-oriented healthcare system became central to health policy in Iran. Several information sources were utilized to establish need. Improving death certification was an immediate and important part of this process.

COMMENT

Improved knowledge about personal rights, community and environmental health policies, and involvement of the media led to an increased range and depth of needs. Moving towards quality improvement and a needs-driven healthcare system requires continuous needs assessment. Novel methods of HNA, such as postal and telephone surveys, group discussions, surrogates for need such as quality-of-life measurement (commonly used in developed countries) or other locally designed methods such as the basic development needs approach, may be relevant to the Iranian PHC network.

The devastation of Bam: an overview of health issues 1 month after the earthquake

The appalling earthquake in the ancient city of Bam on December 27th 2003 was one of the worst disasters since the last century in Iran. Further to the chilling statistics of human loss, essential services including water supply, power, telephone, health care services, main roads, and the city's only airport were crippled. From the 'public health' and 'health emergency' perspectives, the initial priorities were to minimise avoidable further mortality and morbidity. This required prompt evacuation of the injured, defining catchment areas, establishment of efficient systems for disease control, organising a disaster management plan, out patient management, co-ordination of international aid, and re-organising the current PHC network in the district. The second stage, each department planning health delivery for the subsequent year, was rapidly initiated. This paper discusses these strategies, which were designed specifically for Bam but are likely useful in similar situations.