A comparison between Cox proportional hazard models and logistic regression on prognostic factors in gastric cancer.

BACKGROUND: Despite its decreasing prevalence in industrialized nations, gastric cancer remains one of the most frequent cancers in the world. Since stomach cancer often was not detected until an advanced state, survival rate was rather low. AIM: The aim of the present study is to compare the Cox proportional hazard model and Logistic regression model to estimate prognostic of patients with gastric cancer. MATERIAL AND METHODS: To determine the independent prognostic factors reducing survival time for gastric cancer, we compared the parametric methods (logistic regression) and non-parametric methods (Cox proportional hazard models) applied to patients who registered in one cancer registry center located in southern Iran. RESULTS: Of 442, 266 (60.2 %) died. In multivariate analyses using the Cox proportional hazard model, Age at diagnosis (P = 0.018, Hazard rate = 1.84), grade of tumor (P = 0.018, Hazard rate = 1.56), and metastasis (P = 0.004, Hazard rate = 1.53) were the most independent prognostic factors. As well as, using the stepwise logistic regression model, Age at diagnosis, (P = 0.005, Odds Ratio = 1.01), grade of tumor (P = 0.025, OR = 1.95), and metastasis (P < 0.001, OR = 2.81) were also the most independent factors who affected on survival. CONCLUSION: Although regression coefficients are not all the same, these three factors are the most prognostic factors that affect on survival of gastric patients in both multivariate analyses.

Anti-HBc & HBV-DNA detection in blood donors negative for hepatitis B virus surface antigen in reducing risk of transfusion associated HBV infection.

BACKGROUND & OBJECTIVE: Though sensitive screening assays for detection of hepatitis B virus surface antigen (HBsAg) are available, occasional cases of post-transfusion hepatitis B virus infection (PTH) still occur. The present study was undertaken to assess the prevalence of anti-hepatitis B core (anti-HBc) positivity and presence of HBV-DNA in serum sample of healthy blood donors negative for both HBsAg and anti-HCV antibody in Shiraz, Iran. Since anti-HBc detection is not mandatory in Iran, we evaluated whether anti-HBc detection could be adopted as a screening assay for safety of donated blood. METHODS: Two thousands serum samples negative for both HBsAg and anti-HCV collected from healthy blood donors were tested for the presence of anti HBc antibody. All samples positive for anti-HBc antibody were then investigated for determination of anti-HBc titre, anti-HBs titre, HbeAg and anti-HBe antibody by enzyme immunoassay (EIA). Every sample that tested negative for HBsAg but positive for anti-HBc alone or in combination with other serological markers was also examined for the presence of HBV-DNA by polymerase chain reaction (PCR). RESULTS: Of the 2000 samples tested, 131 (6.55%) blood samples were found to be positive for anti- HBc. HBV DNA was detected among 16 of 131(12.2%) anti-HBc positive specimens. Further, there was an association between the titration of anti-HBc antibody and the intensity of expected PCR product band. The liver function test results were all in normal range except in 4 of 16 HBV-DNA positive subjects. The mean levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in HBV-PCR positive subjects were 14 IU/l and 23.7 IU/l respectively. INTERPRETATION & CONCLUSION: Anti-HBc antibody should be tested routinely on blood donors volunteers and if the sample found positive regardless of anti-HBs titre, the blood should be discarded. Further testing for HBV-DNA would be appropriate to follow up the donor for HBV infection.

Current substance use in patients with gastric cancer in Southern Iran.

BACKGROUND: Psychiatric disorders may affect patients suffering from cancer and substance use disorders. OBJECTIVE: This study was undertaken to evaluate the prevalence of tobacco and opioid use in patients with gastric cancer in Shiraz, Fars Province and Southern Iran. MATERIALS AND METHODS: In a hospital survey of 177 gastric cancer patients aged 24 years and more, a semistructured-interview was performed based on SDM-IV criteria during the year 2003. RESULTS: The mean age of the patients was 58.13 (SD = 14.03) years. Among the subjects, 50.9% (90) were tobacco dependent (61.5% men and 29.4% women, P < 0.001), while 10 (5.7%) were opioid-dependent (7.3% men and 1.9% women, P = 0.16). Tobacco and opioid-dependency were not significantly related to age groups, economical or occupational status. Mean ages of tobacco and opioid-dependants were not significantly different from nondependants. CONCLUSIONS: Tobacco and opioid dependency were common problems among gastric cancer patients. This report provides useful information for health planning. Men were at greater risk than women. Treatment programs should focus on all age-groups, all occupations and all income-levels.

Cytokine gene polymorphisms in renal transplant recipients.

OBJECTIVE: Acute rejection remains an important cause of graft loss after renal transplantation, and cytokines are key mediators in the induction and effector phases of all immune and inflammatory responses. However, the influence of gene polymorphisms on the functional immune response of transplant recipient outcomes remains controversial. MATERIALS AND METHODS: The amplification refractory mutation system polymerase chain reaction was used to detect the interleukin-10 (IL-10) (-1082 G/A), tumor necrosis factor-alpha (TNF-alpha) (-308 G/A), and interferon-gamma (IFN-gamma) (+874 T/A) single nucleotide polymorphisms in 100 of the first adult kidney recipients at our institution who were receiving cyclosporine-based immunosuppressive therapy. The diagnosis of acute rejection was based on clinical and histologic findings according to the Banff criteria. RESULTS: The results of multivariate analyses showed no significant association between episodes of acute rejection and single nucleotide polymorphisms in IL- 10, TNF-alpha genes, or dinucleotide repeat polymorphisms in the IFN-gamma gene. CONCLUSIONS: Our results demonstrate that cytokine gene polymorphisms did not influence the early outcome of kidney transplantation.

Outcome of hepatitis B and C virus infection on graft function after renal transplantation.

INTRODUCTION: Chronic liver disease resulting from hepatitis B virus (HBV) and hepatitis C virus (HCV) infections is still a major concern in kidney recipients. It is unclear whether HCV antibody status and markers of HBV infection are associated with renal dysfunction. Thus, we designed a study to investigate the incidence of HBV and HCV infection after renal transplantation and whether these infections alter graft function. METHODS: Fifty-eight patients who underwent renal transplantation participated in the study. Serum creatinine and aminotransferase levels were measured with standard automated analyzers. Anti-HCV antibodies were detected with an enzyme immunoassay, and a reverse transcriptase-polymerase chain reaction (RT-PCR) technique was used to test for HCV-RNA. Serological markers for HBV (HBsAg and anti-HBc antibody) were detected by enzyme immunoassay. All samples from patients who were seropositive for HBsAg or anti-HBc antibody were PCR-tested for HBV-DNA. A serum sample collected from living donors was tested for anti-HCV antibodies and serological markers for HBV. Serum creatinine and aminotransferase levels were also measured in living donors. RESULTS: Anti-HCV was not detected in serum samples of any cases before transplantation. However, 10 (17.2%) tested positive after transplantation. HCV-RNA was detected in 2 of the 10 patients (3.4% of all patients). None of the pretransplantation serum samples tested positive for HBsAg. However, anti-HBc antibody was identified in 8 (13.8%) of the 58 patients.. No HBV DNA was detected in serum samples of the patients with anti-HBc or HBsAg-positive. HBsAg was only detected in 1 (1.7%) recipient after transplantation. None of the 58 patients showed clinical signs or symptoms of renal dysfunction during the study period. CONCLUSION: Our data suggest that, neither HBV nor HCV infection appears to cause or contribute to renal dysfunction in the early period (1 year) after renal transplantation. Nevertheless, a long-term consequence of chronic HBV or HCV liver disease or graft loss is not impossible in renal transplant recipients.

Results of liver transplantation: analysis of 140 cases at a single center.

The Shiraz Organ Transplant Center in southern Iran has been performing all liver transplantations in Iran and certain neighboring countries for 12 years. This study evaluated the 140 operations performed from April 1993 through November 2004. Sixty-one percent of the recipients were men and 39% were women. The average recipient age was 29.9 +/- 14.0 years. One hundred twenty-eight patients has a full-size cadaveric transplant. Most frequent causes of cirrhosis were cryptogenic and viral. An acute rejection episode occurred in 47.5% of cases, and two episodes in 8%. Most frequent short-term complications included respiratory, neurologic, and biliary problems. The 1-, 2-, and 3-year patient survival rates were 92%, 89%, and 85%, respectively. The experience that the Shiraz Organ Transplant Center has had with liver transplantation indicated success comparable to that noted in other reports. The calculated trend suggests that a goal of 100 transplantations for 2005 is within reach.

Risk of viral transmission via bone marrow progenitor cells versus umbilical cord blood hematopoietic stem cells in bone marrow transplantation.

Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for children and certain adults with malignant and nonmalignant hematologic disease. Since viral infections are the major problem, this study examined those that might potentially be transmitted to HSCT recipients via bone marrow (BM) versus umbilical cord blood (UCB). BM progenitor cells, peripheral blood leukocytes, and plasma samples were collected from 30 allogenic BM donors. Umbilical cord blood hematopoietic stem cells and plasma samples were also collected from 34 UCB donors. Viral DNA extracted and purified from collected specimens was processed using nested polymerase chain reactions (PCR) to detect human parvovirus B19 (HPV B19), human herpesvirus-6 (HHV-6), varicella-zoster virus (VZV), human cytomegalovirus (HCMV), and Epstein-Barr virus (EBV). The prevalences of HCMV DNA in collected BM progenitor cells versus UCB hematopoietic stem cells were 73% versus 23%, respectively. Conversely, HHV-6 DNA was not detected in any collected specimen by simple PCR. Distribution of the other investigated virus DNAs except EBV DNA was similar in specimens collected from both groups. EBV DNA was not determined in UCB hematopoietic stem cells. The results indicate that the risk of viral transmission to BM transplant recipients via UCB hematopoietic stem cells is less than that with BM progenitor cells.

Bcl-2 expression in acute myelogenous leukemia: the relation to myeloid antigen expression and response to therapy in Iranian patients.

Product of Bcl-2 gene prolongs survival of hematopoietic cells by inhibition of programmed cell death. The aim of this study is to examine the expression of the bcl-2 protein in a group of patients with AML and its relation to clinical features and response to therapy. Slides from the bone marrow or peripheral blood of 70 patients with AML were assessed for the expression of bcl-2 by immunocytochemistry. The expression of myeloid and non-lineage associated markers was detected by indirect immunofluorescence method. Correlation between bcl-2 and markers expression and patients characteristics was determined. More than 20% positivity for bcl-2 was found in 22 (31.4%) patients. Bcl-2 expression showed an association with M4 and M5 subtypes (p<0.01) and was correlated with clinical parameters including WBC and platelet count, extramedullary disease and Hb level. Bcl-2 expressing cells were significantly higher in CD15(+) and CD13(+) patients and lower in CD11b(+) and CD33(+) cases (p<0.001). Complete remission (CR) rate was significantly lower in cases with 20% or more bcl-2 positivity than others (24.4% v 75.6%). A shorter CR duration was observed in bcl-2+ patients when compared with bcl-2- ones (571+/-50 versus 850+/-17 days)(p=0.0001). The expression of bcl-2 was also associated with shorter survival (p=0.0001). Survival time for bcl-2+ patients was 831+/-44 days versus 1119+/-17 days for bcl-2- ones. CD11b and CD33 positivity was associated with longer survival whereas CD13 and CD15 positivity was correlated with lower survival (p<0.007). In multivariate analysis bcl-2 positivity was associated with poor survival. Bcl-2 expression showed a prognostic value in our patients indicating that even despite of some differences in treatment regimen, immunocytochemical analysis of this marker is still a simple and inexpensive method for evaluation of prognosis in AML patients. Bcl-2 expression may be related to the expression of differentiation associated markers.

Anthrax: pathological aspects in autopsy cases in Shiraz, Islamic Republic of Iran, 1960-2001.

Anthrax, like tuberculosis, shows a new epidemic spread in industrialized countries, revealing some ambiguous aspects to the disease and providing new challenges to medicine. Shiraz University of Medical Sciences has records of 7130 autopsies performed in the past 40 years, 33 of which are anthrax cases. We reviewed all the pathology slides of these cases and classified the organs involved in a search for unrecognized microscopic findings. The most common cause of death was sepsis, caused by organ involvement and direct cytotoxicity of Bacillus anthracis, in addition to its exotoxin production. Novel findings included hyaline membrane formation in respiratory system cases that is similar to acute (adult) respiratory distress syndrome and evidence of primary gastrointestinal involvement, showing the ability of the organism to pass the gastric barrier.

Anthrax: pathological aspects in autopsy cases in Shiraz, Islamic Republic of Iran, 1960-2001

Anthrax, like tuberculosis, shows a new epidemic spread in industrialized countries, revealing some ambiguous aspects to the disease and providing new challenges to medicine. Shiraz University of Medical Sciences has records of 7130 autopsies performed in the past 40 years, 33 of which are anthrax cases. We reviewed all the pathology slides of these cases and classified the organs involved in a search for unrecognized microscopic findings. The most common cause of death was sepsis, caused by organ involvement and direct cytotoxicity of Bacillus anthracis, in addition to its exotoxin production. Novel findings included hyaline membrane formation in respiratory system cases that is similar to acute [adult] respiratory distress syndrome and evidence of primary gastrointestinal involvement, showing the ability of the organism to pass the gastric barrier

High risk HPV types in southern Iranian patients with cervical cancer.

This study was undertaken to assess the rate of HPV infection in cervical carcinoma among southern Iranian patients. 101 archival cervical carcinoma tissue samples of a 10 year period were studied for the presence of HPV DNA in southern Iran by a polymerase chain reaction method. In addition, the presence of high risk HPV-16 and HPV-18 genotypes was investigated. In total, 88 (87.1%) of the samples were HPV DNA positive, of which 83 were squamous cell carcinomas and 5 were adenocarcinomas. HPV-16 genotype was detected in 26.7% of HPV positive cervical carcinomas; however, none of the samples were positive for the existence of HPV-18 genotype. Collectively, these results suggest that HPV-16 and HPV-18 are not the frequent high risk HPV types in our patients and circulating HPV types in southern Iranian population are different from many other populations.

Study of the association of HLA class I antigens with kala-azar.

HLA class I antigen frequencies were studied in 52 patients with kala-azar and compared with 222 unrelated healthy controls. The relative risk (RR) and etiologic or preventive fraction (EF/PF) were determined for each character, and statistical significance was evaluated with chi 2 with Yates' correction. Results showed that the only antigen with a statistically significant difference was HLA-A26 (15.38 vs. 1.35%; p = 0.004), with RR = 13.27 and EF = 0.142. This indicates a high risk of contracting the disease for HLA-A26-positive individuals and a relatively remarkable influence of this antigen on the prevalence rate of kala-azar.

Cytopathology of alpha chain disease involving the central nervous system and pleura.

Alpha chain disease, a lymphomatous disorder characterized by the synthesis and secretion of an abnormal IgA immunoglobulin devoid of light chains, involves mainly the gastrointestinal tract. This paper presents the cytologic and histologic findings in two cases of alpha chain disease involving the central nervous system and pleura. Most of the cell populations in the cerebrospinal fluid (CSF) and pleural fluid resembled immature plasma cells (immunoblasts); many of these cells were degenerated, with well-preserved plasma cells seen more rarely. While the definitive diagnosis of alpha chain disease depends on immunochemical analysis of serum proteins, cytology can play a role by the identification of malignant cells in CSF and pleural fluid specimens. A positive staining of such cells by the methyl green pyronin reaction may permit the correct diagnosis to be suggested.

Diagnosis of metastatic adamantinoma of the tibia by pulmonary brushing cytology.

A case of adamantinoma of the tibia metastatic to the lung is reported in which the metastatic lesion was initially diagnosed by pulmonary brushing cytology. The cytologic features, including clusters of small cells with either prominent nucleoli or spindle-shaped hyperchromatic nuclei, appear to be distinctive enough to differentiate this lesion from other metastatic malignant tumors of the lung.