Hooman Yarmohammadi

Epidemiological changes in colorectal cancer in Shiraz, Iran: 1980-2000.

Background:u2003 The present study was performed to determine trends in colorectal cancer rates over the past two decades (1970−80 vs 1990−2000) with in a main referral centre in Shiraz, Iran.

β-THALASSEMIA INTERMEDIA FROM SOUTHERN IRAN: IVS-II-1 (G→A) IS THE PREVALENT THALASSEMIA INTERMEDIA ALLELE

The preliminary results of a pilot study are reported, intended as an initiation of a research plan, focused on the prevention of β-thalassemia in Iran. The aims of this study are: (i) to improve the knowledge of the molecular background of β-thalassemia intermedia in Southern Iran; (ii) to verify the role of the −158 Gγ (C→T) (Xmn I) polymorphism as a modulating factor in thalassemia intermedia; (iii) to test the validity of the multiplex and single mutation specific amplification refractory mutation system in analyzing the molecular defects causing β-thalassemia in multiethnic populations; and (iv) to develop suitable strategies for the application of prevention protocols in Iran. To accomplish the task we have selected 87 β-thalassemia intermedia patients and adapted the DNA methodology to detect the following 11 frequent mutations in Iran: codon 5 (−CT); frameshift codons (FSC) 8/9 (+G); codon 30 (G→C); IVS-I-1 (G→A); IVS-I-5 (G→C); IVS-I-6 (T→C); IVS-I-110 (G→A); codons 36/37 (−T); codon 44 (−C); IVS-II-1 (G→A); IVS-II-745 (C→G). Because of the multiethnicity of the population we have also included the Indian IVS-I (25u2005bp deletion) and the Mediterranean IVS-I-130 (G→C) and codon 39 (C→T) mutations. Forty-eight patients were randomly studied for the Xmn I polymorphism together with 50 healthy volunteers as a control group. The molecular analysis conducted in Iran, identified only 31% of the alleles that were presumed to be thalassemic, revealing either a strategic or a technical insufficiency of the chosen method. However, the mutations with the highest prevalence in the country (IVS-II-1, IVS-I-110, IVS-I-1 and FSC 8/9) were found. As expected the IVS-II-1 defect, being the most frequent in south Iran, was present at the highest rate (24%). The Xmn I polymorphism was found in association with this prevalent mutation and was detected in the homozygous state in 87.5% of the patients homozygous for the IVS-II-1 (G→A) mutation. The overall positivity for Xmn I was found in 40.6% of the thalassemic alleles vs. 14% in the non-thalassemic, confirming the hypothesis of an older event, antecedent to the IVS-II-1 mutation. In trying to assess a more suitable molecular detection method we intend to continue this study in collaboration with the European centers involved, applying more effective technologies and better defining the molecular spectrum of β-thalassemia in the sub-populations. We also intend to verify the effect of α-thalassemia in the genotype/phenotype correlation of β-thalassemia intermedia.

CANCER INCIDENCE IN SOUTHERN IRAN, 1998-2002: RESULTS OF POPULATION-BASED CANCER REGISTRY

PURPOSEnThe main aim of this study was to obtain population-based cancer incidence data for the entire population of Fars province in Iran, and to compare these rates with those obtained from a previous study in the same population ten years previously.nnnMETHODSnData were collected on all patients in major cities of Fars province who were diagnosed with cancer between 1998 and 2002. The data were computerized using SPSS (Chicago, IL) software, version 13.0, and MS EXCEL (Microsoft, Redmond, WA) software with Persian fonts. The results are presented as incidence rates of cases by site, sex, age, crude rates, and age-standardized rates per 100,000 person-years (ASRs), using the direct method of standardization to the world population.nnnRESULTSnDuring the 5-year study period, 8359 new cancer cases were registered. Diagnosis of cancer was based on histopathological criteria in 86.7%, clinical or radiological criteria in 9.4% and death certificate only in 3.9% of cases. According to the calculated ASRs, the 5 most frequent cancers in women were breast (13 per 100,000), stomach (4.4 per 100,000), lung and bronchus (2.9 per 100,000), uterus (2.7 per 100,000), and colon and rectum (2.6 per 100,000); and in men, the 5 most frequent types were stomach (9.2 per 100,000), bladder (6.8 per 100,000), lung and bronchus (6.3 per 100,000), lymphocytic leukemia (4.1 per 100,000), and skin melanoma (3.8 per 100,000). The ASR for all cancers in men was 64.5 per 100,000, and that for women was 55.5 per 100,000.nnnCONCLUSIONnConsidering the limitations of this study, our results should be taken as the minimum incidence rates of cancers in Fars province, southern Iran. Significant differences were observed between the two study periods. However, we most likely have underestimated the frequencies of some tumors.

Urological complications in 980 consecutive patients with renal transplantation

Aim: To present the urological complications of renal transplantations performed in the last 14u2003years at one center and to briefly explain a modified method of Lich–Gregoir ureteroneocystostomy.

Inherited coagulation disorders in southern Iran

Summary.u2002 A comprehensive survey concerning the Shiraz Hemophilia Society and the associated haemophilia treatment centre was undertaken in April 2002 to collect data on demographics, signs and symptoms in the southern Iranian population with haemophilia and allied disorders. The total number of patients with coagulation disorders was 367. Haemophilia A (factor [F] VIII deficiency) was found in 271, 39 had haemophilia B (FIX deficiency) and 24 had von Willebrand disease. The rare coagulation disorders (nu2003=u200333) included 11 patients with FX deficiency; 10 with FVII; six with FXIII; two with afibrinogenaemia; two with FXI; one with combined FVIII and FV; and one with combined FVII, FVIII and FIX deficiency. The prevalence was 6.64 per 100u2003000 inhabitants. The most common symptoms were haemarthrosis, haematomas and epistaxis. None of the patients were human immunodeficiency virus positive but 47 (15%) were hepatitis C virus positive and two (0.7%) were hepatitis B positive, so that the rate of transfusion‐transmitted infections was lower compared with other populations.

Effect of Fluoxetine Alone and in Combination with Sildenafil in Patients with Premature Ejaculation

Introduction: The aim of this study was to compare the efficacy of fluoxetine alone and combined with sildenafil in patients complaining of premature ejaculation. Patients and Methods: Ninety-one married potent men, 21–43 years old, with premature ejaculation but without any obvious organic cause were enrolled. Pretreatment evaluation included history, physical examination, and self-administration of the International Index of Erectile Function questionnaire. The patients were randomly divided into two groups: group A patients (n = 48) received 20 mg fluoxetine daily for 4 weeks and then 20 mg as needed 2–3 h before sexual activity for 4 months, and group B patients (n = 43) received group A regimen plus 50 mg sildenafil as needed 1 h before sexual activity for 4 months. Results: Ejaculatory latency time and intercourse satisfaction significantly improved in group B as compared with group A (p < 0.05). Conclusion: Fluoxetine combined with sildenafil seems to provide significantly better ejaculatory latency time and intercourse satisfaction as compared with fluoxetine alone in patients with premature ejaculation.

Surgical management of carotid body tumours: a 24-year surgical experience.

Background:u2003 Carotid body tumours (CBT) are rare tumours, best treated by complete surgical resection. However, there is no uniform agreement on the method of resection. The aim of this study was to review our 24u2003years’ experience of meticulous subadventitial excision of CBT.

Evaluation of the Incidence of Sensorineural Hearing Loss in Beta-Thalassemia major Patients under Regular Chelation Therapy with Desferrioxamine

With the improved life expectancy of β-thalassemia major patients, new clinical problems, such as hearing loss, must be evaluated. To determine the incidence of sensorineural hearing loss and its relationship to desferrioxamine (DFO), 128 patients receiving subcutaneous DFO in doses from 21 to 39 mg/kg/day were studied. These patients had received their total weekly dose of DFO according to two different methods. The first group (QOD group of 52%) had received it on an every other day basis. The second group (QD group of 48%) had received it on 6 days a week. Otological examinations and pure tone audiometry were performed on the patients as they routinely visited Shiraz Cooley’s Center, to find a possible correlation between the dose and duration of therapy. 56 patients (44%) in both groups had no evidence of drug-induced auditory abnormalities. Of the patients in the QOD group 44.7% had hearing loss in the right ear and 41.8% in the left ear at a frequency of 8,000 Hz compared to the QD group, 27.8 and 23%, respectively (with p < 0.047 and p < 0.02, respectively). No correlation was found between the duration of DFO therapy and sensorineural deficit. A significant correlation was found between the dose of drug given at each episode of DFO therapy and hearing loss at the frequency of 8,000 Hz, when comparing the QOD group with the QD group. Hence, it may be concluded that DFO ototoxicity is determined not only by the total amount of the drug given, but also by its maximal plasma concentration. Thus we suggest periodical audiologic checkups and a low dosage of DFO (below 50 mg/kg/day) given on at least 5–6 days a week for the prevention and prompt diagnosis of audiologic complications.

The prevalence of signs and symptoms of childhood leukemia and lymphoma in Fars Province, Southern Iran

BACKGROUNDnLeukemia and lymphomas are still the common childhood cancers in Iran. This study was undertaken to determine the prevalence of signs and symptoms of these malignancies in children of Fars Province, Southern Iran.nnnMETHODSnA total of 368 cases of children who were less than 15 years old and diagnosed as acute lymphocytic leukemia (ALL, n=211), acute myeloid leukemia (AML, n=64), Burkitt lymphoma (BL, n=40), chronic myeloid leukemia (CML, n=5), Hodgkins disease (HD, n=33) or non-Burkitt-type, non-Hodgkins lymphoma (NBNHL, n=15) referring to the hospitals of Shiraz University of Medical Sciences from April 1997 to March 2002 were enrolled. A questionnaire was provided to record the age, median age at the onset of the disease, sex, type of malignancy and the signs and symptoms at the time of presentation.nnnRESULTSnThe common sign or symptoms were fever (74%), in ALL, AML, NHL, and BL patients, hepatosplenomegaly (100%) in CML patients, and lymphadenopathy (54%) and fever (54%) in Hodgkins disease.nnnCONCLUSIONnKnowledge of signs and symptoms and types of presentations of childhood leukemia and lymphoma may help a physician to improve the patients outcome. This study revealed that attention to uncommon signs and symptoms in history taking and physical examination together with laboratory tests may increase the physicians awareness and better diagnosis of pediatric malignancies and would also be beneficial for the patient.

Analysis of cytotoxic T lymphocyte associated antigen 4 gene polymorphisms in patients with ulcerative colitis

Background and Aim:u2002 Ulcerative colitis (UC) is a multifactorial disease associated with dysregulated immunity. Recently, cytotoxic T lymphocyte associated antigen 4 (CTLA‐4) gene polymorphisms have been reported in association with several autoimmune diseases in several populations. In the present study, the possible implication of the CTLA‐4 gene as a risk factor for UC in the Iranian population was investigated.