Zohreh Sanaat

Dietary Resistant Starch Contained Foods and Breast Cancer Risk: a Case-Control Study in Northwest of Iran

BACKGROUND A protective effect of resistant starch (RS) containing foods on carcinogenesis has been shown from several lines of experimental evidence for gastrointestinal cancers. Therefore, we aimed to investigate the association between RS contained foods and breast cancer (BC) risk in a hospital-based, age- and origin- matched, case-control study. MATERIALS AND METHODS A validated, semi-quantitative, food frequency questionnaire (FFQ) was completed by 306 women newly diagnosed with BC aged 25 to 65 years, and 309 healthy women as matched controls. Odds ratios (ORs) and 95% confidence intervals (95%CI) were estimated using conditional logistic regression models. RESULTS Reduced BC risk was associated with the highest tertile of whole-wheat bread and boiled potato consumption with adjusted ORs at 0.34 (95%CI: 0.19-0.59) and 0.61 (95%CI: 0.37- 0.99), respectively. Among consumers of whole-wheat bread consumers were considered, the protective role of cereals remained relatively apparent at higher intakes level of fiber rich breads at adjusted models (OR=0.53, 95%CI: 0.28-1.01). Moreover, high intake of legumes was found out to be a significant protective dietary factor against risk of BC development with an OR of 0.01 (95%CI: 0.03-0.13). However, consumption of white bread and biscuits was positively related to BC risk. CONCLUSIONS Our results show that certain RS containing foods, in particular whole wheat bread, legumes and boiled potato may reduce BC risk, whereas higher intake of white bread and biscuits may be related to increased BC risk.

Survival analysis of breast cancer patients in northwest Iran.

BACKGROUND Breast cancer is the most frequently occurring cancer among Iranian women; however limited studies have been conducted to address survival rates. OBJECTIVE The objective was to examine survival rates in Tabriz (Northwest of Iran) and compare with those of data reported from other cities and countries. METHODS Survival rates were calculated for one, three, five, seven and ten years for 271 breast cancer patients referred to one university clinic during 1997-2008. RESULTS Survival analysis demonstrated a lower survival rate compared to western countries. CONCLUSIONS Survival rates for our patients are similar/better than other cities in Iran, but lower than certain European countries and the US. Further studies with a higher number of patients are now required.

Nutritional assessment of patients with acute leukemia during induction chemotherapy: association with hospital outcomes

Abstract Cancer-related malnutrition causes morbidity and reduced survival. The aim of this study was to evaluate the nutritional and inflammatory status of patients with acute leukemia in association with duration of neutropenic fever (DNF) and length of hospital stay (LHS) during induction chemotherapy. Fifty-five patients with acute lymphoblastic leukemia (ALL) (n = 28) and acute myeloid leukemia (AML) (n = 27) completed the study. There were significant differences between the two groups according to LHS and DNF (p = 0.022 and p = 0.012, respectively): both had a longer period in patients with AML. The patients were statistically different according to body mass index (BMI), pre-albumin, high-sensitivity C-reactive protein (hs-CRP) and patient-generated subjective global assessment (PG-SGA) score (p = 0.049, p = 0.028, p < 0.001, p = 0.030). In patients with ALL, serum albumin and pre-albumin levels were associated with LHS and DNF, respectively. Moreover, PG-SGA score was associated with DNF. In patients with AML, BMI and second pre-albumin level < 10 mg/dL were associated with DNF. Pre-albumin was the common indicator for chemotherapy-related complications in patients with both ALL and AML. Early nutritional assessment can help to find patients with acute leukemia who need nutritional support, and it may contribute to better outcome and less toxicity.

Age pattern of the occurrence of breast cancer in the northwest of Iran

Breast cancer represents 27% of the cancers and 19% of the cancer deaths in female population. The aim of this study was to document the age pattern of the incidence of breast cancer in Iranian female population in the northwest region of the country. The study subjects were 1764 patients with breast cancer diagnosed/registered in the six university clinics between 1988 and 2008 in the northwest of Iran. The highest occurrence rates were observed for the birth year cohorts 1940-1949 (for 59-69 years old), 1950-1959 (for 49-58 years old), and 1960-1969 (for 39-48 years old). Among these three cohorts, the highest rate was observed in 1950-1959 birth year cohort (284.38 per 100,000 female populations, 95% CI: 260-310). This rate was significantly higher compared with the similar rates of other birth cohorts. There was no statistically significant difference between various years in terms of the average age at the diagnosis of breast cancer in our study setting. Despite the previous research reports, we found no significant difference between the mean ages at diagnosis of breast cancer from 1988 to 2008 in Iranian female population.

Upper gastrointestinal bleedings in patients with hereditary coagulation disorders in Northwest of Iran: prevalence of Helicobacter pylori infection.

Objective Upper gastrointestinal (UGI) bleeding is one of the most life-threatening complications, in up to 25% of persons with hemophilia (PWH). Recurrent bleeding is common and can be caused by the Helicobacter pylori infection. Our aim was to evaluate the role of H. pylori infection in UGI bleeding in PWH. Material and methods Ninety patients with hereditary bleeding disorders, 30 patients with (group A), and 60 patients without (group B) a history of UGI bleeding episodes were included. The prevalence of H. pylori infection was investigated by stool antigen test, and serum serologic tests including immunoglobulin G and anti-CagA. Results Among 90 patients (81 men, nine women, mean age 31.30±10.72 years), 66 patients with hemophilia A, 10 patients with hemophilia B, six patients with Von Willebrand disease, five patients with platelet function disorders, and three patients with other factor deficiencies were evaluated. About 46.7% of patients in group A, and 23.3% of patients in group B were anti-CagA–positive (P=0.02), whereas 76.7% of patients in group A and 51.7% of patients in group B had H. pylori immunoglobulin G antibodies (P=0.02). H. pylori antigen in stool was positive in 76.7% in group A and 55% in group B (P=0.03). No statistically significant difference was found between type and severity of diseases and risk of UGI. Conclusion H. pylori infection should be considered as an important cause of UGI bleeding in PWH. We would recommend stool antigen test as a new and noninvasive screening test for diagnosis of H. pylori infection in all patients with hereditary hemorrhagic disorders.

Effect of taurine on febrile episodes in acute lymphoblastic leukemia.

PURPOSE The purpose of our study was to evaluate the effect of oral taurine on the incidence of febrile episodes during chemotherapy in young adults with acute lymphoblastic leukemia. METHODS Forty young adults with acute lymphoblastic leukemia, at the beginning of maintenance course of their chemotherapy, were eligible for this study. The study population was randomized in a double blind manner to receive either taurine or placebo (2 gram per day orally). Life quality and side effects including febrile episodes were assessed using questionnaire. Data were analyzed using Pearsons Chi square test. RESULTS Of total forty participants, 43.8% were female and 56.3 % were male. The mean age was 19.16±1.95 years (ranges: 16-23 years). The results indicated that the levels of white blood cells are significantly (P<0.05) increased in taurine treated group. There was no elevation in blasts count. A total of 70 febrile episodes were observed during study, febrile episodes were significantly (P<0.05) lower in taurine patients in comparison to the control ones. CONCLUSION The overall incidence of febrile episodes and infectious complications in acute lymphoblastic leukemia patients receiving taurine was lower than placebo group. Taurines ability to increase leukocyte count may result in lower febrile episodes.

SUCCESSFUL MANAGEMENT OF TOTAL KNEE REPLACEMENT IN A HIGH RESPONDER HEMOPHILIA PATIENT WITH A HISTORY OF INHIBITOR

The development of inhibitors against administered clotting factors may render replacement therapy ineffective for some hemophilia patients. Such patients are therefore at the highest risk of developing arthropathy. Elective orthopedic surgery (EOS) in hemophilic patients having such inhibitors remains a rare, expensive, and difficult surgery, whose management represents a significant challenge. We report the case of a 35-year-old man with a severe form of hemophilia A (factor VIII < 1%), who was suffering from repetitive spontaneous hemarthrosis, especially in his knee joints that had consequently become more susceptible to bleeding. The patient had a history of high levels of factor VIII inhibitor (> 5.0 Bethesda Unit [BU]/ml) as shown by the factor VIII inhibitor assay; therefore, we began treatment with factor VIIa for his mild-to-moderate bleeding (90 µg/kg intravenous bolus injections). The interval between injections varied with the severity of the hemorrhage in each bleeding episode. The inhibitor level reduced to 3.1 BU/ml after three months, to 1.6 BU/ml after six months, and disappeared completely after one year of treatment. We administered factor VIII at a dose of 50 IU/kg every eight hours during the first three post-operative days, then continued administration with a dose of 40 IU/kg every 12 hours for another four days, and observed a very good response to treatment with no bleeding. Recombinant activated factor VII (rFVIIa) is not an inhibitor-removal strategy, but an inhibitor-bypassing product. However, in our patient, the treatment of mild-to-moderate bleeding with short-term use of rFVIIa and no exposure to factor VIII caused a gradual reduction in the inhibitor level over a period of 1 year.

Ral signaling pathway in health and cancer

The Ral (Ras‐Like) signaling pathway plays an important role in the biology of cells. A plethora of effects is regulated by this signaling pathway and its prooncogenic effectors. Our team has demonstrated the overactivation of the RalA signaling pathway in a number of human malignancies including cancers of the liver, ovary, lung, brain, and malignant peripheral nerve sheath tumors. Additionally, we have shown that the activation of RalA in cancer stem cells is higher in comparison with differentiated cancer cells. In this article, we review the role of Ral signaling in health and disease with a focus on the role of this multifunctional protein in the generation of therapies for cancer. An improved understanding of this pathway can lead to development of a novel class of anticancer therapies that functions on the basis of intervention with RalA or its downstream effectors.

The Effects of a Patient-Caregiver Education and Follow-Up Program on the Breast Cancer Caregiver Strain Index

Background: In recent years, the caregiving responsibilities of cancer patients’ family members have increased dramatically. Reducing caregiver strain and burden supports the mission of professional nursing. Objectives: The aim of this study was to determine and compare the caregiver strain index scores of breast cancer informal caregivers, before and after a patient-caregiver educational and telephone follow-up program. Patients and Methods: This is an experimental two-group design study. Participants were recruited from an outpatient chemotherapy unit of the largest hematology and oncology research center in Northwest Iran. Thirty patient-caregiver pairs were randomly allocated to intervention and control groups. The intervention group received 2 face-to-face education sessions at bedside and 4 subsequent telephone follow-up sessions. The control group received routine care. Pre and post tests were administered in both groups pre and post intervention. To analyze the data, SPSS (13th version) software was used. Results: The caregiver strain index decreased significantly in the intervention group after the patient-caregiver education and follow-up (P < 0.001), while the control group’s scores did not change (P = 0.04). Conclusions: It appears that the patient-caregiver education and follow-up program had a beneficial effect on the caregiver strain index compared to the usual care.

A Novel Oncolytic Herpes Capable of Cell‐Specific Transcriptional Targeting of CD133± Cancer Cells Induces Significant Tumor Regression

The topic of cancer stem cells (CSCs) is of significant importance due to its implications in our understanding of the tumor biology as well as the development of novel cancer therapeutics. However, the question of whether targeting CSCs can hamper the growth of tumors remains mainly unanswered due to the lack of specific agents for this purpose. To address this issue, we have developed the first mutated version of herpes simplex virus‐1 that is transcriptionally targeted against CD133+ cells. CD133 has been portrayed as one of the most important markers in CSCs involved in the biology of a number of human cancers, including liver, brain, colon, skin, and pancreas. The virus developed in this work, Signal‐Smart 2, showed specificity against CD133+ cells in three different models (hepatocellular carcinoma, colorectal cancer, and melanoma) resulting in a loss of viability and invasiveness of cancer cells. Additionally, the virus showed robust inhibitory activity against in vivo tumor growth in both preventive and therapeutic mouse models as well as orthotopic model highly relevant to potential clinical application of this virus. Therefore, we conclude that targeting CD133+ CSCs has the potential to be pursued as a novel strategy against cancer. Stem Cells 2018;36:1154–1169