Colorectal Cancer in North-Eastern Iran: a retrospective, comparative study of early-onset and late-onset cases based on data from the Iranian hereditary colorectal cancer registry

Background The incidence rate of colorectal cancer (CRC) is increasing among patients below 50 years of age. The reason for this is unclear, but could have to do with the fact that indicative variables, such as tumour location, gender preference and genetic preponderance have not been followed up in a consistent mann er. The current study was primarily conducted to improve the hereditary CRC screening programme by assessing the demographic and clinicopathological characteristics of early-onset CRC compared to late-onset CRC in northeast Iran. Methods This retrospective study, carried out over a three-year follow-up period (2014–2017), included 562 consecutive CRCs diagnosed in three Mashhad city hospital laboratories in north-eastern Iran. We applied comparative analysis of pathological and hereditary features together with information on the presence of mismatch repair (MMR) gene deficiency with respect to recovery versus mortality. Patients with mutations resulting in absence of the MMR gene MLH1 protein product and normal BRAF status were considered to be at high risk of Lynch syndrome (LS). Analyses using R studio software were performed on early-onset CRC (n = 222) and late-onset CRC (n = 340), corresponding to patients ≤50 years of age and patients > 50 years. Results From an age-of-onset point of view, the distribution between the genders differed with females showing a higher proportion of early-onset CRC than men (56% vs. 44%), while the late-onset CRC disparity was less pronounced (48% vs. 52%). The mean age of all participants was 55.6 ± 14.8 years, with 40.3 ± 7.3 years for early-onset CRC and 65.1 ± 9.3 years for late-onset CRC. With respect to anatomical tumour location (distal, rectal and proximal), the frequencies were 61, 28 and 11%, respectively, but the variation did not reach statistical significance. However, there was a dramatic difference with regard to the history of CRC in second-degree relatives between two age categories, with much higher numbers of family-related CRCs in the early-onset group. Expression of the MLH1 and PMS2 genes were significantly different between recovered and deceased, while this finding was not observed with regard to the MSH6 and the MSH2 genes. Mortality was significantly higher in those at high risk of LS. Conclusion The variation of demographic, pathological and genetic characteristics between early-onset and late-onset CRC emphasizes the need for a well-defined algorithm to identify high-risk patients.

Inequality trends in the distribution of healthcare human resources in eastern Iran

Background Inequitable distribution of human resources in healthcare is one of the main obstacles to improve any health system. This study aimed to evaluate inequalities in the distribution of human resources in healthcare in South Khorasan Province, Iran. Methods We have investigated three types of health staff (i.e. nurses, general practitioners, and specialists) from 2013 to 2018. Data were collected from the annual reports of the Statistical Centre of Iran. The Gini coefficient and time trend regression were applied to measure the inequality. Results The distribution of specialists and general practitioners were the highest and lowest inequality, respectively. Inequalities in the distribution of nurses and specialists have decreased from 2013 to 2018, while the Gini coefficients of the general practitioners have increased from 0.31 to 0.38. According to the regression analysis, inequality in the distribution of nurses and specialists was decreasing over the time; however, the decline was only significant for specialists. While the coefficient B for general practitioners is positive, this indicates raised inequality, but the observed increase was not significant. Conclusions This study revealed that Iran, similar to several other low- and middle-income countries, is with faced the challenge of inequitable distribution of human resources in healthcare, which in turn indicates the necessity of reforms at national and regional levels to address inequalities in the distribution of healthcare human resources, particularly in South Khorasan Province. Hence, the main policy recommendation is to focus on continuous monitoring and evaluation of resource allocation in South Khorasan Province to reduce inequalities.

Geopolitics of Chabahar Port for Iran, India and Afghanistan

In January 2016, Iran, India and Afghanistan signed a trilateral economic agreement on developing the Chabahar Port in south-eastern Iran. This project holds immense economic and geopolitical value for both Iran and India. Chabahar, as Iran’s first deep water port, connects it to oceanic trade routes. This helps Iran to mitigate US sanctions and sustain trade relations with neighbours and independent states such as India. For India, Chabahar is the key point of the ‘International North–South Transport Corridor’, an ambitious project connecting India to Central Asia and Europe. The article analyses the geostrategic, economic and trade-related importance of Chabahar port from both Iranian and Indian perspectives. This Iranian–Indian trade co-operation is considered a strategic alternative, if not a rival, to the Belt and Road Initiative (BRI) and the China–Pakistan Economic Corridor (CPEC), whose key point is the Gwadar port in Pakistan, next door to Chabahar.

Characteristics of gastric precancerous conditions and Helicobacter pylori infection among dyspeptic patients in north-eastern Iran: is endoscopic biopsy and histopathological assessment necessary?

Background Early detection and appropriate treatment of precancerous, mucosal changes could significantly decrease the prevalence of life-threatening gastric cancer. Biopsy of the normal-appearing mucosa to detect Helicobacter pylori and these conditions is not routinely obtained. This study assesses the prevalence and characteristics of H. pylori infection and precancerous conditions in a group of patients suffering from chronic dyspepsia who were subjected to gastric endoscopy and biopsy mapping. Methods This cross-sectional study included dyspeptic patients, not previously treated for H. pylori, undergoing esophagogastroduodenoscopy (EGD) with their gastric endoscopic biopsies obtained for examination for evidence of H. pylori infection and precancerous conditions. Demographic and clinical data on the gender, smoking, opium addiction, alcohol consumption, medication with aspirin, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) and family history of cancer were collected by interviewing the patients and evaluating their health records. The cohort examined consisted of 585 patients with a mean (SD) age of 48.0 (14.46) years, 397 (67.9%) of whom were women. Results H. pylori infection was identified in 469 patients (80.2%) with the highest prevalence (84.2%) in those aged 40–60 years. Opium addiction correlated with a higher a H. pylori infection rate, while alcohol consumption was associated with a lower rate by Odds Ratio 1.98 (95% CI 1.11–3.52) and 0.49 (95% CI 0.26–0.92), respectively. The prevalence of intestinal metaplasia, gastric atrophy and gastric dysplasia was 15.2, 12.6 and 7.9%, respectively. Increased age, positive H. pylori infection, endoscopic abnormal findings and opium addiction showed a statistically significant association with all precancerous conditions, while NSAID consumption was negatively associated with precancerous conditions. For 121 patients (20.7% of all), the EGD examination revealed normal gastric mucosa, however, for more than half (68/121, 56.2%) of these patients, the histological evaluation showed H. pylori infection, and also signs of atrophic mucosa, intestinal metaplasia and dysplasia in 1.7, 4.1 and 1.7%, respectively. Conclusion EGD with gastric biopsy mapping should be performed even in the presence of normal-appearing mucosa, especially in dyspeptic patients older than 40 years with opium addiction in north-eastern Iran. Owing to the high prevalence of precancerous conditions and H. pylori infection among patients with dyspepsia in parts of Iran, large-scale national screening in this country should be beneficial.

The death anxiety in the shadow of perceived stress: a danger facing hospitalized patients with COVID-19 (Preprint)

UNSTRUCTURED COVID-19 has become a public crisis in the world. This study aimed to determine the relationship between perceived stress and death anxiety in COVID-19 hospitalized patients. Participants consist of 200 COVID-19 patients admitted to a hospital in eastern Iran selected by convenience sample and an online survey. The results showed a significant direct relationship between perceived stress and death anxiety in patients (p <0.05). In addition, perceived stress predicted death anxiety.

Diversity of Hard Tick Populations and Their Geographical Variations in Northwestern Iran

Background: Ticks are forced vertebrate ectoparasites, including humans, and are vectors of serious diseases such as Crimean Congo Hemorrhagic Fever, Relapsing Fever, and various forms of encephalitis. Spatial assessment of the prevalence of ticks and detection of high risk areas for tick-borne disease transmission and evaluation of ecological measures are key aims of this research. Methods: Ticks were collected using standard methods from 27 villages in the region of Sarab County in north-eastern Iran during the four seasons of 2018–2019 and identified using valid keys. The calculations of indices for biodiversity were based on the Margalef index, Shannon-Weiner index and Simpson index. R2.15 Statistical software was used for statistical analysis of indices of biodiversity, and ArcMap10.4.1 software, IDW and GeneralG methods were used. Analysis were used to investigate spatial distribution and to determine important tick hotspots. Results: A total of 2500 animals surveyed, 35% of them were infected. In total, 1416 ticks were caught, 74.6 %, 23.9% and 1.4 % were adult, nymph and larvae respectively. 94% of the ticks were hard ticks including 6 genera. According to the Margalef diversity index, the highest species biodiversity was related to summer (1.4234), and the lowest was relat­ed to winter (0.7379), Conclusion: Large hotspot area was found in the central part of the study area. The area of study was very prone to tick-borne disease transmission in terms of tick diversity and tick species richness. Tick-borne disease control is an im­portant measure.