---

Background and Purpose: Each year, about 50,000 new cases of cancer occur in Iran and the most common being the gastrointestinal (GI) tract (38%). Colorectal cancers account for the 3rd and 4th most prevalent cancers in Iranian men and women, respectively. Since genetic and environmental factors lead to differences in colorectal cancer occurrence in different geographic regions and races, we designed a study to assess characteristics of this cancer, in the Guilak race of Mazandaranian people.
Materials and methods: The records of all colorectal cancer patients who were referred to in a private GI clinic or admitted in hospitals and were studied during 1999 to 2007. Data was analyzed using SPSS software, Chi- Square and T-Tests.
Results: 296 cases of colorectal cancers (CRCs) were enrolled in the study. There were 2 cases of colon lymphoma and 1 case of cervical cancer with metastasis to colon. The remaining 293 patients had colorectal Aden carcinoma, of which 152 were males and 141 were females. The mean age of patients was 52.6 ± 15.2 years. 98 patients (33.5%) were under 45 years of age. A total of 70 cases (24%) had familial history of CRC. Moreover, 47% of patients under 45 years had positive familial history for CRC , of whom 43 patients (14.6%) were classified as having Hereditary Non- Polyposis Colorectal Cancer (HNPCC). 125 patients had rectal, while 168 cases had colon cancers. Right- sided colon cancers were 2 times more prevalent than the left- sided involvements. In addition, right- sided colon cancers were relatively more prevalent in those with positive familial history of CRC. Importantly, about half of all patients showed advanced stages of the disease (Lymph node involvement or distal metastases) at the time of diagnosis.
Conclusion: Regarding the younger age of involvement, the significant positive familial history, the more prevalent proximal colon cancers and advanced stages of the disease at the time of diagnosis, we recommend to design screening programs for earlier detection of CRCs in this geographic region.

---

Background and purpose: Apoptosis is a physiological mechanism of programmed cell death that dysregulation in this process may lead to carcinogenesis. Functional gene polymorphism in Fas can alter transcriptional activities and thus change the risks of cancer. A to G substitution in Fas -670 promoter region disrupts the binding site of STAT1 transcription factor. This study aimed to assess the association of genetic variants of Fas -A670G polymorphism with the potential risk of gastric cancer. Materials and methods: Genomic DNA was extracted from 159 patients with gastric adenocarcinoma and 170 healthy people as control group. Two groups had similar age, sex and ethnic background. Gastric cancer was diagnosed based on clinical and endoscopic findings, and pathological confirmations. Genotyping was done according to PCR-RFLP method. The association of genotypes or allele with disease was analyzed by logistic regression model and odd ratio was obtained at confidence level of 0.05. Results: Results showed that the mean age of patients was not significantly different with that of control group. (62.14 + 12, and 58.93 + 14.2, P= 0.9). Also, allele frequency in the patients and controls was not significantly different (58.6% vs. 61.8%, P=0.47). Meanwhile, the genotype frequencies of –A670G polymorphism were significantly different in two groups. The A/G heterozygosity was significantly less frequent in the patients than that of controls (42.4% vs. 51.8%, P=0.041). On the other hand, the presence of heterozygous A670G decreased the cancer risk (R= 0.5 and CI 0.26-0.94). Conclusion: Our findings indicated that A670G polymorphism in Fas promoter region might be associated with the risk of gastric cancer. Therefore, genetic variation in Fas/FasL system may contribute to etiology of gastric cancer due to corruption in apoptotic process.

---

Background and purpose: Ïron deficiency is the most common nutritional deficiency in both developing and developed Çountries. Âmong its symptoms, pica is the most common and may appear in various forms even before anemia. Ït causes problems such as poisoning, intestinal problems, damage to the teeth, and parasitic fungal and bacterial infections, etc. The aim of this study was an epidemiological survey of pica disorder in women with iron deficiency and the associated factors.
Materials and methods: This was a cross-sectional study in which 260 women with iron deficiency anemia were enrolled during one year based on low hemoglobin, its percent saturation and low ferritin levels. Â questionnaire was employed to obtain information such as age, iron supplement use, family history, type of pica, etc.
Results: Âmong the participants, 177 patients (68.1 %) had one or more types of pica and 83 (31.9 %) had none. Moreover, forty four patients (17 %) had pica positive family history. The pica type, from high to low prevalence, consisted of ingesting sugary and starchy materials, ice, curd, plaster, soil, etc.
Çonclusion: Çonsidering the diversity, relatively high prevalence, serious and dangerous complications caused by pica, early treatment of anemia and promotion of public awareness seems necessary

---

Background and purpose: Gastric cancer is one of the most common gastrointestinal cancers in the world. Gastric cancer is the most common cancer in north of Iran. Interleukin-17F (IL-17F) is a pro-inflammatory cytokine expressed by a novel subset of CD4+ Th cells (Th-17), and it causes the occurrence and strengthening the inflammatory response. This study aimed to assess the association between IL-17F- A7488G polymorphism and potential susceptibility to gastric cancer. Materials and methods: A case-control study consisting of 161 gastric cancer patients with mean age 62.14 ± 12.6 and 171 healthy controls with mean age 58.93 ± 14.2 was conducted. Genomic DNA was extracted and genotypes of - A7488G polymorphism were assessed through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The frequency of G allele was higher in gastric cancer patients (12.1%) compared with the control group (9.15%), but these differences were not significant (P═0.22). In addition, the distribution of GG genotype was not significantly differed between the patients and the controls (4.3% vs. 1.8%, P=0.182). Furthermore, logistic regression analysis revealed no significant association between the presence of 7488G allele and clinical stages (P=0.28), tumor grade (P=0.36) and H. pylori infection (P=0.89). Conclusion: These results suggest that IL-17F A7488G polymorphism in the promoter of IL-17F gene is not directly assumed as a genetic risk factor in the predisposition to gastric cancer.

---

Background and purpose: The objective of this study was to determine the influence of 3 vitamin K epoxide reductase complex subunit 1 (VKORC1) polymorphisms (-1639G>A, 1173C>T and 3730G>A) on warfarin dose requirement in patients from Mazandaran province, Iran. Materials and methods: A total of 29 patients taking warfarin for at least 3 months and had stable dose requirements were enrolled in the study. DNA samples from these patients were genotyped for polymorphisms in VKORC1 gene and statistical analysis was performed to examine the associations between demographic characteristics (eg, age, sex, weight, height and BMI), genetic factors, and maintenance dose of warfarin Results: In -1639G>A polymorphism, 25 patients (86.2%) were AA, 2 patients (6.9%) were GA and 2 patients (6.9%) were GG genotype. Mean dose of warfarin in patients with AA genotype was lower but their INR was higher than two others genotypes. In 1173C>T, 26 patients (89.7%) were TT, 2 patients (6.9%) were CC and one patient (3.4%) was CT. Mean dose of warfarin in patients with CT genotype was lower but their INR was higher from two others genotypes. In 3730G>A, 28 patients (96.5%) were GG and only one patient (3.5%) was GA. INR in this patient was higher than other genotype. Significant correlation was obtained only between -1639G>A polymorphism and warfarin dose requirement Conclusion: In the present study, we observed genetic polymorphism in all 3 regions. -1639G>A polymorphism was important determinants of warfarin dose requirements in our patients. Correlation between dose requirements and INR with polymorphisms was similar to other studies however, percentage of genotypes in each polymorphism was different from other populations.

---

Background and purpose: Beside the environmental determinants there are major genetic factors that could cause Myocardial Infarction (MI). The aim of this study was to clarify the relationship between factor V Leiden and prothrombin G20210A with acute MI in patients younger than 50 years of age. Materials and methods: In this case-control study we recruited 101 MI patients and 101 healthy individuals in Fatemeh Zahra Hospital, affiliated to Mazandaran University of Medical Sciences. Demographic information and risk factors including age, past history of MI, diabetes mellitus, hypertension, dyslipidemia, and smoking were recorded. Genes of factor V Leiden and prothrombin G20210A were analyzed using PCRRFLP method. Results: Among all subjects, 191 (94.55%) had no factor V Leiden gene, 10 (4.95 %) were heterozygous, and one (0.49%) was homozygous. In case group, and control group there were seven (6.9%) and three (2.97%) heterozygous for factor V Leiden, respectively (P= 0.27). There was no mutation of prothrombin G20210A gene in 197 (97.5%) individuals and only five (2.5%) were heterozygous. There was no statistically significant difference between the two groups (P= 0.17). Conclusion: The prevalence of factor V Leiden and prothrombin G20210A gene mutation, in patients was not significantly different from that of the normal individuals. However, further studies are recommended in this age group to investigate these factors.

---

Background and purpose: Colorectal cancer is the fourth most common cancer in Iran. The incidence of this cancer, especially in the northern regions in Iran, has increased in the last two decades. This study was designed to update the demographic and clinical characteristics of patients with colorectal cancer in Mazandaran province. Materials and methods: All patients with diagnosis of colorectal cancer who were treated during 2008-2014 in Imam Khomeini Educational Hospital and Touba polyclinic (a university affiliated center) were included. We evaluated the age, sex, location of tumor, stage of tumor, presence of metastasis, location of metastasis, and clinical symptoms. Results: Three hundred and sixty four patients, including 53.4% male and 46.6% female, were examisned. Almost one-third (31.3%) of patients were younger than 50 years of age and there was no significant difference in the mean age of both sexes (p=0.42). At time of diagnosis, 37.2% of patients were in stage 4. Family history of cancer was positive in 45%, and this rate increased to 63.9% in cases younger than 50. The mean age of patients with positive family history was lower compared to those with negative family history (P=0.028). Conclusion: The mean age of colorectal cancer in studied patients, especially those with positive family history, was lower compared to what have been found in similar studies. The majority of patients were in advanced stages at the time of diagnosis. These findings call for more attention to the initial sign and symptoms of colorectal cancer and carrying out screening programs for early diagnosis and treatment.

---

Background and purpose: Anthracycline is a topoisomerase-interacting agent that is used in treatment of many cancers. We investigated the effects of anthracycline in adults using conventional echocardiography and pulse tissue Doppler imaging.

Materials and methods: This observational before-after study was performed in 35 patients being recently diagnosed with cancer for whom ANT therapy was planned. Echocardiography studies were performed before chemotherapy and 6 months after initiation of the study. Additionally, troponin I and creatinine kinase-MB (CK-MB) were measured one month after the initiation of chemotherapy.

Results: Six months after anthracycline therapy, Changes were seen in the systolic and diastolic left ventricular (LV) function. LV ejection fraction significantly decreased (P <0.001). Additionally, LV end-diastolic volume, LV end-systolic volume and left atrial diameter significantly increased compared with the baseline measures. According to the tissue Doppler imaging, the mitral annuli early diastolic (e') velocity significantly reduced, and the E/e' ratio (the peak early diastolic velocity) significantly increased.

Conclusion: Altered LV systolic and diastolic function was observed after anthracycline chemotherapy.

---

Background and purpose: In many countries, measurements are taken to support cancer patients. In Iran the high costs of cancers and increasing incidence of cancer have made health system authorities to plan for this issue as a top priority of healthcare reform program. The aim of this study was to evaluate the performance of this program in cancer patients in Sari Imam Khomeini teaching hospital, Iran.

Materials and methods: An analytical study was performed in which the costs of leukemia patients admitted in Sari Imam Khomeini Hospital (in two six-month periods, April-October 2013 and 2014) were obtained using their medical and billing records. Data analysis was done in SPSS V.21 applying t-test.

Results: Percentage of direct patient costs were 17.12% and 3.02% in 2013 and 2014, respectively. The portion of the medicine fee paid by patients reduced to 7.7% in 2014 (after implementing the healthcare reform program) from 16.8% in 2013. 

Conclusion: Implementation of healthcare reform program has dramatically reduced the direct patient costs in 2014. Also, the fee paid by patients for medicine has reduced by 9% following the program.  Therefore, adopting new policies that could reduce the costs of medications can be of great benefit in reducing financial barriers to patients.

---

According to the corresponding author of the article entitled “Comparative Study of Direct Patient and Drug Costs before and after the Implication of Healthcare Reform Program in Sari, Iran.” that was published in volume 26, issue 144 of this journal, there are mistakes regarding the affiliations of Shokoufeh Nikfar and Pardis Zaboli. The correct affiliations of these authors are in below.

 
Farzaneh Sarkhanlou¹, Majid Saeedi², Ghasem Janbabai³, Shokoufeh Nikfar⁴, Katayoun Morteza-Semnani², Pardis Zaboli⁵
 
1. MSc student of Drug Quality Assurance, Student Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
2. Professor, Department of Pharmaceutics, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
3. Associate Professor, Department of Oncology and Hematology, Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
4. Associate Professor, Department of Pharmacoeconomics and Pharmaceutical administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
5. PhD Candidate of Pharmacoeconomics and Pharmaceutical administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
 

---

In the article published in Volume 27, issue 158, 2017, the Results section in English Abstract have been published incorrectly. The correct Results is given below:
 
Results: The most frequent sizes of mass were 2-4 cm (n=33, 54%) and 4-5 cm (n=23, 38%). Among the patients, 35 (67.3%) had one tumor before, in 11.5% renew tumor happened, and 65.4% had one tumor after treatment. Liver tumors were controlled in 76.9% in case group which was statistically higher than that in control group (P< 0.0001).
 

---

Background and purpose: The impact of cancer on various aspects of life is definitely proven in many studies. In this research, we aimed to study the psychological, social, and economic status of patients with different types of cancer in Mazandaran province, Iran.
Materials and methods: This cross-sectional study was conducted in patients with cancer who were admitted to Sari Imam Khomeini Hospital, 2017. Data was collected using a researcher-made form that was designed to determine the frequency of the most important and the most common psychological, social, and economic components. The form was completed by researchers, at the Cancer Research Center, for 375 patients with cancer who were selected by convenience sampling.
Results: Psychologically, most of the patients accepted their disease at the time of diagnosis (46.9%). Most of the participants mentioned the death of loved ones as the most important bitter incident before the disease (41.6%). Children status was one of the main concerns among the patients (57.3%). From the social point of view, the majority of patients reported optimum emotional relationship with their spouse (75.4%). The results also showed that most of the patients were financially dependent on their spouse (62.7%).
Conclusion: This study suggests that simultaneous attention to psychological, social, and economic aspects of cancer patients can lead to significant outcomes.
 

---

Background and purpose: Leukemia is a group of cancers caused by accumulation of malignant white blood cells in the blood or bone marrow. The aim of this study was to investigate the efficiency of hypnotherapy on pain relief, death anxiety, resilience, and healing of cancer cells in patients with acute myeloid leukemia treated with chemotherapy.
Materials and methods: A quasi-experimental study was carried out in which the research population were 86 patients of whom 26 (aged 30-50 years old) were selected via convenience sampling. They were randomly assigned into either experimental group or control group. Flow cytometry tests were done to confirm acute myeloid leukemia. The McGill Pain Management, Connor-Davidson Resilience scale, and the Collett-Lester Fear of Death Scale were administered to collect the data. Hypnosis therapy (six sessions) was done in experimental group. Data were analyzed applying analysis of covariance in SPSS V22.
Results: Hypnosis therapy was found to have significant effects on mental dimensions in experimental group compared to the control group (P= 0.039). Follow-up investigations showed more changes in death anxiety compared with other two dimensions in experimental group (6.67). Laboratory results indicated the onset of inflammatory reaction in experimental group.
Conclusion: Hypnotherapy is a powerful method in caring for cancer treatment.
 

---

Background and purpose: Decreasing the quality of life in cancer patients is an essential factor that influences their lives during the process of treatment and after that. A lot of studies have been done to evaluate the efficacy of medical agents on quality of life. In this study, we evaluate the efficacy of Bupropion as an antidepressant agent in quality of life of cancer patients.
Materials and Methods: In this double-blind randomized placebo-controlled clinical trial, a total of 30 eligible cancer patients suffering from fatigue were randomly divided into two 15-individual groups of bupropion and placebo. Bupropion was administered 75 mg/day for the first three days and 150 mg/day (in two doses) till the end of the study for group bupropion. Quality of life was measured by EORCT-QLQ-C3 scale. Adverse effects were assessed based on NCI Common Terminology Criteria for Adverse Events. The study was six weeks long and assessments were done at baseline, second week and sixth week.
Results: There was no significant difference in scores between placebo and bupropion at baseline and second week. While, significant difference was seen at the week six (P=0.005 for function, P=0.036 for symptoms and P<0.001 for health).  Between group assessments showed better average score for bupropion in comparison to placebo. Only two cases of adverse effects were reported.
Conclusion: bupropion can be effective in improvement of quality of life in cancer patients

---

 Background and purpose: Given the role of cancer stem cells in cancer, the aim of this study was to determine the expression of LGR5 marker in gastric cancer and its association with cagA genotype of Helicobacter pylori infection.
Materials and methods: A case-control study was performed in gastric biopsy specimens from antrum and body during endoscopic examination of patients attending Sari Touba Clinic, 2017-2018. After reviewing the patient records, the samples from those aged 50 and higher were studied. Case group included gastric cancer specimens with H. pylori infection (n=30) and control group included non-cancerous samples with H. pylori infection (n=30). LGR5 expression and presence of cagA were evaluated by IHC and PCR methods, respectively.
Results: The mean ages of gastric cancer and control group were 69.5±10.1 and 62.3±7.8, respectively (P= 0.003). Twenty three patients (76.7%) in cancer group and 24 patients (80%) in control group were positive for cagA genotype. Overexpression of LGR5 was observed in 15 patients (51.7%) with gastric cancer and 11 patients (39.3%) in control group (P= 0.429).  LGR5 was also overexpressed in 18 cases (40.9%) with cagA positive genotype and 8 cases (61.5%) with negative cagA genotype (P=0.22).
Conclusion: High expression of LGR5 was observed in half of patients with gastric cancer but it was not significantly associated with cagA H.pylori genotype.

---

Background and purpose: Systemic conditions, such as diabetes or cardiovascular disease are associated with periodontal disease. Recent studies suggested a link between periodontitis and gastrointestinal cancers. Due to the importance of this issue, this study aimed to evaluate the prevalence of chronic periodontitis in patients suffering from gastric, esophageal, and colorectal cancers attending Sari Imam Khomeini Hospital, 2017-2018.
Materials and methods: In this cross-sectional study, clinical examination of 100 patients was performed by assessing clinical attachment loss (CAL), bleeding on probing (BOP), and tooth loss. After recording the periodontal pockets' depth and gingival recession, the CAL was calculated. Chronic periodontitis was categorized as mild, moderate, and severe based on classification of periodontal disease. Chi-Square and ANOVA were applied for data analysis.
Results: According to findings in patients with gastric cancer (n= 23) mild, moderate and sever periodontitis were seen in 8.7%, 26.1%, and 26.1%, respectively. There were 10 patients with esophageal cancer of whom 40% were healthy, 40% had moderate periodontitis, and 20% had severe periodontitis. Among patients with colorectal cancer (n=67), 7.5% had mild periodontitis, 46.3% had moderate periodontitis, and 1.5% had severe periodontitis.
Conclusion: In patients with moderate to severe chronic periodontitis, due to the loss of periodontal support of the teeth that leads to loosening the teeth, the chances of tooth loss increase which naturally disrupts the patient's eating process and causes digestive problems.