Tehran University Medical Journal

Breast cancer diagnosis by thermal imaging in the fields of medical and artificial intelligence sciences: review article

Hossein Ghayoumi Zadeh

Breast cancer is the most common cancer in women and one of the leading of death among them. The high and increasing incidence of the disease and its difficult treatment specifically in advanced stages, imposes hard situations for different countries’ health systems. Body temperature is a natural criteria for the diagnosis of diseases. In recent decades extensive research has been conducted to increase the use of thermal cameras and obtain a close relationship between heat and temperature of the skin's physiology. Thermal imaging (thermography) applies infrared method which is fast, non-invasive, non-contact and flexibile to monitor the temperature of the human body. This paper investigates highly diversified studies implemented before and after the year 2000. And it emphasizes mostly on the newely published articles including: performance and evaluation of thermal imaging, the various aspects of imaging as well as The available technology in this field and its disadvantages in the diagnosis of breast cancer. Thermal imaging has been adopted by researchers in the fields of medicine and biomedical engineering for the diagnosis of breast cancer. With the advent of modern infrared cameras, data acquisition and processing techniques, it is now possible to have real time high resolution thermographic images, which is likely to surge further research in this field. Thermography does not provide information on the structures of the breast morphology, but it provides performance information of temperature and breast tissue vessels. It is assumed that the functional changes occured before the start of the structural changes which is the result of disease or cancer. These days, thermal imaging method has not been established as an applicative method for screening or diagnosing purposes in academic centers. But there are different centers that adopt this method for the diognosis and examining purposes. Thermal imaging is an effective method which is highly facilitative for breast cancer screening (due to the low cost and without harms), also, its impact will increase by combining other methods such as a mammogram and sonography. However, it has not been widely recognizesd as an accepted method for determineing the types of tumors (benign and malignant) and diseases of breast tissue.

Diagnostic accuracy of MRI in staging of cervical cancer

Soheila Aminimoghaddam

Background: Cervical cancer is the third most common gynecologic cancer in women worldwide. Cervical cancer has lower incidence and mortality rates than uterine corpus and ovarian cancer, as well as many other cancer sites. Unfortunately, in countries that do not have access to cervical cancer screening and prevention programs, cervical cancer remains the second most common type of cancer. Staging of the disease is made clinically. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) for diagnosing the invasion of cancer to organs and staging of cervical cancer and the relationship between clinical and pathological findings and the sensitivity and specificity of the assay in cervical cancer.

Methods: The study included records of 40 patients with cervical cancer that undergo surgery or Chemoradiation in Firoozgar University Hospital. In this study that made retrospectively, non-randomized, the MRI reports and clinical findings records and pathology results was discussed. The sensitivity and specificity of MRI for diagnosing the invasion to parameters, bladder, rectum, vagina, pelvic wall and it’s accuracy to determine tumor stage has been set.

Results: A total of 40 patients with pathology information of cervical cancer was retrospectively reviewed in the study. The patients were 28-83 years old by mean age of 49.3 Pathology of cervical cancer in 80% of cases was SCC, 15% adenocarcinoma and 5% melanoma. The sensitivity and specificity of MRI for diagnosing invasion of parameter was 76% and 88%. The sensitivity of MRI in the detection of bladder invasion was 100% and specificity of 100%. The sensitivity of MRI in the diagnosis of rectal invasion was 50% and specificity of 100%. The sensitivity of MRI in the diagnosis of pelvic wall invasion was 100% and specificity of 86%. Sensitivity in detecting invasion into the upper third of the vagina was 100%.

Conclusion: Overall, this study showed a good sensitivity and specificity for detecting invasion into the bladder, vagina, pelvic wall and parameters and good specificity for the diagnosis of rectal invasion and acceptable accuracy at 67.5% for detection of tumor stage by MRI show.

Evaluation of frequency of kirsten rat sarcoma gene mutations in Iranian colorectal cancer

Behzad Poopak

Background: Kirsten rat sarcoma (KRAS) gene is a target of genetic alterations which are diagnostic and prognostic biomarkers in patients with metastatic colorectal cancer who are treated with monoclonal anti-EGFR antibodies such as cetuximab and panitumumab. KRAS mutations are seen in 35-42% of patients with colorectal cancer. The high frequency of these mutations in colorectal cancer represents their high potential as a biomarker in early diagnosis of cancer. This study was done to evaluate the frequency of KRAS gene mutations in a small population of Iranian patients suffering from colorectal cancer.

Methods: 50 formalin-fixed paraffin-embedded tissue blocks with colorectal cancer (CRC), already confirmed by histopathology and immunohistochemistry testing, were received to Payvand Clinical and Specialty Laboratory, Tehran, from across the country in 2015. DNA was extracted from the tissue blocks and its quality was then evaluated. The reverse dot blotting method was used to evaluate KRAS gene mutations.

Results: KRAS mutations were found in 42% of the study patients. 30% and 12% of the mutations were found in codon 12 and codon 13, respectively. Moreover, no mutation was found in codon 61. Results also showed that the most frequency of samples examined belonged to male with 68% (average age of 56 years old) and then to female with 32% (median age of 54.8 years old).

Conclusion: This study was performed to evaluate the frequency of KRAS gene mutations in Iranian colorectal cancer patients. According to the study results, the frequency of KRAS mutations was consistent with that of other countries, reported in previous studies. The high prevalence of these mutations in patients with colorectal cancer indicates the important role of these genes in this group of patients. Thus, the presence of these mutations can be used as a suitable biomarker for evaluation of response to targeted therapies in patients suffering from colorectal cancer.

Pregnancy outcome in amniocentesis and chorionic villous sampling: ten- year report

Mahboobeh Shirazi

Background: Chorionic villus sampling refers to a procedure in which small samples of placenta are obtained for prenatal genetic diagnosis, generally in the first trimester of pregnancy in 11 weeks till 13 weeks+6 days. This procedure provides prenatal diagnosis in pregnancy. Amniocentesis is a technique for windrowing amniotic fluid from the uterine cavity using a needle via a trans abdominal approach. Amniocentesis and chorionic villus sampling are invasive prenatal procedure. Their complications are fetal loss vaginal bleeding, rupture of membrane chorioamnionitis and limb reduction. There are some probable predictors of fetal loss after chorionic villus sampling and amniocentesis including maternal age, gestational age, number of needle insertion, previous miscarriage, and placental location. The aim of this study was to compare procedure related complications of amniocentesis and chorionic villus sampling in a tertiary referral hospital in Iran.

Methods: This retrospective cohort study was done in pregnant women who were high risk in genetic screening tests. The pregnancy outcome of women who underwent amniocenthesis and chorionic villus sampling was assessed in Yas Women General Hospital (Mirza Kuchak Khan), Tehran, Iran, from 2001 to 2011. Group one, pregnant women who underwent amniocentesis, was compared with group two, pregnant women that underwent chorionic villus sampling. The statistical analyses were performed with SPSSv.20 using a significant level of α<0.05.

Results: There were no significant differences between the two groups in procedure related fetal loss before 24th weeks of pregnancy (1.1% in chorionic villus sampling group versus 0.6% in amniocentesis group, P=0.318). A significant relationship between the number of needle insertion in the chorionic villus sampling group and fetal loss before 24th weeks of pregnancy was seen P<0.028. There were no significant differences between the two groups in the occurrence of vaginal bleeding, rupture of membrane, pre-term birth, placenta location, low birth weight and very low birth weight. The risk of chorioamnionitis was higher in chorionic villus sampling group (P=0.019). No significant difference was observed between the liquid and bloody amniotic fluid and pregnancy complications.

Conclusion: There was no significant difference between the procedure related complications of amniocentesis and chorionic villus sampling.

The study of psychiatric comorbidity in patient with pemphigus

Leila Mokhtari

Background: The relationship between skin, neuron system and mental status is complicated. Pemphigus is severe and painful autoimmune skin disorder that occurs in 0.5-1 person in 100000. Regarding the critical role of mental status in autoimmune diseases such as pemphigus, the aim of this research was to investigating psychiatric comorbidity in patient with pemphigus.

Methods: This research was a descriptive survey study. The society of this research included the patients with pemphigus referred to Razi Dermatology University Hospital in Tehran. Participants were 200 persons who were selected through available sampling. Finally, 198 persons filled out the demographic questionnaire and symptom checklist-90 (SCL-90).

Results: This research showed that the prevalence of psychiatric disorders in this sample was 62.62%. 28.78% (57 persons) of patients were male and 33.84% (67 persons) were female. In both genders the symptoms of paranoia were the most prevalent disorders (45% in female and 60% in male) and phobia was the least prevalent in our sample (8.2% in female and 24% in male). The upper grade in education, the less prevalent disorders. 81.45% of participants with mental disorders were married and 18.55% of them were single. Of patients only 26.32% had visited the psychiatrist or psychologist and 95.15% of them had used medications. This research also showed that there was a significant difference between two genders. Men showed higher rate of prevalence in psychiatric symptoms than women.

Conclusion: The results showed that psychiatric disorders in patients with pemphigus are high compared to general population. This research congruent with other researches showed that higher age, lower grade of education and marriage related to worse prognosis in psychological status in patient with pemphigus. Thus dermatologists must recognize and manage these psychiatric comorbidities to treat patients effectively and to improve the quality of life in patients with autoimmune diseases such as pemphigus.

Evaluating the relation of rs1801282 polymorphism in PPAR-γ gene with obesity in Tehran Lipid and Glucose Study (TLGS) participants

Maryam-Sadat Daneshpour

Background: Obesity is one of the most important problems in developed countries and cause cardiovascular diseases, diabetes and hypertension. The complex phenotype influenced by both genetic and the environment factors. One of the most important genes which is effective in this phenotype is peroxisome proliferator-activated receptor gamma (PPAR-γ). This study was carried out of investigate the association of Pro12Ala (rs1801282) polymorphism in mentioned gene with obesity in Tehran Lipid and Glucose Study (TLGS).

Methods: The present study done in September 2014 in Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences. For the present case-control study 239 subjects with excess weight and body mass index more than 30 kg/m2 as a case and 240 subjects with normal weight and body mass index less than 25 kg/m2 as a control were selected. The rs1801282 was proliferated, detected and genotyped using tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) method.

Results: The results indicated that there was significant association between the presence of risk allele G of rs1801282 and obesity disease in the TLGS population (P=0.000). Genotype and allelic frequencies of rs1801282 in patient and healthy group were: 55.2% and 23.8% for GG, 24.3% and 30.4% for GC, 20.5% and 45.8% for CC, 67% and 39% for G, 33% and 61% for C, respectively.

Conclusion: The results of study indicated that the presence of G allele could be increase 1.7 the risk of obesity. These differences in patient and healthy group lead us to select this marker as a genetic marker to predict the risk of obesity. There are statistical differences between the distribution of mentioned polymorphism in Tehranian population and other populations. However, replicating the study in a larger population of Tehranian people with more affected cases is suggested to generalize the results of this study.

FOXP3 polymorphism rs2232365 and its association with multiple sclerosis susceptibility

Mohsen Naseri

Background: Multiple sclerosis (MS) is a chronic inflammatory disorder of the CNS characterized by destruction of the myelin sheath, gliosis and progressive neurological dysfunction. The regulatory T (Treg) cells play a major role in the control of the autoimmunity and inflammation. The forkhead box p3 (FOXP3) is a central molecule in the function of Treg cells that play an important role in the immunoregulation. The aim of this study was to investigation single nucleotide polymorphism (SNP), rs2232365, in FOXP3 gene in patients with multiple sclerosis.

Methods: In a case-control study, peripheral blood samples were collected from 90 patients with MS (46 men and 94 women with different patterns of disease) from January 2014 to April 2015 in the Afzalipoor Hospital, Kerman (a city located in the southeast of Iran). In a total, 90 healthy subjects were also enrolled into the investigation as a control group. The healthy subjects were recruited among blood donations of the Kerman Transfusion Organization and interviewed regarding CNS disease, and none of them had any history of CNS diseases or other relevant disorders. The SNP rs2232365 in FOXP3 gene was assessed by single specific primer-polymerase chain reaction (SSP-PCR) method. Finally, statistical analysis was performed using SPSS version 22 (Chicago, IL, USA).

Results: In both patients and healthy control groups, there was significant difference among subjects with GG, AG, and AA genotypes at rs2232365 in FOXP3 gene. The frequencies of AA and AG genotypes at rs2232365 in the FOXP3 gene were significantly higher in MS group as compared with healthy subjects (P<0.002). Moreover, the frequency of GG genotype was significantly lower in the MS group in comparison with healthy control subjects (P<0.002). The frequency of A allele was significantly higher whereas the frequency of G allele was significantly lower in MS patients as compared with healthy subjects (P<0.001).

Conclusion: The results of the present study suggest that SNP rs2232365 may influence the susceptibility to multiple sclerosis. Therefore, SNP rs3761548 may directly or indirectly alter the level of the FOXP3 protein expression in Treg cells.

The effect of endurance training with cinnamon supplementation on plasma concentrations of liver enzymes (ALT, AST) in women with type II diabetes

Arezoo Tabrizi

Background: Diabetes is associated with many pathological changes and one of the most important consequences of the diabetes is hepatic injury. The present study was performed to investigate the effect of eight weeks endurance training with consumption of cinnamon supplementation on plasma concentrations of liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in women with type II diabetes.

Methods: In this quasi-experimental study, 36 female volunteers with type II diabetes (age 52.72±2.64 years and body mass index 29.28±2.94 Kg/m2) were participated. The subjects were homogenized regarding their body mass index and then were divided randomly into four groups (each group=9 patients): Training, training-cinnamon, cinnamon, and Control. Endurance training was performed for eight weeks (three sessions per week) at the intensity of 60-75% of maximum heart rate for 40-60 minutes. The consumption of cinnamon supplementation was 1.5 gr per day. Plasma concentrations of ALT and AST were measured following 12 hours fasting, 48 hours before and after performing the experiment, by the enzymatic method. Data were analyzed by paired t-test and factorial ANOVA, using SPSS version 21 (Chicago, IL, USA) and at the significant level of P<0.05.

Results: The levels of ALT was reduced in three experimental groups, which only its reduction was significant after consumption of cinnamon P<0.05. Also, plasma concentrations of AST increased in training-cinnamon and decreased in training and cinnamon groups which none of them was not significant. All interventions had no effect on blood fasting glucose in all experimental groups P>0.05. There was no significant difference between groups in pre and posttests.

Conclusion: The results confirm that cinnamon supplementation may be effective in improving the plasma levels of ALT but the intensity and duration of an effective exercise training especially with consumption of cinnamon supplementation simultaneously need more study in diabetic patients.

Determination of propineb residue in consumed tea

Soheil Sobhanardakani

Background: The use of pesticides is essential to pests control in horticultural crops for the production of an adequate food supply for an increasing world population and for the control of insect-borne diseases. Therefore, pesticide residues in environment and food have a negative impact on the health of living organisms especially human. In this regard, the present study was carried out for assessment and comparing of propineb residues in Iranian tea and imported consumed tea.

Methods: In this experimental study, according to the Cochran's sample size formula, 12 samples from 4 brand of imported tea and 6 samples from 2 brand of Iranian tea were collected from market basket of Hamadan City in 2015. After preparation and processing the samples in the laboratory, propineb residues in samples determined using a spectrophotometric method to a wavelength range of 400 nm in 5 replications. Recovery tests were carried out using pesticide-free samples. Also, all statistical analyses were performed using the SPSS statistical package version 19 (Chicago, IL, USA).

Results: The mean concentration of propineb residues in Iranian tea samples were 1.60±0.27 µg/kg and in imported tea samples were 0.78±0.63 µg/kg, respectively and lower than the maximum residue limit (MRL) provided by the European Commission (100 ppb). The results of the comparison of the mean concentration of pesticide residues between Iranian and imported tea samples revealed no statistically significant differences between all the samples together (P=0.17).

Conclusion: The results showed that the residues of propineb were found in all analyzed tea specimens. But according to the mean concentrations of propineb residues in tea samples marketed in Hamedan City were lower than MRL, therefore, no adverse health effects have been established from controlled consuming of tea. Also, concerning increased use of agricultural inputs especially kind of pesticides for pest management by farmers, regular periodic monitoring of chemical pollutants content in Iranian and imported tea are recommended for food safety.

Design and implementation of a children vaccination reminder system based on short message service

Bahareh Azizi

Background: Most problems related to quality of care and patient safety are related to human negligence. One of the causes of these problems is forgetting to do something. This problem can be avoided with information technology in many cases. Some forgotten are very important. Among these is failure to comply with vaccination schedule by parents that can result in inappropriate outcomes. In this study, we developed and evaluated a SMS reminder system for regular and timely vaccination of children.

Methods: In this developmental-applied research, firstly, a child vaccination reminder system was designed and implemented to help parents reduce the forgetfulness. This system based on the child's vaccination history and the date of birth, offer time and type of future vaccines. Then the parents of 27 children, that their vaccination was between 22 June and 21 August 2015, referred to Children's Medical Center, were sent text messages by using this system. We evaluated the accuracy of the system logic by using some scenarios. In addition, we evaluated parents' satisfaction with the system using a questionnaire.

Results: In all cases but one, the system proposed the type and date of future children vaccines correctly. All the parents who have received text messages had good perception and satisfaction on the majority of questions (total mean score of 4.15 out of 5). Most parents (4.92 out of 5) stated that using the system to remind their visit for child immunization was helpful and willing to offer the system to their friends and other families.

Conclusion: Using the short message system is beneficial for parents to remind their children’s vaccination time and increases their satisfaction. So, it can be considered as an important and essential tool in providing healthcare services. SMS is an easy, cheap and effective way to improve the quality of care services.