Tehran University Medical Journal

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In this survey, 600 autopsy files from Legal Medicine Center were reviewed to find out the cause of death in traumatic patients. The results are presented by age, gender, type of trauma and cause of death. The most common type of trauma is vehicle accidents and 70% of subjects are males. Trauma resulting in death is most common ing third decade of life

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Nowadays, trauma is a major complex of industrial and developed countries. Integrated trauma systems have been used for many years to evaluate and minimize the severity of trauma outcomes (mortality and morbidity). We haven't had any trauma system or any comprehensive study, giving us proper information about our country trauma state. This article is based on comprehensive information of a descriptive prospective cohort study, performed in one year period in 3 major trauma centers in Tehran, evaluating 58005 Traumatic patients, referred to emergency rooms of these hospitals. In this article we have tried to represent a complete report of our patients' epidemiologic and demographic factors and trauma inducing mechanisms including traffic accidents, falls, gunshots, cutting objects ..., and their effect on the severity of injury and patients' outcome. Based on our study, traumatic patients are mainly young (age mode between 20-29) males (80%). The majority of patients were illiterate or had a low level of education. The most common mechanism of trauma was hitting of blunt objects (44.9%), however, it was car accidents in hospitalized and severely injured patients (39.9% and 53.7% respectively). The mechanism of trauma correlates significantly to the severity of injury, the need to hospitalization and the patients' outcome. In our study gunshots, car accidents and falls are the most important trauma inducing factors.

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Background and Aim: The better understanding of immunopathologic mechanism of tuberculosis (TB) is necessary for the production of new vaccines and adjunctive immunomodulator drugs. Intended to this object, the following study including the measurement of serum concentrations of Th1 (Interferon (IFN)-y and interkeukin (IL)-2 and Th2 cytokines(IL-4AND IL-10 ) in patients with sputum smear-positive pulmonary TB and comparisons of them with PPpositive healthy persons, was designed.

Materials and Methods: The HIV-negative patients that had sputum smear-positive pulmonary TB as defined WHO criteria and hospitalized in the infectious diseases ward of Imam Khomeini hospital or referred to health care centers in the south of Tehran, were included in the study. The PPD-positive healthy persons who were close contacts with pulmonary TB patients, were considered as control group.

Results: In this research 34 active pulmonary TB patients (including17men and 17 woman)and 23 healthy persons with PPD skin test results  or = 10mm (including 12men and 11 woman) were studied. The mean ages of the patients and the healthy persons were 73 and 41 years and 74 and 27 years, respectively. The mean serum IFN-Y concentration was significantly higher in TB patients but the mean serum IL-2 IL-4and IL-10 concentrations were significantly higher in healthy persons. The com parison of the mean serum levels of these cytokines before and during treatment (about 2 months after starting treatment) showed that the amounts of IFN-y and IL4 were increased and the amounts of IL2 and IL-10 were decreased but only the changes of IL-10 were statistically significant. There were no effect on the cytokine changes before and during treatment by age and gender of the patients.

Conclusion: The results of the study of serum Th1 and Th2 cytokines in pulmonary TB patients were different in comparison with the results of the studies of peripheral blood mononuclear cells (PBMCs) stimulated with M.tuberculosis antigens. SO, the simultaneous measurement of them in serum, pleural fluid, BAL fluid and the medium culture of PBMCs stimulated with the antigens is recommended.

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Background: We aimed to demonstrate the mechanism of fracture and functional outcome of patients with hip injury in our clinical setting.
Methods: In a historical cohort, all women 50 years of age and older admitted to three university hospitals of Tehran University of Medical Sciences (Shariati, Imam Khomeini and Sina) with the diagnosis of hip fracture from 21 March 2003 to 21 March 2004 were included in this study (n=115). Follow up was conducted via telephone post and even home visit to record the functional status of the patients at the time of study (5 Jan 2005) measured with Barthel index in addition to the exact mechanism of injuries.
Results: The mean and standard deviation of age were 76.3 ± 10.6 years. About 88.7% of injuries had occurred at home (65.2% on the carpet), the remaining happening in the streets. Mean length of hospitalization was 11 ± 7.9 days. Among our patients, 71% could mobilize spontaneously without aids before injuries. This had reduced to 20% at the time of follow-up. The mean Barthel index was 97.2 ± 8.2 before fracture and 75 ± 21.1 at the present. Among our patients, five cases died during hospitalization and 29 of them died afterwards (total: 34 or 29.6%).
Conclusion: The most common external cause of injuries in our cases was stumbling at home especially on carpeted surfaces. This necessitates preventive measures aimed at physical standards of houses and education of elderly on healthy locomotion, indoors.

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Background: The outcome of acute hepatitis B infection may be influenced by host genetic factors like human leukocyte antigen (HLA). To investigate the association between the HLA-DRB, DQA1 and DQB1 alleles and chronic hepatitis B infection, 50 patients with chronic hepatitis B (based on 6 months positive of HBsAg and HBc antibody and HBeAg and antibody by serological test), were selected from Turkman population in north east of Iran .Allele frequency in patients were compared with a 65 aged and sex match control group from healthy blood donor of that ethnic population.
Methods: HLA DRB, DQA1 and DQB1 alleles were determined using polymerase chain reaction based on sequence specific primer (PCR-SSP) method. Allele frequencies in patients and control subjects were compared by Epi-info statistical soft-wear.
Results: There was a significant increase and positive association in HLA-DRB1*0301, DQA1*0501 and DQB1*0604 allele frequency in patients group while the frequency of HLA-DRB1*1301, 1501 and DQB1*0401 and DQA1*0401, 0102 were lower in patients than control group and shows negative association.
Conclusion: In Iranian Torkman population, HLA DRB1*0301, DQA1*0501 and DQB1*0604 have an important role in susceptibility to chronic hepatitis B infection and HLA DRB1*1301, 1501, DQB1*0401 are associated with protection to chronic hepatitis B infection. Larger case control studies may be helpful to confirm our investigation.

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Background: Laparoscopic hernioplasty is a standard technique with increasing interest of patients and surgeons. Bilateral hernioplasty can be performed by laparoscopy as well. The aim of this study is to show laparoscopic bilateral hernioplasty is an acceptable method and use of eye-shaped mesh getting the best result.
Methods: In 54 cases with bilateral inguinal hernia, under general anesthesia laparos-copic reconstruction with eye-shaped prolene mesh performed. All cases of recurrent, big, direct, indirect and femoral hernia were entered in the study.
Results: Seven of 54 cases were female. Four cases (male) had direct hernia, four female had femoral hernia and remaining of the study group had indirect form. Direct hernia 4 case (male), femoral hernia 4 (female) and remaining were indirect hernia. Operation performed without any complications in all cases. In 12 cases sac of hernia was too much enlarged so technique of bridge at the base of sac used. In five cases diameter of defect was more than 2 centimeter. In three of them defect repaired by suture before mesh insertion. Postoperative complications were seroma at distal of mesh in 23 cases (absorbed during 3 weeks spontaneously), reaction to mesh in one case (mesh and protack removed after 3 months of operation. Conservative management was ineffective and anterior repair performed), recurrence in one case (after 2 months of operation due to displacement of mesh in big direct hernia). Post operative hospital stay was 1.3 day (mean time). Painless movement and mobilization was obvious after 48 hours.
Conclusion: Laparoscopic bilateral hernioplasty using eye-shaped prolene mesh is an acceptable method with good results especially in indirect hernia. In direct hernia, repair of defect by suturing and fixation of mesh is preferred.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Pulmonary resection is one of the most common thoracic surgeries Bronchial stump closure is important topic and still is controversy Bronchial stump closure with stapler is a new method that in addition to rapidity, lowering separation and dehiscence of suture line and lowering contamination of the operative site with bronchial secretions, and lowering the main complication after pulmonary resections which is sustained air leak- main factor in delaying discharge and patients dissatisfaction.
Methods: Two groups of 16 patients in a randomized clinical trial compared. In one group bronchial stump closed with stapler and the other stump closed with hand sewn method. Bronchial closing time, Operative time, time of airleak, time of chest tube, time of discharge and complication recorded and compared.
Results: In the stapler group time of bronchial closing was significantly shorter. Operative time was not different. time of air leak was not statistically different. No patients with long airleak, and the number of patients without airleak was greater. In the stapler group, time of having chest tube was statistically shorter and time of discharge in stapler group was shorter than hand sewn group.
Conclusions: Bronchial closing with stapler in pulmonary resection is a safe method and in addition to rapidity, time of chest tube and time of discharge was shorter. Although Time of air leak was not statistically different but patients in stapler groups had less Days with air leak and long air leak was zero in this group.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Flexor tendon injury is one of the unanswered problems in reconstructive surgery of the hand. Although pull out method is one of the best reconstructive approaches but still is controversial. Surgeons prefer immobilization to prevent laceration at the site of the suture but it may cause adhesion and lead to surgical failure. The aim of this study was to perform a new surgical method to achieve a tendon repair without these problems.
Methods: In this case-series study, 80 fingers with flexor tendon impairment selected and divided into four groups (tendon laceration & avulsion, tendon graft reconstructed in 1 & 2 stages) then patients were surgically treated by the new technique. The most important aspect of the technique is the placement of the suture in the direction of strength therefore, following any tension the suture would be tighter and this point help us to mobilize the injured tendon immediately after the surgery then we analyzed the results depends on the patient's group.
Results: The pull out and surgical (functional) results were evaluated. 97% of the pull out results were good and 3% were poor and surgical results were 23.9% excellent, 52.2% good, 17.9% fair and 6% poor.
Conclusion: Depend on the acceptable results, immobilization in these patients is unnecessary & active and passive range of motion would be gradually increased as soon as possible. However biomechanical studies would be beneficial to evaluate this suture influence and designing future studies to compare this technique with old methods would be essential.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Kienbock disease is characterized by avascular necrosis of the lunate bone. Without treatment, it is usually progressive. While many factors may predispose to Kienbock's disease, it is likely caused by a combination of repetitive loading, vascular risk and mechanical predisposition. Treatments therefore have been designed to decrease compressive loading of the lunate, to prevent lunate collapse, and to allow lunate revascularization. There has been suggested different treatments, no treatment has ever been proved successful and the rate of surgical complication is relatively high. In this study we performed a new surgical method in the treatment of Kienbock disease. In this method we performed lunate decompression which is a very simple procedure and has no potential complication.
Methods: in this study, 11 patients with Kienbock disease in the stage of I to IIIb were surgically treated by a new method of lunate core decompression. The pain, range of motion, functional disability and radiographic indices of the patients were evaluated after two years.
Results: the average age of patients were 29 years, 8(72%) were men. The mean pre-operative pain score (VAS) diminished from 87.5 to 13.5 postoperatively (p<0.001) and DASH score from 84 to 14 (p<0.001) and range of motion was also significantly improved. 7(63%) persons were very satisfied, 2(18%) were satisfied and 2(18%) were not much changed.
Conclusions: Our findings suggest that the new surgical treatment of lunate core decompression could probably be a simple and effective treatment of Kienbock disease without any potential complication.

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Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system with presumed autoimmune origin. T cells are considered to play a pivotal role in orchestrating the self-reactive immune responses in multiple sclerosis (MS). This study was performed to investigate the role of polymorphisms of the programmed cell death 1 (PD-1) gene on susceptibility to ankylosing spondylitis.This gene codes an immunoreceptor named PD-1, which has a cytoplasmic domain containing two tyrosine residues located within immunoreceptor tyrosine-based inhibitory and switch motifs (ITIM and ITSM), suggesting that PD-1 is predominantly inhibitory which responsible for the negative regulation in T cell activation and peripheral tolerance. We investigated whether PD-1 gene polymorphism is a genetic modifier for risk and progression of MS.Methods: Blood samples from 150 Iranian Relapsing-Remitting MS patients (mean age, 34.98 years) and 202 healthy controls (mean age, 30 years) were enrolled in this study.The PD-1.3 (7146 G/A Intron 4) and PD-1.9 (7625 C/T Exon 5) polymorphisms were detected by Polymerase Chain Reaction and Restriction Enzyme digestion or Restriction Fragment Length Polymorphism (PCR-RFLP). Results: No significant association of the mutated alleles with the disease were detected. Because of the ethnic group genetic variation, our data is not like some of Asian population such as Korea and China.Conclusions: Our data suggest that PD-1 polymorphisms are not act as genetic modifiers of the progression of MS, possibly these polymorphisms don't induce a partial defect in PD-1 mediated inhibition of T-cell activation.

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Background: Based on the reports, high frequency of special alleles of HLA class II genes might be associated with susceptibility to or protective from a particular cancer. These alleles might vary depending on the geographical region. Here we investigate the association between alleles of HLA class II genes and breast cancer in Iranian women.
Methods: 100 patients with pathologically proved breast cancer who referred to Cancer Institute, Tehran University of Medical Sciences in Tehran, Iran, were divided to two groups based on ages (40 years old and less/ or more than 40 years old) and were randomly selected and compared with a group of 80 healthy blood donor subjects. HLA class II alleles were determined by amplification of DNA with polymerase chain reaction (PCR) method followed by HLA-typing using sequence-specific primer (SSP) for each allele.
Results: The most frequent alleles in the DR and DQ regions in group 1 (40 years old and less) in comparison with control group were HLA-DQA1*0301 (p=0.002) and HLA-DQB1*0302 (p>0.05). In contrast HLA-DQA1*0505 (p=0.004) had significantly lower frequency in this group compared with control group. Patients of group two (more than 40 years old) had a higher frequencies of HLA-DQA1*0301 (p=0.001) and HLA-DRB1*1303 (p=0.02) and a lower frequency of HLA-DQA1*0101 (p=0.002) compared to healthy control.
Conclusion: These findings provide information of a positive and negative association between certain alleles of HLA class II and breast cancer in our population and also might support that the pattern of inheritance in the early and late onset of breast cancer differ substantially.

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Background: Varicocele is a dilated vein of the pampiniform plexus that cause to det-rimental time-dependent effects so this study describes the effect of varicocele on the level of IL-6 and interferon gamma in serum and testis tissue, number of sertoli and spermatogonia cells, seminiferous tubules diameter and sperm activity in immature rats. Methods: Thirty six immature rats, 5-6 weeks aged were investigated in this study. The sham groups underwent sham operation and varicocele groups underwent partial liga-tion of the renal vein. Serum, testis and sperm samples were collected at 9, 11, and 13 weeks after induction of varicocele or sham operation to evaluate histological parame-ters (seminiferous tubules diameter, number of sertoli and spermatogonia cells), per-centage of sperm motility and viability and levels of cytokines. Testicular morphology was evaluated. Results: Varicocele significantly caused an increase in serum and testis IL-6 and inter-feron gamma, compared to related sham groups and previous varicocele groups (P<0.05). Varicocele significantly caused decreases in sertoli cells and spermatogonia cells number with increasing varicocele time, compared to related sham groups and previous varicocele groups (P<0.05). In the evaluation of seminiferous tubules diameter external, internal and epithelium diameter were decreased compared to sham related groups and previous varicocele groups. In all varicocele groups, all kind of sperm motility and viability decreased compared to the related sham-operated groups (P<0.05). Varicocele had deteriorating effects on testis tissue because our observations in varicocele groups demonstrated that the external, internal and germinal epithelium height was reduced by the time and in the evaluation of testicular cells, sertoli and spermatogonia cells number were decreased by the time compared to sham related groups and previous varicocele groups. Conclusion: This study suggests varicocele had a detrimental time-dependent effect on cytokines levels and decrease in sertoli and spermatogonia cells number, seminiferous tubules diameter and sperm indices.

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Background: Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Methods: Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital’s Consultation cen-ter for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome (AIDS). Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method (PCR-SSP). Results: Seventy three patients (59.8%) were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% (95% CI: 0.005-7.30). No association between presence of allele and investigated vari-ables were identified. Conclusion: Frequency of HLA-B*57:01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings.

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Background: Any time before labor that termination of pregnancy for mother and fe-tus is better than keeping pregnancy, this is indication of induction for labor. The condi-tion of cervix is the most important factor for labor induction. Cervical condition, In many cases that candidate for induction of labor before labor pain, is poor. As the cervical ripening is quite important for success of labor induction. This study is attempting to compare two methods of cervical ripening. Methods: During this clinical study, 100 patients admitted in Ahwaz Imam Khomeini Hospital from 2010 to 2011. All of these patients had BISHOP score bellow 5, were di-vided to two groups for cervical ripening. Group one: trans cervical catheter and group two: laminaria. After placing transcervical foley catheter and laminaria for patient in-duction with oxytocin was started according to classic protocol. Then the time lapse from the beginning of induction to enter the active phase of labor and also from start of induction till delivery and appearing the side effect in both group was assessed. The result was analysed by SPSS 16 program. Results: Fifty three of patient (53%) were primiparous and the rest 47 (47%) were mul-tiparous. All of them had bishop score bellow 5. The average age for the patient group 1 was 27.1 and the average age for other group was 27.18. The time lapse from start of induction to enter active phase of labor in first group was 5.7±2.67 hours and this time for 2nd group was 7.51±2.33 hours. Also the time interval between the start of induction and delivery in group 1 was 10.3±4.35 hours and this time for group 2 was 12.5±4.9 hours. In both cases there was meaningful difference between two groups. There was no difference between both group for appearing the side effects. Conclusion: Based on this study, it seems using trans- cervical catheter for cervical rip-ening and aid to successful induction of labor is beneficial.

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Background: The incidence rate of gastric cancer in Western countries has shown a remarkable decline in recent years although it is still the almost common cancer between men in Iran. The proto-oncogene MYC, located at 8q24.1, regulates almost 15% of human genes and is activated in 20% of all tumors. MYC amplification and overexpression of its protein product are observed in 15-30% of gastric neoplasia. The objective of this study was to find the preference of CISH or IHC in the diagnosis and prognosis of gastric cancer. Methods: In this cross-sectional investigation, 102 paraffin blocks samples of Iranian patients with gastric cancers were studied. All the patients had undergone primary surgical resection at the Cancer Institute Hospital, Tehran University of Medical Sciences from 1987 to 1993. CISH and IHC techniques were applied to the samples. CISH was carried out on 3-µm-thick tissue sections and with a ZytoDot CISH Implementation Kit (ZytoVision GmbH, Germany). IHC was down using the HRP method with the monoclonal antibody. A universal peroxidase-conjugated secondary antibody kit was used for the detection system. All samples were gastric adenocarcinoma and were selected randomly. Results: Our data revealed that both diffuse and intestinal types of gastric cancer occurred significantly in men more than women. Our results showed an indication of some correlation between grades and CISH results, although the difference was not significant. Our data also showed that CISH+ patients (43.1%) were more frequent in comparison with IHC+ patients (14.7%). There was a correlation between CISH and IHC. This result revealed that there was a significant difference between grades and IHC. There was also no statistically significant difference between CISH amplification in diffuse and intestinal types. Conclusion: Our conclusion is that for the treatment, management of stomach cancer, and monitoring of progress and prognosis of the tumor that is almost important for patients and clinicians, CISH test is a better and feasible to IHC test, with regards to sensitivity and specificity.

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Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorders in reproductive age women. These women confer with complications of pregnancy such as gestational diabetes, pregnancy-induced hypertension, preeclampsia and neonatal complications such as small for gestational diabetes (SGA) are more prevalence in women with PCOS. The aim of this study was to evaluate the incidence of complications associated with PCOS in pregnant women.

Methods: This was an observational and prospective study which recruited 205 pregnant women with PCOS from Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences (AJUMS) between 2013 and 2014. Inclusion criteria were women with PCOS and gestational age over 20 weeks. The demographic and clinical variables including mother's age, body mass index (BMI) and conditions of pregnancy including pregnancy-induced hypertension, preeclampsia, gestational diabetes and overt diabetes and neonatal complications such as preterm labor (PTL), SGA and intrauterine fetal death (IUFD) were recorded.

Results: The prevalence of hypertension disorders, preeclampsia, gestational diabetes and overt diabetes were observed in 44 (21.5%), 18 (8.8%), 29 (14%) and 22 (11%) patients, respectively. The history of familial diabetes was shown in 28 patients (13.6%). In addition, the history of pregnancy induced hypertension was reported in 25 patients (12.1%). Only 6 patients (2.9%) had history of gestational diabetes. Among neonatal complications due to PCOS, SGA with 15.3% and then PTL with 12.6% had highest prevalence. IUFD was shown only in 2 patients.

Conclusion: Pregnant women with PCOS are at the higher risk for pregnancy and neonatal complications. Specifically, these women should be evaluated for pregnancy induced hypertension during pregnancy than others.

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Background: HLA disease association was investigated in several autoimmune, cancer and infectious diseases. The outcome of tuberculosis (TB) infection may be influenced by host genetic factors like MMP-1, MCP-1, IL-10, IL-12, TNF-α, IFN-γ and human leukocyte antigen (HLA). Given the paucity of information with regard to the association between the human leukocyte antigens (HLA) and TB infection among Iranians, we aimed to identify HLA polymorphisms that might confer susceptibility or protect against TB.

Methods: In this case-control study, to investigate the association between the HLA-DRB1 and DQB1 alleles and TB, 50 patients with tuberculosis were selected from Sistani population in Golstan University of Medical Sciences, Golestan Province, North East of Iran, from September 2015 to February 2016. Allele frequencies in patients were compared with a 100 aged and sex match control group from healthy blood donor of that ethnic population. HLA-DRB1 and -DQB1 alleles were determined using polymerase chain reaction based on sequence specific primer (PCR-SSP) method by low to intermediate resolution kits supplied by CTS (Collaborative Transplant Study, Heidelber University, Germany). Using EPI-info statistical software Chi-square test and fisher exact test, 95% confidence interval and odd ratio were calculated and allele frequencies in patients and control subjects were compared. P-value less than 0.05 were considering statistically significant.

Results: The results of this study showed a significant increase and positive association  with -DRB1*04:03 (OR=3.13, CI 95% (2.47-3.96), -DRB1*14:04 (OR=3.13, CI 95% (2.47-3.96), -DQB1*0201 (OR=2.67, CI 95% (1.18-6.04), -DQB1*0601 (OR=3.16, CI 95% (1.36-7.73) ,while the frequency of -DRB1*07 (OR=0.16, CI 95% (0.05-0.52) were lower in patients than control group and shows negative association.

Conclusion: The results of this study confirmed some of the previous positive and/or negative association, however it is suggested that HLA-DRB1*04:03, -DRB1*14:04, -DQB1*0201, -DQB1*0601- have an important role in susceptibility to tuberculosis infection and -DRB1*07 was associated with protection in Iranian Sistani population. Larger case-control sample size studies may be helpful to confirm our investigation. In addition population-specific studies is needed for evaluation of the role of HLA polymorphisms in tuberculosis in different ethnic groups.

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Background: Cancer is the third leading cause of death in Iran. Cancer treatment is very costly and chemotherapy drugs are one of the main causes of the high cost of cancer treatment. The purpose of this study was to evaluate the cost of chemotherapy drugs of five most common cancers and identifying the factors might affect the costs of chemotherapy drugs in a one of the large provinces of Iran, located in the center of the country.
Methods: In a cross-sectional study, the data of all patients with five common cancer diagnosed from March 2015 to March 2016 in Isfahan Province in Iran were collected from the Cancer Registry Center of Isfahan, as well as the pharmacies which distribute chemotherapy drugs. The required information (including, patient characteristics, type of cancer, and the costs of chemotherapy) of patients was obtained by linking the information of patients registered in the distributor pharmacies with the patients registered at the Isfahan Cancer Registry Center through the national code of the patients.

Results: Breast, skin, colorectal, stomach and thyroid cancers were the most common cancers within the evaluated period of time in Isfahan Province. Colorectal cancer with an annual average total cost of 110,510,720 IRR (Rials) per patient was the most expensive cancer during the evaluated time period while thyroid cancer with an annual average total cost of 40,791,123 IRR per patient was the least costly cancer within the evaluated time period in Isfahan among the five most common cancers, considering the chemotherapy medicines cost. The highest cost in the colorectal cancer was due to the drug cetuximab distributed under the trade name Erbitux®. Regardless of the cancer type, the mean annual total cost of chemotherapy drugs per patient within the considered period of time calculated to be 96,307,145 IRR. Conclusion: The chemotherapy cost of the common cancers was high with an annual average of more than 96 million IRR (Rials) per patient, within the considered time period. This was particularly true for colorectal cancer with an annual average cost of more than 110 million Rials.

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Conclusion: In combination with the carbohydrate adjuvant containing sucrose ester compared to the formulation with alum adjuvant, the NP could provide proper and considerable protection and immunity against the homologous strain (H1N1) of the Influenza A virus. It is recommended that SE usage as an adjuvant results in an adequate immune response and less toxic effect.

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