Non-alcohol fatty liver disease in Asia:Prevention and planning

AIM:To review all of epidemiological aspects of nonalcoholic fatty liver disease(NAFLD) and also prevent this disease is examined.METHODS:We conducted a systematic review according to the PRISMA guidelines.All searches for writing this review is based on the papers was found in Pub Med(MEDLINE),Cochrane database and Scopus in August and September 2014 for topic of NAFLD in Asia and the way of prevention of this disease,with no language limitations.All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed.RESULTS:NAFLD is the most common liver disorder in worldwide,with an estimated with 20%-30% prevalence in Western countries and 2%-4% worldwide.The prevalence of NAFLD in Asia,depending on location(urban vs rural),gender,ethnicity,and age is variable between 15%-20%.According to the many studies in the world,the relationship between NAFLD,obesity,diabetes mellitus,and metabolic syndrome(MS) is quiet obvious.Prevalence of NAFLD in Asian countries seems to be lower than the Western countries but,it has increased recently due to the rise of obesity,type 2 diabetes and MS in this region.One of the main reasons for the increase in obesity,diabetes and MS in Asia is a lifestyle change and industrialization.Today,NAFLD is recognized as a major chronic liver disease in Asia.Therefore,prevention of this disease in Asian countries is very important and the best strategy for prevention and control of NAFLD is lifestyle modifications.Lifestyle modification programs are typically designed to change bad eating habits and increase physical activity that is associated with clinically significant improvements in obesity,type 2 diabetes and MS.CONCLUSION:Prevention of NAFLD is very importantin Asian countries particularly in Arab countries because of high prevalence of obesity,diabetes and MS.

Hepatitis C infection and lymphoproliferative disease:Accidental comorbidities?

Chronic hepatitis C virus(HCV)infection has been associated with liver cancer and cirrhosis,autoimmune disorders such as thyroiditis and mixed cryoglobulinema,and alterations in immune function and chronic inflammation,both implicated in B cell lymphoproliferative diseases that may progress to non-Hodgkin lymphoma(NHL).HCV bound to B cell surface receptors can induce lymphoproliferation,leading to DNA mutations and/or lower antigen response thresholds.These findings and epidemiological reports suggest an association between HCV infection and NHL.We performed a systematic review of the literature to clarify this potential relationship.We searched the English-language literature utilizing Medline,Embase,Paper First,Web ofScience,Google Scholar,and the Cochrane Database of Systematic Reviews,with search terms broadly defined to capture discussions of HCV and its relationship with NHL and/or lymphoproliferative diseases.References were screened to further identify relevant studies and literature in the basic sciences.A total of 62 reports discussing the relationship between HCV,NHL,and lymphoproliferative diseases were identified.Epidemiological studies suggest that at least a portion of NHL may be etiologically attributable to HCV,particularly in areas with high HCV prevalence.Studies that showed a lack of association between HCV infection and lymphoma may have been influenced by small sample size,short follow-up periods,and database limitations.The association appears strongest with the B-cell lymphomas relative to other lymphoproliferative diseases.Mechanisms by which chronic HCV infection promotes lymphoproliferative disease remains unclear.Lymphomagenesis is a multifactorial process involving genetic,environmental,and infectious factors.HCV most probably have a role in the lymphomagenesis but further study to clarify the association and underlying mechanisms is warranted.

Bayesian adjustment for over-estimation and under-estimation of gastric cancer incidence across Iranian provinces

AIM To correct the misclassification in registered gastric cancer incidence across Iranian provinces in cancer registry data. METHODS Gastric cancer data is extracted from Iranian annual of national cancer registration report 2008. A Bayesian method with beta prior is implemented to estimate the rate of misclassification in registering patient'spermanent residence in neighboring province. Each time two neighboring provinces with lower and higher than 100% expected coverage of cancer cases are selected to be entered in the model. The expected coverage of cancerous patient is reported by medical university of each province. It is assumed that some cancer cases from a province with a lower than 100% expected coverage are registered in their neighboring province with more than 100% expected coverage. RESULTS The condition was true for 21 provinces from a total of 30 provinces of Iran. It was estimated that 43% of gastric cancer cases of North and South Khorasan provinces in north-east of Iran was registered in Razavi Khorasan as the neighboring facilitate province; also 72% misclassification was estimated between Sistan and balochestan province and Razavi Khorasan. The misclassification rate was estimated to be 36% between West Azerbaijan province and East Azerbaijan province, 21% between Ardebil province and East Azerbaijan, 63% between Hormozgan province and Fars province, 8% between Chaharmahal and bakhtyari province and Isfahan province, 8% between Kogiloye and boyerahmad province and Isfahan, 43% Golestan province and Mazandaran province, 54% between Bushehr province and Khozestan province, 26% between Ilam province and Khuzestan province, 32% between Qazvin province and Tehran province(capital of Iran), 43% between Markazi province and Tehran, and 37% between Qom province and Tehran. CONCLUSION Policy makers should consider the regional misclassification in the time of programming for cancer control, prevention and resource allocation.

Polyp detection rate and pathological features in patients undergoing a comprehensive colonoscopy screening

AIMTo identify the prevalence, and clinical and pathologic characteristic of colonic polyps among Iranian patients undergoing a comprehensive colonoscopy, and determine the polyp detection rate (PDR) and adenoma detection rate (ADR). METHODSIn this cross-sectional study, demographics and epidemiologic characteristics of 531 persons who underwent colonoscopies between 2014 and 2015 at Mehrad gastrointestinal clinic were determined. Demographics, indication for colonoscopy, colonoscopy findings, number of polyps, and histopathological characteristics of the polyps were examined for each person. RESULTSOur sample included 295 (55.6%) women and 236 (44.4%) men, with a mean age of 50.25 ± 14.89 years. Overall PDR was 23.5% (125/531). ADR and colorectal cancer detection rate in this study were 12.8% and 1.5%, respectively. Polyps were detected more significantly frequently in men than in women (52.8% vs 47.2%, P vs 56.4 years, P CONCLUSIONThe prevalence of polyps and adenomas in this study is less than that reported in the Western populations. In our patients, distal colon is more susceptible to developing polyps and cancer than proximal colon.

Trend of hepatocellular carcinoma incidence after Bayesian correction for misclassified data in Iranian provinces

To study the trend of hepatocellular carcinoma incidence after correcting the misclassification in registering cancer incidence across Iranian provinces in cancer registry data. METHODSIncidence data of hepatocellular carcinoma were extracted from Iranian annual of national cancer registration reports 2004 to 2008. A Bayesian method was implemented to estimate the rate of misclassification in registering cancer incidence in neighboring province. A beta prior is considered for misclassification parameter. Each time two neighboring provinces were selected to be entered in the Bayesian model based on their expected coverage of cancer cases which is reported by medical university of the province. It is assumed that some cancer cases from a province that has an expected coverage of cancer cases lower than 100% are registered in their neighboring facilitate province with more than 100% expected coverage. RESULTSThere is an increase in the rate of hepatocellular carcinoma in Iran. Among total of 30 provinces of Iran, 21 provinces were selected to be entered to the Bayesian model for correcting the existed misclassification. Provinces with more medical facilities of Iran are Tehran (capital of the country), Razavi Khorasan in north-east of Iran, East Azerbaijan in north-west of the country, Isfahan in central part and near to Tehran, Khozestan and Fars in south and Mazandaran in north of the Iran, had an expected coverage more than their expectation. Those provinces had significantly higher rates of hepatocellular carcinoma than their neighboring provinces. In years 2004 to 2008, it was estimated to be on average 34% misclassification between North Khorasan province and Razavi Khorasan, 43% between South Khorasan province and Razavi Khorasan, 47% between Sistan and balochestan province and Razavi Khorasan, 23% between West Azerbaijan province and East Azerbaijan province, 25% between Ardebil province and East Azerbaijan province, 41% between Hormozgan province and Fars province, 22% betweenChaharmahal and bakhtyari province and Isfahan province, 22% between Kogiloye and boyerahmad province and Isfahan, 22% between Golestan province and Mazandaran province, 43% between Bushehr province and Khozestan province, 41% between Ilam province and Khuzestan province, 42% between Qazvin province and Tehran province, 44% between Markazi province and Tehran, and 30% between Qom province and Tehran. CONCLUSIONAccounting and correcting the regional misclassification is necessary for identifying high risk areas and planning for reducing the cancer incidence.

Bayesian adjustment of gastric cancer mortality rate in the presence of misclassification

To correct for misclassification error in registering causes of death in Iran death registry using Bayesian method. METHODSNational death statistic from 2006 to 2010 for gastric cancer which reported annually by the Ministry of Health and Medical Education included in this study. To correct the rate of gastric cancer mortality with reassigning the deaths due to gastric cancer that registered as cancer without detail, a Bayesian method was implemented with Poisson count regression and beta prior for misclassified parameter, assuming 20% misclassification in registering causes of death in Iran. RESULTSRegistered mortality due to gastric cancer from 2006 to 2010 was considered in this study. According to the Bayesian re-estimate, about 3%-7% of deaths due to gastric cancer have registered as cancer without mentioning details. It makes an undercount of gastric cancer mortality in Iranian population. The number and age standardized rate of gastric cancer death is estimated to be 5805 (10.17 per 100000 populations), 5862 (10.51 per 100000 populations), 5731 (10.23 per 100000 populations), 5946 (10.44 per 100000 populations), and 6002 (10.35 per 100000 populations), respectively for years 2006 to 2010. CONCLUSIONThere is an undercount in gastric cancer mortality in Iranian registered data that researchers and authorities should notice that in sequential estimations and policy making.