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Adherence to capecitabine, an effective oral chemotherapy agent, is essential in achieving treatment response in cancer. In this study, we aimed to investigate factors associated with non-adherence to capecitabine in a sample of patients with gastrointestinal cancer. We enrolled 98 patients with colon, rectal or gastric cancers who were undergoing treatment with capecitabine as part of their single or multi-agent chemotherapy regimen. The patients were followed during cohort time up to four consecutive cycles of their chemotherapy. For adherence measurement, the participants were asked to bring back the leftover medicines at the time of follow-up visits and were considered adherent if they had taken ≥95% of their prescribed dose. The mean adherence rate was 97.7%, and the patients were adherent to capecitabine in 93.1% of their cycles. The patients who underwent neoadjuvant chemotherapy were significantly less adherent to capecitabine (60%) as compared with adjuvant (95.2%) and palliative chemotherapy (94.6%) [P=0.004]. Multivariable logistic regression revealed that neoadjuvant chemotherapy and the presence of nausea and mucositis were inversely associated with adherence rate. We did not find any association between adherence and any of our laboratory findings. Our findings suggest a high adherence rate to capecitabine among patients with gastrointestinal cancers. Neoadjuvant chemotherapy and the presence of nausea and mucositis may play a significant role in non-adherence to capecitabine.

BACKGROUND Colorectal cancer (CRC) is one of the most common cancers worldwide. Recently treatments of advanced CRC have been immensely improved. In this study we reported the current state of advanced CRC in Iran regarding treatment and outcomes from 2000 to 2016. METHODS 370 subjects with stage III or IV of the disease were included in this study. Pathological subtypes other than adenocarcinoma were excluded. Demographics and other relevant clinical data were collected. RESULTS Mean age at diagnosis was 55.4 ± 12.6 years. Significant differences regarding the age, sex, primary tumor complication and location, lymph node involvement, and tumor size were not detected between patients with stage III and IV. Overall survival rate at 5 years was 69.5% (95% confidence interval: 60.8% - 76.6%) and 21.73% (95% CI: 12.46% - 32.70%) for patients with stage III and IV, respectively. Analysis of prognostic factors revealed that tumor grade was an independent factor predicting poorer outcome (poorly differentiated vs. well or moderately differentiated). Furthermore, in stage IV of the disease, IVb subgroup was found to be associated with a poorer outcome compared with stage IVa. CONCLUSION Even with the acceptable survival rates and more effective treatments, it seems that clinicopathological characteristics have yet the most important prognostic effect in advanced CRC.

Background and Objective: Excessive daytime sleepiness (EDS) is a common problem in patients referred to sleep clinics, which could result in adverse consequences in their personal and social activities including motor vehicle accidents (MVAs). Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT) are known methods for measuring EDS. In this study, we aimed to evaluate the relationship between EDS and MVAs. Materials and Methods: Medical records of 144 patients (106 men) with EDS referred to Baharloo Sleep Clinic, Tehran, Iran, were assessed in this cross-sectional study. All participants filled out a questionnaire including demographic characteristics, ESS, and history of MVAs due to sleepiness in the last five years and underwent full-night polysomnography (PSG) and MSLT. Sleepiness was categorized to normal, moderate, or severe according to mean sleep latency (MSL) in MSLT. Results: Patients with history of MVAs had a significantly less MSL and higher ESS scores than those without MVAs (6.6 ± 3.9 vs. 9.3 ± 6.5, P = 0.038; and 17.9 ± 4.4 vs. 15.6 ± 5.5, P = 0.030, respectively). MVAs were reported in 41.9%, 31.0%, and 16.1% of patients with severe, moderate, and normal sleepiness, respectively. There was a significant relationship between severity of sleepiness and history of MVAs (P = 0.020). Regression analysis showed that after adjustment for age and sex, ESS and MSL remained significantly different between patients with and without MVAs. Conclusion: ESS score and MSL would help sleep clinicians to find high-risk patients for safety-sensitive jobs, the issue which should not be overlooked by them during visits in sleep clinic.

Background and Objective: Narcolepsy is a disorder recognized by excessive daytime sleepiness (EDS). Several studies demonstrated its association with human leukocyte antigen (HLA) DQB1*0602, DQA1*0102, and DRB1*15. Our study aimed to perform HLA-typing on patients with EDS. Moreover, we performed HLA-typing for family members of the patients. Materials and Methods: We studied 83 patients with EDS and 77 of their first-degree relatives. Patients filled out a questionnaire including Epworth Sleepiness Scale (ESS), and underwent polysomnography (PSG) and multiple sleep latency test (MSLT). The whole blood samples were drawn from the patients and their families for HLA typing (class II). International classification of sleep disorders-2 (ICSD-2) criteria was used as the gold standard for diagnosing narcolepsy. Results: HLA DQB1*0602 was present in 20 (45.5%) of narcoleptic patients and 2 (5.1%) of patients with other causes of EDS. Prevalence of DQB1*0602 in family members of narcoleptic patients were higher than family members of patients with other causes of EDS (38% vs. 11.1%, P = 0.06). DQB1*0602, DQA1*0102, and DRB1*15 were more prevalent in narcoleptic patients with cataplexy than narcoleptic patients without cataplexy and patients with other causes of EDS. The sensitivities of the DQB1*0602 for diagnosing narcolepsy, narcolepsy with cataplexy, and narcolepsy without cataplexy were 40%, 60%, and 20%, respectively; while specificities were 93.9%, 87.9%, and 70.6%, respectively. Conclusion: HLA typing can be helpful in patients with atypical cataplexy and inconclusive MSLT results. More studies of Iranian narcoleptic patients are required for analyzing their HLA sequences.

Abstract Background and Objective: Obstructive sleep apnea (OSA) has been associated with metabolic syndrome, diabe-tes mellitus, and cardiovascular diseases. Insulin resistance and increased leptin levels could explain the impaired meta-bolic conditions in patients with OSA. This study aimed to assess the association of OSA severity with insulin re-sistance and leptin levels in a group of patients referred to a sleep disorders’ clinic. Materials and Methods: Seventeen patients without OSA and 28, 33, and 30 patients with mild, moderate, and se-vere OSA; respectively, were included in this study. All participants underwent full night polysomnography (PSG), and blood samples were collected in the morning after PSG. The insulin resistance index was estimated by homeostasis model assessment (HOMA). Results: HOMA values were not significantly different among the study groups. Significant difference in leptin lev-el was found between patients with severe and mild OSA. Leptin level was significantly correlated with age (r = 33, P = 0.020), apnea–hypopnea index (AHI) (r = 0.41, P = 0.004), and oxygen desaturation index (r = 46, P = 0.030). HOMA was insignificant positive correlation only with triglyceride level (P = 0.010). Stepwise multiple regression analysis showed that AHI, body mass index, and gender were determinants of leptin levels, however, no variable was found for predicting HOMA. Conclusions: Present findings suggest that leptin levels might be independently associated with severity of OSA. Other factors other than insulin resistance should be considered for increasing vascular diseases in patients with OSA.

Narcolepsy is a rare, disabling disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations and sleep paralysis. Several studies demonstrated its association with HLA-DQB1*0602 in various ethnic groups. Our study aimed to determine the prevalence of HLA-DQB1*0602 allele in Iranian patients with narcolepsy and assess its predictive parameters for diagnosing narcolepsy. In addition, car accidents and job problems were assessed among narcoleptic patients. We studied 44 narcoleptic patients, 30 patients with other types of excessive daytime sleepiness (EDS) and 50 healthy age and sex matched individuals in this case-control study. Patients and controls filled out a questionnaire including items about car accidents due to sleepiness and job problems. International classification of sleep disorders-2 criteria was used as the gold standard for diagnosis of narcolepsy. The DNAs isolated from whole blood samples were collected from the patients and controls to assess the presence of HLA-DQB1*0602. The results showed that HLA DQB1*0602 was present in 4 (8%) individual of controls and 20 (45.5%) patients with higher prevalence in patients with cataplexy (78.9%) than patients without cataplexy (p

Background and Objective: STOP-BANG questionnaire is a well-known obstructive sleep apnea (OSA) screening tool. This study aimed to evaluate that patients with high probability of OSA in STOP-BANG questionnaire meet the criteria for assessment by split-night polysomnography (PSG). Materials and Methods: Patients who were admitted to three sleep clinics and underwent full-night PSG entered into the study. The patients filled in the STOP questionnaire at their first clinic visit. Weight, height, and neck circumference were measured by technicians for computing STOP-BANG score. The apnea–hypopnea index (AHI) was used for diagnosis of OSA for which 5 ≤ AHI < 15, 15 ≤ AHI < 30, and AHI ≥ 30 were considered as mild, moderate, and severe OSA, respectively. AHI cutoff levels of 20 and 40 were used to evaluate split-night PSG criteria. Sensitivity analysis was performed for identifying predictive parameters. Results: In assessment of 990 patients, the sensitivity of the STOP-BANG ≥ 3 for OSA diagnosis at AHI thresholds of 5, 15 and 30 were 93, 96 and 97.8, and the specificity were 39, 24.5 and 20, respectively. The specificities of the STOP-BANG score ≥ 7 for OSA diagnosis at AHI thresholds of 20 and 40 were 99.2 and 97.9, and the positive predictive values were 90.5 and 64.3, respectively. Conclusion: We found that the STOP-BANG could be considered not only as an OSA screening test, but also as a test to determine proper patients for split-night PSG, the benefit of which is a cost reduction in OSA management.

Background: Adjuvant chemotherapy (ACT) for patients with Stage II colorectal cancer (CRC) is an area of controversy in oncology. International guidelines recommend the use of ACT in patients with specific high-risk features. This study aimed to investigate the effectiveness of ACT in improving survival in patients with and without high-risk features. Materials and Methods: A total of 225 patients with Stage II CRC who underwent primary tumor resection were included in this study. Patients with one or more high-risk features including T4 tumor, poor differentiation, lymphovascular invasion, perineural invasion, bowel obstruction, local perforation, positive resection margins, or suboptimal lymph node sampling (fewer than 12 nodes) were classified as high risk. The survival analysis was performed between patients who only received curative surgery and those received single-agent (5-fluorouracil [5-FU] and leucovorin [LV] or capecitabine) or multiagent ACT (oxaliplatin and 5-FU + LV or oxaliplatin and capecitabine). Results: The 5-year overall survival (OS) rate was 88.4%, and the 5-year disease-free survival (DFS) rate was 80.4%. The 5-year OS and DFS rates improved insignificantly with ACT (89.8% vs. 81.2%, P = 0.59 and 81.3% vs. 74.6%, P = 0.41, respectively); however, multiagent ACT results to inferior 5-year OS and DFS compared to single-agent ACT (82.1 vs. 92.8%, P = 0.14 and 70.1% vs. 86%, P = 0.07, respectively). ACT was associated with insignificant improved OS and DFS in both high-risk and low-risk groups, but high-risk patients who received multiagent ACT had a significant inferior OS and DFS in comparison with those received single-agent ACT. T4 tumor and obstruction were independent poor prognostic factors affecting OS and DFS. Conclusion: In our population, the improvement of OS and DFS with ACT was not statistically significant in high-risk and low-risk patients with Stage II CRC.

Background and Objective: Obstructive sleep apnea (OSA) is the most common respiratory disorder during sleep and a risk factor for myocardial ischemia. In this study, we evaluated the proportion of subjects at high risk for OSA and prevalence of its predictors among patients admitted for acute myocardial infarction (MI). Materials and Methods: A total of 210 patients with MI admitted at the cardiac care unit of Baharloo Hospital, Tehran, Iran were enrolled in this study. The STOP-BANG questionnaire was used for diagnosing high- risk patients of OSA. Anthropometric and demographic characteristics, family and personal history, results of biochemical tests, and the time of the onset of MI in patients were recorded. Results: Based on the STOP-BANG questionnaire, 112 patients (53.3%) were at high risk for OSA. The lev- el of fasting blood sugar (FBS) was significantly higher in high-risk patients for OSA. Regression analysis showed that FBS could be a predictor of OSA in patients with MI (P value: 0.005). From midnight to 5:59, the frequency of the onset of MI was significantly higher in patients at high risk for OSA compared with those at low risk (42% vs. 16.3%, P

Background and Objective: Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing. Multivariable apnea prediction (MAP) index consists of three questions about the frequency of OSA symptoms plus body mass index (BMI), age and sex that categorizes the patients to low and high risk for OSA using a formula. Objective MAP index was calculated by discounting the questions from formula. In this study, we evaluated the utility of the MAP index and objective MAP index in screening of the OSA. Materials and Methods: In a cross-sectional study, we enrolled 609 patients of three sleep clinics suspected of having OSA who underwent polysomnography (PSG) as a gold standard test for OSA diagnosis. The apnea-hypopnea index (AHI) of the PSG was used to classify the severity of OSA. Results: A significant strong correlation was observed between MAP index and objective MAP index using Spearman’s coefficient (r=0.801, P

Aplastic anemia (AA) is a rare disease in which hematopoietic stem cells are severely diminished resulting in hypocellular bone marrow and pancytopenia. Etiology of AA includes auto immunity, toxins, infection, ionizing radiation, drugs and rare genetic disorders, but in the majority of cases no cause can be identified. In the present study we assessed response rate, survival, relapse and clonal evolution in patients with AA treated with immunosuppressive therapy.Patients with AA who received immunosuppressive therapy between May 1998 and September 2013 were included in this study. Patients with non-severe AA (NSAA) were treated with cyclosporine (CsA) and danazol while patients with severe AA (SAA) as well as patients with NSAA who progressed to SAA after beginning of the treatment, were candidates for receiving antithymocyte globulin in addition to CsA and danazol.Among the 63 studied patients, 29 (46%) had NSAA and 34 (54%) had SAA. Three months after treatment, overall response was 58.6% in NSAA and 12.9% in patients with SAA. Survival of all patients at 5, 10 and 15 years were 73%, 55% and 49%, respectively. Survival rates were significantly higher in patients with NSAA compared to patients with SAA as well as in patients who responded at 6 months compared to non-responders. The relapse risk was 39.7% at 10 years. Relapse occurred in patients who discontinued the therapy more than those who continued taking CsA (p value

Traffic fatalities are a major cause of morbidity and mortality in Iran. Occupational sleep medicine field needs more cost-effective and applicable tests for screening purposes. This study reports on a pilot screening study for drowsy drivers in an urban Iranian sample of commercial drivers. The Maintenance of Wakefulness Test (MWT) measures the ability to remain awake objectively. Sleep latency in MWT is a reasonable predictor of driving simulator performance in drivers. In this study, we evaluate whether the Epworth Sleepiness Scale (ESS) and MWT are equally useful in drivers with possible Excessive Daytime Sleepiness (EDS). 46 consecutive road truck drivers in a transportation terminal entered into this study. The ESS score of patients with normal and abnormal MWT was 3.24±2.4 and 4.08±3 respectively which was not significantly differenced (P value = 0.34). No significant correlation was found between the ESS and sleep latency in MWT (r=-0.28, 95%CI= -0.58 to 0.02). By using the receiver operating characteristic analysis, the area under the curve was found to be 0.57 (95% confidence interval = 0.37- 0.77) which is not statistically acceptable (P value=0.46). Our finding showed that the MWT and ESS do not measure the same parameter.

Abstract : Background: This study evaluated the effect of adjuvant chemotherapy and hormone therapy on overall survival and disease-free survival in patients with breast cancer with hormone receptor-positive, HER2-negative tumor without lymph node involvement. Methods: Breast cancer patients with hormone receptor-positive, HER2-negative, and no lymph node involvement were included in this retrospective cohort study. Patient records were used to collect data on sex, age, time of disease onset, tumor subtype, tumor size, grade, lymphovascular and perineural involvement, ki67, and treatment protocols. Patients were divided into 2 groups: Patients who received both adjuvant chemotherapy and hormonal therapy and patients who received hormonal therapy only. Disease-free survival index (DFS) and overall survival index (OS) were evaluated. Results: Sixty-seven female patients were enrolled in this study. Of them, 68.2% received both adjuvant chemotherapy and hormonal therapy and 31.6% received hormonal therapy only. During follow-up, recurrences occurred in 8 patients. The 3-year and 5-year DFS were 93.4% and 90%, respectively. The 3-year and 5-year DFS were 94% and 92%, respectively, in patients who received both adjuvant chemotherapy and hormonal therapy, and 91% and 85%, respectively, in patients who received hormonal therapy. None of the factors studied affected the 3-year and 5-year DFS. The 3-year and 5-year DFS OS were 98.6% and 96.9%, respectively CONCLUSION: Adjuvant chemotherapy in patients with breast cancer with hormone receptor-positive, HER2-negative, and no lymph node involvement compared with similar patients receiving hormone therapy alone had no significant difference in disease-free survival index and overall survival index. Keywords: breast cancer; disease-free survival index; overall survival index