Vol 49 No 2 (2020)

Published: 2020-01-29

Review Article(s)

  • XML | PDF | downloads: 234 | views: 206 | pages: 211-220

    Background: Road accident statistics has been seen increasing over the years despite numerous efforts made by the authorities. Human factors have contributed 90% of accident occurrence with risky driving behavior being one of the significant human factors that can be further explained through norms. This review paper aimed to investigate the relationship between norms and drivers’ risky driving behavior.

    Methods: A systematic review process was conducted through four academic databases namely Scopus, Wiley Online Library, Emerald and Web of Science of no limitation for date. Overall, 3443 titles were identified and after several screening and reviewing processes, only 27 studies were included.

    Results: The results of the review demonstrated mixed findings between subjective norm and risky driving behavior, whereas the relationship between group norm, moral norm, injunctive norm, descriptive norm and risky driving behavior were observed significant.

    Conclusion: Appropriate educational awareness is required to educate the society in practicing good norms for mutual benefit of the society. Parents also need to set a good example for their children by abiding the traffic rules and regulation.

  • XML | PDF | downloads: 162 | views: 139 | pages: 221-229

    Recently convergence science was proposed and promoted in a large report from US National Science Foundation and Department of Commerce (NSF/DOC). The report was entitled “converging technologies for improving human performance. “It was dealing with converging of four technologies as: Nanotechnology, Biotechnology, Information technology and Cognitive science (NBIC). The report has gained tremendous popularity throughout the academia and scientific world. On Dec 2015 in a monthly meeting of the department of basic science of Iran Academy of Medical Science, the report of NSF/DOC on NBIC has been discussed. A working group has been established for more discussion and application in Iran. Several seminars in this regard have been performed, and presently this technology has been started as pilot in some technical universities in Iran. After US National Research Council (NCR) in the year 2014 and Massachusetts Institute of Technology (MIT) on convergence in biomedicine, the concept opened a new gate to approach solving medical and health care problems; the convergence technology in biomedical sciences has become interested and gained great popularity among the working group of convergence science in academy of medical science. This technology can lead to advances in fighting chronic diseases such as cancer, dementia, psychiatric disorders, disease of aging and others. The following is summary of proposed discussions in several gathered groups of scientists in this field.

Original Article(s)

  • XML | PDF | downloads: 203 | views: 180 | pages: 240-248

    Background: We aimed to compare the efficacy between clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and their effects on IL-6.

    Methods: A retrospective analysis and collection of 200 ACS patients diagnosed by the Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China in 2016 were performed. Patients were randomly divided into clopidogrel group and ticagrelor group. Data of left ventricular ejection fraction and ACS clinical classification before PCI, PCI treatment, IL-6, platelet aggregation status, maximum platelet aggregation rate (MPAR), P2Y12 response unit (PRU) and adverse reaction of patients were collected. After PCI, patients were followed up for 1 year to compare the ischemia after treatment between clopidogrel group and tigravilol group.

    Results: MPAR and PRU after PCI of clopidogrel group were significantly higher than those of ticagrelor group (P<0.05). The expression of IL-6 in two groups peaked at 1 day after PCI and then decreased. That of ticagrelor group was consistently lower than that of clopidogrel group (P<0.05). The incidence of ischemic events after treatment in clopidogrel group was significantly higher than that in ticagrelor group (P<0.001).

    Conclusion: Compared with clopidogrel, tigerrilol had more significant inhibition of platelet aggregation after PCI in ACS patients, and tigerrilol had better effect after interventional treatment in ACS patients. In addition, compared with clopidogrel, tegrel can significantly inhibit the expression of IL-6 in patients with ACS and better alleviate the inflammatory response after PCI.

  • XML | PDF | downloads: 184 | views: 319 | pages: 249-256

    Background: Caregiver burden is a multidimensional response to physical, psychological, emotional, social and financial stressors, usually associated with the experience of caring and can be objective or subjective. The objective of current study was to explore the caregiver burden among parents of hearing impaired and intellectually challenged children in Pakistan.

    Methods: A Comparative cross sectional survey was conducted on n=162 parents of hearing impaired (HI) and intellectually challenged (IC) children from July 2018 to February 2019. Convenient sampling technique was used to collect the data from Parents of hearing impaired and intellectually challenged children with age range 1-16 years in National Institute of Rehabilitation Medicine and Al-Farabi Special Education Institute Islamabad. Caregiver Burden Inventory was used to assess the caregiver burden.

    Results: The results showed a greater need for respite and other services in both groups. Parents of intellectually challenged children need more respite and other services as compared to hearing impaired children (60.62±11.43 ver. 45.74±11.20, p<0.001). A total of 3 (4.0%) parents of hearing impaired children reported rare need for respite and other services, 32(42.7%) reported sometimes and 40(53.3%) reported frequent need. On the other hand 12(13.8%) parents of intellectually disabled children reported sometimes, 66(75.9%) reported quite frequently and 9(10.3%) nearly always a greater need for respite and other services.

    Conclusion: The parents of hearing impaired or intellectually challenged children face significant burden of their disabled child. In addition, due to cognitive deficits that lead to behavioural abnormalities the parents of intellectually challenged children face more burden and stress.

  • XML | PDF | downloads: 120 | views: 117 | pages: 257-266

    Background: We aimed to detect IL-17, MMP-9 and CD23 in serum of patients with colorectal cancer to provide some proper references for diagnosis and treatment of this disease.

    Methods: Overall, 287 patients with colorectal cancer were collected in the Digestive Surgery Department of Chinese PLA General Hospital, Beijing, China from January 2017 to November 2018 and were used as the study group, meanwhile, 200 people who took physical examination in the same period were used as the control group. They were retrospectively analyzed. The concentrations of IL-17, MMP-9 and CD23 in serum were detected by ELISA 10 d before and after treatment and 30 d after treatment. The relationship between IL-17, MMP-9 and CD23 concentration and clinicopathology was analyzed.

    Results: The concentrations of CD23, IL-17 and MMP-9 in peripheral blood of the patients in the study group were significantly higher than those in the control group (P<0.001). IL-17, MMP-9 and CD23 were negatively correlated with treatment time and pathological features in the study group (P<0.001).

    Conclusion: The concentrations of IL-17, MMP-9 and CD23 obviously increased in peripheral blood of patients with colorectal cancer, the three were negatively correlated with treatment time and were significantly correlated with TNM staging and differentiation degree of colorectal cancer. It is expected to estimate the illness.

  • XML | PDF | downloads: 169 | views: 138 | pages: 267-273

    Background: This study attempted to identify the problem South Korea faces in its development of the medical tourism industry from the perspective of English education.

    Methods: To assess the preparedness and problems of future Korean nurses in dealing with foreign patients, a questionnaire was conducted in 2017 on 146 freshman and sophomore nursing major students at CHA University in South Korea.

    Results: Although the nursing major students were highly satisfied with the English instructors, they did not feel that the curriculum prepared them well to deal with foreign patients in the future. They also felt that the teaching methodology employed in the class should be changed to incorporate more medical content into the nursing English program.

    Conclusion: In order for South Korea to play a bigger role in the medical tourism industry, higher education institutions for medicine need to pay more attention to the English education of their students. More specifically, team-taught English for Specific Purposes (ESP) curricula should be established in order to meet the needs of future medical professionals.

  • XML | PDF | downloads: 136 | views: 165 | pages: 274-282

    Background: Lip, oral cavity, and pharyngeal cancers have been globally estimated to account for about 3.8% of all cancer cases and 3.6% of cancer deaths. Mortality of these cancers is generally higher in developing than in developed countries. Overall cancer mortality rate in Serbia is one of the highest in the world. The aim of this study was to determine the mortality rate trends and the most common localization of lip, oral and pharyngeal cancers in Serbia.

    Methods: The study was conducted in 2018 as descriptive epidemiological study and included years from 1999 to 2015. The differences in standardized mortality rates and number of deaths were analyzed with regard to age, gender, and tumor localization. Linear trend and regression were used to determine mortality rate trend.

    Results: There was statistically significant difference in the number of deaths between men and women in the ages of 40 and over (P < 0.01); male/female cancer mortality ratio was 4.56:1. Generally, the most common localization of this carcinoma was hypopharynx. There was no statistically significant increase of mortality rates from these cancers for both genders (males: y = 4.77 + 0.42x, P = 0.069 % change = +20.35; females: y = 1.03 + 0.01x, P = 0.40 % change = +4) during 17-year period.

    Conclusion: Promotion of healthy habits, life-styles and regular inspection of mouth by patients and health professionals should be better prioritized especially in developing countries where implementing and improving national health prevention programs are essential.

  • XML | PDF | downloads: 184 | views: 222 | pages: 283-293

    Background: The proportion of government healthcare expenditure in China increases due to rapid economic development in recent years. The growth of government healthcare expenditure can promote physical health improvement of human capitals and thereby facilitate economic growth. Hence, exploring the effects of government healthcare expenditure on economic growth is important.

    Methods: Spatial correlation of economic growth under different spatial weights was tested, and the effects of government healthcare expenditure on economic growth were analyzed by constructing a spatial Durbin model with the panel data of 31 provinces in China gathered from 2005 to 2017.

    Results: Government healthcare expenditure in China significantly and positively affects economic growth under three spatial weight matrices. The spatial weight of economic distance influences economic growth more significantly compared with the 0–1 spatial weight and the spatial weight of geographical distance. The total and the direct effects of government healthcare expenditure are significantly positive. Furthermore, the direct effects are significant, whereas the indirect effects show different degrees of significance.

    Conclusion: The total effect of government healthcare expenditure on economic growth is significant and positive, with direct effects exceeding the indirect ones. Hence, the China’s government must continue to increase financial investment to public health services to promote high-quality economic growth in the country.

  • XML | PDF | downloads: 188 | views: 269 | pages: 294-303

    Background: The primary indicator of public health, which all nations aim to prolong, is life expectancy at birth. Uncovering its socioeconomic determinants is key to extending life expectancy. This study examined the determinants of life expectancy in Malaysia.

    Methods: This observational study employs secondary data from various official sources of 12 states and one federal territory in Malaysia (2002-2014). Panel data of 78 observations (13 cross-sections at six points in time) were used in multivariate, fixed-effect, regressions to estimate the effects of socioeconomic variables on life expectancy at birth for male, female and both-gender.

    Results: Poverty and income significantly determine female, male, and total life expectancies. Unemployment significantly determines female and total life expectancies, but not male. Income inequality and public spending on health (as a percentage of total health spending) do not significantly determine life expectancy. The coefficients of the multivariate regressions suggest that a 1% reduction in poverty, 1% reduction in unemployment, and around USD 23.20 increase in household monthly income prolong total life expectancy at birth by 17.9, 72.0, and 16.3 d, respectively. The magnitudes of the effects of the socioeconomic variables on life expectancy vary somewhat by gender.

    Conclusion: Life expectancy in Malaysia is higher than the world average and higher than that in some developing countries in the region. However, it is far lower than the advanced world. Reducing poverty and unemployment and increasing income are three effective channels to enhance longevity.

  • XML | PDF | downloads: 119 | views: 150 | pages: 304-311

    Background: To investigate the expression of microRNA-29c (miR-29c) in glioma and its effects on cell proliferation and apoptosis.

    Methods: A retrospective analysis was performed on 76 glioma patients in People's Hospital of Weifang, Weifang, Shandong, China from May 2013 to June 2017 (experimental group) and 63 healthy subjects in the same period (control group). qRT-PCR was used to detect the miR-29c expression. Changes of serum miR-29c expression level and the correlation of miR-29c of glioma patients with the degree of tumor differentiation and pathological type were observed. Cells were grouped before transfection into blank group (no transfection), negative control group (transfected with miRNA NC) and experimental group (transfected with miR-29c mimics). CCK-8 assay was used to detect cell proliferation, flow cytometry to detect apoptosis.

    Results: Expression of miR-29c in serum was significantly lower in experimental group than that in control group (P<0.05). The expression level of miR-29c of glioma patients increased with the degree of tumor differentiation (P<0.05). miR-29c in serum was not significantly correlated with the pathological type.

    Conclusion: miR-29c could inhibit the proliferation of glioma cells and promote apoptosis. miR-29c is lowly expressed in glioma, and the overexpression of which in glioma cells can inhibit tumor cells proliferation and promote apoptosis. It may be a tumor suppressor miRNA of glioma, and the expression level of which can be used as reference for evaluating the grade of glioma. It is indicated that the abnormal expression of miR-29c may be a key factor in the occurrence and development of glioma.

  • XML | PDF | downloads: 133 | views: 166 | pages: 312-322

    Background: High-risk (HR) Human papillomaviruses (HPVs) are known as the main factors implicated in the pathogenesis of cervical preinvasive and invasive lesions. Therefore, the presence or absence of HR-HPV can be followed for the prognosis of low-grade and high-grade squamous intraepithelial lesions. Since the overexpression of p16INK4a protein depends on the presence of transcriptionally-active HPV, and due to its availability and simple interpretation, it may be considered as a proper marker to diagnose cervical cancer.

    Methods: An immunohistochemical analysis of p16INK4a was performed in 72 cervical tissue specimens at Imam Khomeini Complex Hospital (Tehran, Iran) from 2016 to 2018. The performance parameters were calculated and compared using receiving operating characteristics curve (ROC) details.

    Results: p16INK4a is significantly up-regulated in the cervical cancer samples in comparison with that in normal samples. Moreover, the ROC data showed the potential ability of p16INK4a under determined conditions as a diagnostic marker for CIN 2-3 staging and invasive cervical cancer. The molecular typing disclosed the attendance of HPV DNA in 44.4% of cases (32/72) with a predominance of HPV type 16.

    Conclusion: The molecular biomarker p16INK4a can be a good candidate for the early diagnosis and prognosis of cervical cancer in HPV-infected patients. Considering the increase in the expression level of p16INK4a in cancer and precancer tissues, p16INK4a may be used for early detection of cervical cancer.

  • XML | PDF | downloads: 124 | views: 186 | pages: 323-331

    Background: To investigate any subject, a scholar needs a suitable instrument to collect the required information with the utmost accuracy and the least amount of error. Therefore, this study aimed at designing and conducting a psychometric analysis of an assessment instrument for innovation capabilities of Medical Sciences Universities using the Cube Model Approach.

    Methods: This study began by searching in questionnaires in the fields of input and process, considering innovation outcomes. Accordingly, a preliminary questionnaire was developed, and in the second stage, to determine the validity of the designed instrument, the face validity, content validity, and construct validity of the instrument were approved, and in the third stage, using Cronbach's alpha, its reliability was assessed. At first 200 phrases were obtained, finally, 25 questions were initially approved in three areas of structure (input), innovation processes, and output. All the phrases were retained in the face validity and content validity carried out quantitatively and qualitatively.

    Results: Exploratory Factor Analysis was performed on 25 items, and finally the terms were set in six factors. These factors explained 53.19% of the total variance. The rotated factor loading for all questions was obtained more than 0.3, and therefore, no questions were eliminated. Calculation of the Cronbach's alpha coefficient confirmed the high internal consistency of the questionnaire (0.762).

    Conclusion: This instrument was designed for the first time in the context of Iranian academic culture and seems to be a suitable instrument for the assessment of innovation capabilities, considering its adequate validity and reliability, simplicity, and practicality.


  • XML | PDF | downloads: 128 | views: 144 | pages: 332-340

    Background: This study was conducted to evaluate the success rate of male infertility treatment and the factors affecting its outcome.

    Methods: In a historical cohort study, from Mar 2013 to Mar 2014, 323 couples with male factor were investigated. Couples had treated with IUI or/and ICSI were included randomly. Assisted reproduction technology (ART) outcome (treatment success) was defined as a live birth. Age, duration of infertility, type of infertility, treatment history and clinical examination results were investigated. The logistic regression and survival analysis were applied.

    Results: The average of men age, duration of infertility and BMI were 33.5, 4.7 (yr) and 26.6 (kg/m2) respectively. 87.9% of men have primary infertility and average duration of treatment was 14.1(month). Previous treatment, type of infertility, treatment method, man's BMI, normality of sperm and sperm head were important variable that affecting outcome. The rate of live birth in the first attempt was 29.7%, and 44.9% of the couples succeeded to give live birth after several treatment cycles. Couples who had no previous history of treatment were 8.5 times more successful in live birth. The Cox analysis showed that "BMI of man" and percentage of "Sperm with normal head" are predictors that had a significant effect on live birth.

    Conclusion: Live birth in the first treatment cycles was influenced by four variables but two other variable were affecting several treatment cycles outcome. The chances of successful treatment were higher with taking into account the length of time and having live birth was determined as 78% for five years of continuous treatment. 

  • XML | PDF | downloads: 175 | views: 233 | pages: 341-350

    Background: Survival time is one of the indicators used for evaluation of the quality of care in different types of malignancies, including breast cancer. The present study aimed to estimate the survival rate of breast cancer and its related factors among Iranian patients.

    Methods: Overall, 3148 cases of breast cancer who referred to the Cancer Research Center in Shahid Beheshti University of Medical Sciences, Tehran, Iran during 1994-2017 participated in this longitudinal study. Survival estimates were calculated using the Kaplan-Meier method and the Bayesian generalized Birnbaum–Saunders model with cure rate from geometric distribution. Clinical, pathological, and biological variables as potential prognostic factors were entered in univariate and multivariate analyses.

    In order to identify the significant prognostic factors, 95% highest posterior density (HPD) intervals were used.

    Results: The overall 1, 5, 10, 15, 20 and 25-year survival rate were 95%, 75%, 60%, 47%, 46% and 46%, respectively. A significant relation was observed between survival time and the variables such as age, size of tumor, number of lymph nodes, stage, histological grade, estrogen receptor, progesterone receptor, and lymphovascular invasion.

    Conclusion: The findings of this study might help the health managers to plan long-term programs considering regional determinants, public education, and screening for early detection of breast cancer cases which can eventually influence the overall survival rate of these patients.


  • XML | PDF | downloads: 171 | views: 163 | pages: 351-359

    Background: This study aimed to identify the prevalence and potential factors associated with Entamoeba gingivalis in adolescents in the city of Kerman, southeastern Iran, 2017.

    Methods: In this descriptive cross-sectional study, 315 adolescents (mean age; 15 yr) consisting of 189 males and 126 females were randomly selected. For each adolescent, two specimens were collected for culturing and examination by polymerase chain reaction (PCR). Univariate and multivariate logistic regression models were performed to explore any association with demographic and clinical variables.

    Results: The prevalence of E. gingivalis was 11.7%. Totally, 30 (15.9%) males and 7 (5.6%) females were infected with E. gingivalis. The rate of infection in males was 2.8 times higher than that in females (P<0.001). Statistical analysis identified 4 major factors including sex (OR=4.12, P<0.001), gingival index with severe inflammation (OR = 50, P<0.001), Candida spp. infection (OR=4.41, P<0.001) and decay-missing- filled teeth [DMFT (OR=3.27, P<0.001)]. In contrast to the aforementioned factors, adolescents with history of antibiotic consumption were significantly protected from E. gingivalis infection (OR= 3.24, P<0.001). Culture media detected 9.2% (n= 29), whilst PCR identified 11.4% (n= 36) of infection.

    Conclusion: The present findings clearly demonstrate a positive association between E. gingivalis and distinct demographic and clinical risk determinants. Therefore, dental practitioners and health surveillance personnel should be aware of these confounding factors to rigorously detect and critically manage oral health issues in school-age children in order to prevent or at least minimize the eventual periodontal complications in later life.




  • XML | PDF | downloads: 151 | views: 152 | pages: 360-368

    Background: Although the prevalence of abdominal obesity and metabolic syndrome has been widely studied in the adult population, little is known about it in children and adolescents especially in developing countries. This study aimed to determine the prevalence of abdominal obesity and metabolic syndrome among children and adolescents in Yazd Greater Area, Iran; over the period of 2016-2017.

    Methods: This study was part of a larger national study with a cross-sectional design. Using multistage cluster random sampling method, 1035 children, and adolescents of both sexes aged 6-18 yr were randomly selected from rural and urban districts in Yazd Greater Area, Iran. Components of metabolic syndrome, and anthropometry measured in the standard situation.

    Results: The prevalence of abdominal obesity in children 6-10 yr old was 13.2% in boys versus 24.7% in girls. The overall prevalence of metabolic syndrome according to International Diabetes Federation (IDF) criteria in adolescents aged 10-18 yr old was 7.6% (9.4% in boys). The most prevalent metabolic syndrome components were low HDL-cholesterol (56.2%) and abdominal obesity (27.8%).

    Conclusion: Comparatively, the prevalence of metabolic syndrome in Yazd is high. Low HDL-cholesterol levels and abdominal obesity were the most common component, and family history of heart disease, BMI, and male gender were the main determinants of metabolic syndrome in adolescents.

  • XML | PDF | downloads: 120 | views: 140 | pages: 369-376

    Background: After cellulose, chitin is one of the most important polymers in crustaceans, insects, and fungi. Chitosan is one of the most important derivatives of chitin, which has important characteristics including degradability, non-toxicity, and biocompatibility antimicrobial and antioxidant properties.

    Methods: Chitosan was extracted from Penaeus semisulcatus shrimp using chemical methods and the degree of its austenitization was determined using a sub-red spectrophotometer and XRD. The nanoparticles were then synthesized using the ionic gelation method and analyzed through SEM. The antimicrobial effects of nanoparticles were also evaluated using antimicrobial tests on Listeria monocytogenes and Salmonella typhi.

    Results: Nanoparticles have antimicrobial activity and can inhibit bacterial growth at different concentrations.

    Conclusion: Chitosan nanoparticles have an inhibitory effect on Listeria monocytogenes, which is a gram-positive bacterium.


  • XML | PDF | downloads: 124 | views: 114 | pages: 377-385

    Background: Iodine is a key element in the synthesis of thyroid hormones. The deficiency of the secretion of them will Reduce IQ, disturbance in the psychomotor growth and shortened height. Urinary iodine is a good indicator of iodine intake status. Urinary iodine status in at-risk groups is one of the most important indicators of community status.

    Methods: All 56 universities/medical faculties in Iran should determine and report median urinary iodine and its relative distribution in school children aged 8 to 10 yr, to determine the status of urine output. The sample size in each university/college is 240 students and the cluster sampling method (48 clusters in each area in 2016) and based on probability Measurement. The amount of urinary iodine was measured quantitatively by acid digestion.

    Results: The mean urinary iodine excretion was estimated at 18.61 μg/dl. The median urinary iodine concentration in 52 universities was sufficient, and the national mean of urinary iodine excretion rate was 19.3 μg/dl. The iodine status was estimated in the optimal range in 65.6% of the students and in only 4.7% in the range of moderate and severe deficits, based on the urinary iodine index.

    Conclusion: Iodine is sufficient in most parts of the country. The implementation of the country’s national program for the prevention and control of iodine deficiency disorders has made more important the quality control of the collaborative laboratories of this program than before. Moreover, it is absolutely essential to avoid excessive iodine in order to prevent possible side effects.

National Report

  • XML | PDF | downloads: 156 | views: 125 | pages: 230-239

    Background: The level of obesity is related to spatial characteristics around the individual. The objective of this study was to empirically analyze the effect of smoking, drinking, and urban environment on obesity in community residents.

    Methods: This study was conducted for empirical analysis using Ordinary Least Squares (OLS) model not considering time or space-effects, Temporal Autoregressive (TAR) model considering time-effect only, Spatial Autoregressive (SAR) model considering space-model only, and STAR model considering both time and space effects. This study covered 25 autonomous districts in Seoul City, South Korea in terms of space and from 2009 to 2014 in terms of time.

    Results: The STAR model yielded an adjusted R square higher than that from OLS, TAR, or SAR model. Empirical results from the STAR model showed significantly positive (+) effects of the ratio of dependent elders, ratio of smokers, ratio of drinkers, and areas of retail floor space on obesity. In contrast, effects of length of bicycle road and the amount of collected local tax on obesity were negative (-) with statistical significance.

    Conclusion: Smoking and drinking rate and the length of bicycle road can contribute to personal obesity.

Case Report(s)

  • XML | PDF | downloads: 108 | views: 99 | pages: 386-388

    VIPoma is an unusual neuroendocrine neoplasm that autonomously secretes VIP. It is associated with secretory diarrhea and electrolyte disturbances. Herein we report a case of a male patient, who was hospitalized in the Department of Endocrinology in Hedi Chaker Hospital, Sfax, Tunisia. He presented VIPoma syndrome, with hepatic metastases at diagnosis. He had a history of chronic, watery diarrhea. He was dehydrated with many electrolytic disorders as hypokalemia, hyponatremia and metabolic acidosis. Abdominal CT scan showed a heterogeneous mass in the pancreatic head with multiple hepatic lesions. A high VIP hormone level was found. Histological study of a liver biopsy revealed hepatic metastases of neuroendocrine carcinoma. The patient received analogues of somatostatin and systemic chemotherapy, with a transient symptomatic relief. Sadly the patient was lost to follow-up.

Letter to the Editor