Vol 49 No 7 (2020)

Published: 2020-06-30

Review Article(s)

  • XML | PDF | downloads: 235 | views: 206 | pages: 1202-1210

    Background: We aimed to use the scientometric approach to evaluate immunological studies on the subject of sulfur mustard over the past 20 years.

    Methods: In this scientometric study, the Web of Science Core Collection was searched on the studies about sulfur mustard. The published papers related to the field of immunology were retrieved from these papers. HistCite software and VOSviewer were the applied software packages for bibliometric analysis, information visualization, and creating bibliometric networks.

    Results: Over the past 20 years, 741 researchers from 22 countries have published 201 scientific papers in 95 journals. Iran and the United States with 93 and 68 published articles ranked at the top. The Journal of International Immunopharmacology, with 33 published papers, 439 Total Global Citation Score (TGCS), and 105 Total Local Citation Score (TLCS) was the most productive and most influential in this regard. The paper entitled "Biomonitoring of exposure to chemical warfare agents: A review" and another paper entitled "Sardasht-Iran Cohort Study of Chemical Warfare Victims: Design and Methods" were the most influential papers in this topic with 200 TGCS and 27 TLCS, respectively. The most productive and the most influential centers were “Immunoregulation Research Center of Shahed University” and “The Janbazan Medical and Engineering Research Center (JMERC),” respectively.

    Conclusion: The result of our report as the unique scientometric evaluation of the research on sulfur mustard and Immunology can be used as a roadmap for authors, researchers, and policymakers to define the best ways to allocate their financial and executive resources.

  • XML | PDF | downloads: 481 | views: 628 | pages: 1211-1221

    Background: The current study aimed to identify effective factors on the death among COVID-19 patients.

    Methods: All articles published in the period Jan 1, 2020, to Mar 23, 2020, written in English and reporting factors associated with COVID-19 mortality were reviewed. The random-effects model with 95% CI was used to calculate the pooled Odds Ratio (OR) and Hazard Ratio (HR). Data were analyzed using Stata ver.11.0.

    Results: The older age OR: 1.21(1.10-1.33) and male gender OR: 1.41(1.04-1.89) were most prone to death due to COVID-19. The Comorbidity with some chronic diseases such as Diabetes type2 OR: 2.42(1.06-5.52), Hypertension OR: 2.54(1.21-5.32), Kidney disorder OR: 2.61(1.22-5.60), Respiratory disorder 3.09 (1.39-6.88) and Heart diseases OR: 4.37 (1.13-16.90) can increase the risk of COVID19 mortality.

    Conclusion: Infection with COVID-19 is associated with substantial mortality mainly in older patients with comorbidities. We found the significant effect of age, gender and comorbidities such as Diabetes Mellitus, Hypertension, Kidney disorders and Heart diseases on the risk of death in patients with COVID-19. The factors associated with mortality found in this research can help to recognize patients with COVID-19 who are at higher risk of a poor prognosis. Monitoring these factors can serve to give early warning for the appropriate interventions.

  • XML | PDF | downloads: 165 | views: 149 | pages: 1222-1231

    Background: This systematic review and meta-analysis was conducted to obtain a conclusive result on the influence of probiotics/synbiotic on serum levels of zonulin. Data related to serum levels of zonulin were extracted to determine the effects of probiotic/synbiotic on intestinal permeability.

    Methods: The literature search was conducted across the Cochrane Central Register of Controlled Trials, PubMed, Scopus and ISI Web of Science, Search up to Nov 2018. Clinical trials evaluating the effect of probiotic/synbiotic on serum zonulin levels of all human subjects were included.

    Results: Nine studies (including 496 intervention and 443 control subjects) met the inclusion criteria for the meta-analysis. According to the meta-analysis, probiotic/synbiotic has a significant effect on serum zonulin reduction (WMD=-10.55 [95% CI: -17.76, -3.34]; P=0.004). However, the high level of heterogeneity was observed among the studies (I2=97.8, P<0.001). The subgroup analysis suggested study quality, blinding, study duration, Participants age, subject's health status and supplement type as sources of heterogeneity.

    Conclusion: Probiotic/synbiotic have favorable effects on serum levels of zonulin as a measure of intestinal permeability. However, the results should be interpreted with caution due to the high heterogeneity and further evidence is required before definitive recommendations can be made.

Original Article(s)

  • XML | PDF | downloads: 172 | views: 172 | pages: 1232-1241

    Background: To investigate the effect of perceptual stress reduction control intervention on the level of symptomatic groups at different time points in breast cancer.

    Methods: A total of 124 breast cancer patients were divided into intervention group and control group, 62 cases in each group. Perioperative nursing and chemotherapy nursing were given to the control group, and the intervention group was given the interventional stress reduction control intervention. The level of symptom clusters of different time points were compared between the two groups.

    Results: The incidence and severity of myelosuppression in the intervention group were slightly lower than those in the control group. The adverse reactions of bone marrow suppression at T3 were much lower than those in the control group, and the differences were significant (P=0.003, P=0.043). The control group had higher incidence and more severe symptoms of nausea, vomiting and diarrhea than the intervention group (P=0.002, P=0.042). The symptoms of breast pain and swelling at T1 in the intervention group were significantly lower than those in the control group (P=0.000, P=0.000). There was no significant difference in breast symptoms between the two groups at T2 and T3 (p>0.05). At the time of T2 and T3 of chemotherapy, the health promotion behavior scores of the intervention group were higher than the control group, and the difference was statistically significant (PT2=0.000, PT3=0.000).

    Conclusion: Perceptual stress reduction control intervention can effectively relieve bone marrow suppression, digestive tract discomfort and breast symptoms, and promote health promotion behavior.

  • XML | PDF | downloads: 127 | views: 305 | pages: 1242-1251

    Background: Chemotherapy may lead to cancer patient malnutrition, associated with reduced response, and increased complications to anticancer therapy. This study aimed to evaluate the nutritional status of Algerian colorectal cancer patients.

    Methods: This cross-sectional study was conducted during 2016-2017 at the Oncology departments from the Algerian East included 90 patients with colorectal cancer. For each patient, a questionnaire, anthropometric measurements and biochemical tests have been done.

    Results: The 50-59 yr and 60-69 age groups represented more than half of the population. Obesity and underweight were significantly higher in female patients according to their actual Body mass index (BMI). Prevalence of underweight increased after cancer diagnosis, while obesity prevalence has decreased significantly. The malnutrition classification based on Mid-upper-arm muscle circumference (MUAMC) and the triceps skinfold thickness (TST) has shown a significant higher prevalence of malnutrition among male patients than females. The classification of Nutrition risk index (NRI) has shown a significant high percentage of male patients having malnutrition. In our study, no significant differences were recorded for biochemical tests. Anemia recorded the higher prevalences for both sex compared to other deficiency. Hypoironemia prevalence’s was higher among male patients than females while hypokalemia and hypoproteinemia prevalence’s were higher in female patients.

    Conclusion: Malnutrition in CRC patients must be combated by early detection to decrease complications associated to cancer and chemotherapy.

  • XML | PDF | downloads: 71 | views: 115 | pages: 1252-1261

    Background: We aimed to investigate the changes of serum adiponectin and glycated albumin (GA) levels in gestational diabetes mellitus patients and their relationship with insulin resistance.

    Methods: Overall, 137 pregnant women were enrolled from Jinan City People's Hospital, Laiwu District, China from Jan 2015 to Jun 2018. Among them, 71 pregnant women with gestational diabetes mellitus were examined as diabetes group, and 66 normal pregnant women as normal pregnant women group. In addition, 58 normal non-pregnant women of childbearing age who were examined in our hospital during the same period were selected as a control group. The serum adiponectin and GA levels of the three groups were compared, and the relationship between serum adiponectin, GA levels and insulin resistance was analyzed.

    Results: The serum adiponectin level of pregnant women in gestational diabetes mellitus (GDM) group was significantly lower than that of normal pregnant women and control group (P=0.031, P=0.027). The serum GA level of pregnant women in GDM group was significantly higher than that of normal pregnant women and control group (P<0.001). Pearson correlation analysis showed that GA was positively correlated with Fasting plasma glucose (FPG), Fasting insulin (FINS) and Insulin resistance index(HOMA-IR) levels (P<0.001), while adiponectin was negatively correlated with FPG FINS and HOMA-IR levels (P<0.001).

    Conclusion: Abnormal levels of serum GA and adiponectin are closely related to insulin resistance in patients with gestational diabetes mellitus. Detection of serum GA and adiponectin levels can diagnose gestational diabetes mellitus quickly and effectively.

  • XML | PDF | downloads: 60 | views: 118 | pages: 1262-1268

    Background: Omitting axillary lymph node dissection (ALND) is recommended for early-stage breast cancer patients with 1-2 sentinel lymph nodes (SLNs) macro-metastases and breast-conserving therapy. However, it is not safe for part of patients, so it is significant to find risk factors and develop a predictive model of non-SLNs metastases in breast cancer patients with 1-2 SLNs macro-metastases and breast-conserving therapy.

    Methods: This retrospective study enrolled 228 breast cancer patients with 1-2 SLNs macro-metastases who underwent ALND and breast-conserving surgery between Jan 2012 and Dec 2017 at Cancer Hospital Chinese Academy of Medical Sciences. Chi-square test and backward stepwise binary logistic regression were used to find factors that influenced non-SLN metastases, then a predictive model was formulated and obtained its area under the curve.

    Results: Tumor pathologic invasion size, number of positive SLNs and ALN status on imaging was associated with non-SLNs metastases. The predictive model was also formulated based on these three factors to assess and the area under the curve of model was 0.708.

    Conclusion: We developed a predictive model to assess the high-risk cohort of patients of non-SLNs metastases which can be an auxiliary tool for doctors.

  • XML | PDF | downloads: 129 | views: 177 | pages: 1269-1277

    Background: To date, there is no data available of health literacy of the population in Kazakhstan. This study was aimed to assess the health literacy of the rural population for the development of the targeted health education programs.

    Methods: The adapted HLS-EU-Q47 survey was carried out among 1650 respondents aged 18-76 from rural settlements in Almaty region of Kazakhstan in 2013. The health literacy competences to assess, understand, appraise and apply health information on healthcare, disease prevention and health promotion were measured. The associations between the health literacy competencies and demographic and socio-economic characteristics were shown through a multiple linear regression analysis.

    Results: The overall health literacy rate of the rural population of Almaty region was problematic and inadequate. With regards to their age, sex, social and economic characteristics, the health literacy competencies differ according to health literacy domain. Respondents with low education level or perceived social status had respectively low health literacy scores, especially in appraising and applying information of disease prevention.

    Conclusion: Low educated people and with lower income have lower health literacy in comparison to respondents with higher education level and higher income. Respondents with higher health literacy have higher rate of self-assessed health.

     

     

     

     

  • XML | PDF | downloads: 77 | views: 109 | pages: 1278-1288

    Background: The role of serum calcium in coronary artery disease (CAD) patients with or without first incident acute myocardial infarction has not been studied previously. This study aimed to assess the relationship between serum calcium and first incident acute myocardial infarction.

    Methods: This cross-sectional study was conducted from Jan 2014 to Dec 2016. All the participants were from our database, described in detail elsewhere including 1609 cases and 3252 controls. Multiple logistic regression was carried out to explore the effect of serum calcium on first incident acute myocardial infarction. Interaction between serum calcium and risk factors were evaluated.

    Results: Patients with first incident acute myocardial infarction have significantly lower serum calcium concentrations than those without acute myocardial infarction (2.18 (0.21) vs 2.24 (0.19) mmol/L, P<0.0001). After adjusting for sex and age, logistic regression showed that serum calcium was significantly associated with first incident acute myocardial infarction (odds ratio (OR): 1.50, 95% confidence interval (CI): 1.41-1.60). Further adjusted for potential confounders, serum calcium was associated with first incident acute myocardial infarction (OR: 1.32, 95% CI: 1.22-1.42). Moreover, the association still existed when patients were divided into subgroups according to gender and age. A significant interaction was found between serum calcium and diabetes mellitus (DM), lipoprotein (a) (Lp (a)), and serum albumin.

    Conclusion: Serum calcium was associated with first incident acute myocardial infarction among CAD patients in both sexes and in age categories. This study provides further evidence showing the value of serum calcium levels in clinical practice.

     

     

  • XML | PDF | downloads: 106 | views: 140 | pages: 1289-1297

    Background: This study aimed to determine the factors affecting early diagnosis and screening behaviors of healthcare workers concerning breast cancer and the breast cancer risk levels using the risk identification model and to evaluate the relationship between breast cancer risk levels and early diagnosis and screening behaviors.

    Methods: Overall, 466 healthcare workers from Balikesir Province, Turkey participated in this cross-sectional study. Data were collected thanks to a questionnaire prepared by the researchers. Cuzick-Tyrer model was utilized to determine breast cancer risk levels.

    Results: 78.1% of the healthcare workers regularly perform breast self-examination (BSE), 11.6% had clinical breast examination (CBE), 7.7% had breast ultrasound scan and 4.5% had mammography. BSE behavior increased, as education level got higher. Mammography screening behavior increased in those aged 40 yr and older and those with breast or ovarian cancer history in their family. There was not any relationship between breast cancer risk levels and early diagnosis and screening behaviors.

    Conclusion: Early diagnosis and screening behaviors of healthcare workers were low concerning breast cancer. Age, education level and family history are the most prominent factors affecting early diagnosis and screening behaviors of healthcare workers. Informing healthcare workers on breast cancer risk factors and screening can make positive contributions to them and the public through them.

  • XML | PDF | downloads: 71 | views: 149 | pages: 1298-1306

    Background: Effect of miR-215 on the expression of tumor suppressor gene retinoblastoma (Rb)1 in Rb cell lines was investigated.

    Methods: A total of 128 patients were selected. The expression of miR‑215 in cancer and adjacent healthy tissues of the 128 patients was detected by reverse transcription-quantitative PCR (RT-qPCR). HXO‑Rb44 and Y79 cell lines were transfected with miR‑215 analogs or miR‑215 inhibitors, and the expression of Rb1 protein in the cell lines was detected by western blotting.

    Results: The expression of miR-215 in the adjacent healthy tissues of patients was significantly lower than that in cancer tissues (P<0.001). The expression of miR-215 in Y79 and HXO-Rb44 cells was significantly higher than that in APRE-19 cells (P<0.001). The expression of miR-215 in HXO-Rb44 cells was significantly higher than that in Y79 cells (P<0.001). The expression of miR-215 was statistically different from the degree of differentiation and nerve infiltration (P<0.05). The expression of Rb1 in cancer tissues was significantly lower than that in adjacent tissues (P<0.001), the expression of APRE-19 was significantly higher than that in Y79 and HXO-Rb44 cells (P<0.001), and the expression of Rb1 in HXO-Rb44 cells was significantly higher than that in Y79 cells (P<0.05). There was a negative correlation between miR-215 and Rb1 in the tissues of patients, and Rb1 expression decreased with the increase of miR-215 (r=-0.576, P<0.001).

    Conclusion: miR‑215 is highly expressed in Rb cell lines, and is related to the clinicopathological features of this disease.

  • XML | PDF | downloads: 85 | views: 158 | pages: 1307-1315

    Background: Toxocariosis is a parasitic disease caused by the larval stage of Toxocara species from dog and cat. It has a worldwide distribution with higher prevalence in children. This study aimed to determine seroprevalence of Toxocara infection and its association with some risk factors among children of Aras Free Zone (Jolfa City) in Northwest of Iran.

    Methods: Sera were collected from 514 children aged 4–12 yr old attending to some medical centers in the study area from May 2018 to Feb 2019. Anti-Toxocara IgG antibodies assay was performed using commercial ELISA kit (Nova Tec, Germany). The seropositivity rate was determined and its association with different demographic criteria and risk factors were statistically analyzed.

    Results: The overall seroprevalence was 2.3% (12/514). Risk factors of children’s age group and contact with either pet animals (dog and cat) and/or soil were significantly associated with seropositivity. However, there was not any relationship between Toxocara infection and gender of children, place of residency (urban or rural) and their mothers’ education level.

    Conclusion: Both girls and boys are at risk of Toxocara infection in the study area. Younger age of childhood and contact with sources of infection were important associated factors. More probably, additional criteria are involved in the initiation of infection.

  • XML | PDF | downloads: 447 | views: 485 | pages: 1316-1323

    Background: Given the epidemic of Corona disease and its associated anxiety, it is necessary to develop a tool to measure anxiety. This study was conducted to instruct Corona Disease Anxiety Scale (CDAS) to measure the level of anxiety, during the prevalence of the COVID-19 in Iran.

    Methods: The present study was considered as applied research in terms of purpose and descriptive-correlational research in terms of methodological. 318 individuals (aged from 18 to 60 years old) completed the Corona Disease Anxiety Scale (CDAS) and the General Health Questionnaire (GHQ) online

    Results: Corona Disease Anxiety Scale had a good internal consistency (α=0.91) and good convergent validity, correlating with the GHQ-28 (r=0.49, P>0.01). Exploratory analysis revealed psychological and physical factors. These 2 factor account for 51% of the total variance and 9 items were loaded on every factor.

    Conclusion: This scale is reliable and valid scale for measuring Corona anxiety in non-clinical Iranian population.

  • XML | PDF | downloads: 56 | views: 135 | pages: 1324-1329

    Background: Tamoxifen (TAM) is widely used for adjuvant therapy in breast cancer patients. Tamoxifen therapy may lead to serious side effects. Anti-apoptotic substances in combination with chemotherapy drugs can result in additive or synergistic effects. Lauryl gallate (LG), a Gallic acid derivative, has been proven to inhibit tumor growth, without affecting normal cells. This study aimed to investigate the synergistic effect of TAM and LG in breast cancer cell line (MCF-7).

    Methods: In this experimental study, performed in ShahreKord University of Medical Science, Iran in 2017, the MCF-7 cells were treated by final concentrations of 10 μM TAM alone, and in combination with 200 μM of LG. We also used EX-527, as SIRT-1 inhibitor to examine the role of SIRT1 in cell apoptosis. BCL-2 and SIRT1 gene expression were measured by real-time PCR method, and cell apoptosis was investigated by flow cytometry.

    Results: Tamoxifen alone and in combination with LG decreased BCL-2 expression 2.64±0.75 and 6.38±1.9 fold, respectively, after 48 h (P<0.05). SIRT1 expression was increased 1.67±0.22 and 2.47±0.34 - fold by TAM alone and in combination with LG, respectively (P<0.05). TAM alone and in combination with LG increased the percentage of apoptotic cells 15.79±2.81 and 60.67±6.23 percent, respectively after 48 h (P<0.001).

    Conclusion: The combination of LG and TAM is more effective for induction of apoptosis of breast cancer cells, compared to individual use of each. Thus, our data pave the way for new therapeutic options for suppressing breast cancer growth.

  • XML | PDF | downloads: 90 | views: 189 | pages: 1330-1338

    Background: Air pollution have led to severe problem of adverse health effect in the world. This study aimed to conduct the health risk assessment, cancer risk analysis, and non-cancer risk for exposure to volatile organic compounds (VOCs) and hydrogen sulfide (H2S) in petrochemical industry.

    Methods: In this cross-sectional research, 123 samples were collected in the ambient air in Iran during winter 2016. For sampling and analysis of VOCs and H2S, 3 methods (numbers 1500, 1501, and 6013) presented by the National Institute of Occupational Safety and Health (NIOSH) were used. For determination of risk assessment of chemical pollutants, semi-quantitative method presented by the Occupational Safety and Health Division, Singapore was used. Finally, for calculation of cancer risk analysis, Chronic Daily Intake (CDI) and calculation of non-cancer risk, Exposure Concentration (EC) were used.

    Results: Average concentration of benzene (2.12±0.95) in breathing zone of workers were higher than the Threshold Limit Values-Time Weighted Average (TLV-TWA) (P<0.05). Among chemical substance, benzene had very high rank of risk in petrochemical industry. Rank of risk for H2S, toluene, and xylene present in the breathing zone of workers was low. The mean cancer risk for workers exposed to benzene was estimated 8.78×10-3, in other words, 8.7 cancer per 1000 i.e. higher than the acceptable standard of 10-6. In our study, non-cancer risk for BTX was higher than the acceptable standard of 1.

    Conclusion: In particular, overall cancer and toxic risk can be associated with long term exposure to benzene.

  • XML | PDF | downloads: 87 | views: 304 | pages: 1339-1347

    Background: Hand Eczema (HE) is chronic skin disease with a high prevalence in population. It has negative impact on the quality of life. Due to the public interest in herbal remedies, we attempt to assess the efficacy of pumpkin ointment in treatment of chronic HE in this research.

    Methods:  This study was conducted in an outpatient clinic at Imam-Khomeini Hospital in Tehran (Iran) from May 2015 to Nov 2016. We performed a double-blind trial on 60 patients with chronic HE randomized to four groups included pumpkin, betamethasone, eucerin and almond ointment (n=15 for each group) for 28 days. Patients were ordered to apply ointments twice a day. Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI) of the patients were evaluated by a dermatologist on the 1st, 14th and 28th d after the start of treatment.

    Results: Patients’ DLQI scores in pumpkin and betamethasone group was significant and pumpkin group showed a better response in quality of life (P=0.001). Betamethasone and pumpkin ointment were effective and showed significant improvement compared with almond and eucerin and reduce HECSI scores (P=0.002 and P=0.012 respectively). Betamethasone ointment outcome on HECSI scores in comparison with topical pumpkin was significant (P<0.001). No clinically adverse effects were observed.

    Conclusion: Although pumpkin ointment showed a better response in patients’ DLQI in HE but it was less effective than betamethasone in decreasing HECSI.

  • XML | PDF | downloads: 70 | views: 300 | pages: 1348-1354

    Background: The head louse infestation is a public health issue in the world especially, affecting most people who live in camps, school-aged children and their families. Head lice treatment has economic ramifications that often under calculated. The aim of this study was evaluation of economic burden associated with head louse infestation in Iran.

    Methods: In a cross-sectional study, 500,002 infestations were diagnosed among suspected head lice infested people who referred to health care system in all provinces of Iran during 2017. Direct and indirect costs related to paid by patients and government systems were extracted by referring to accounting documents and interviews with patients and experts and were recorded in researcher-made forms. Microsoft Excel 2010 software was used for economic burden calculation.

    Results: The incidence rate of head lice infestation in Iran was 500,002/79,926,270 (625.5 per 100,000 populations). Economic burden of head lice in the country was calculated at 5,790,143$. Direct and indirect costs, governmental cost, out of pocket and total costs of head lice were included 3.14$, 2.84$, 5.98$, 5.60$ and 11.58$ per case respectively.

    Conclusion: The direct and indirect costs associated with treatment of infestations were relatively high. Therefore, the creation of medical facilities such as availability of diagnostic and treatment strategies can be effective in the control of infestation. The adoption of infestation prevention methods, such as health education to people at risk of infestation, reduces the incidence of head lice and imposition of related treatment costs on governmental health care system and head lice cases.

  • XML | PDF | downloads: 61 | views: 83 | pages: 1355-1363

    Background: This study measured tetracycline residue in table eggs sampled from Isfahan markets in 2015 and assessed the toxic effects of heated egg yolk on hepatic cells

    Methods: Forty commercial and six locally produced eggs were randomly collected and tested for tetracycline resides using competitive ELISA with a mean recovery value of 65.22% and limit of detection (LOD) of 4 ng/g. For the seven most contaminated samples, albumen and yolk were examined individually and, despite the very low detected level in the yolk, the samples were subjected to boiling for 10 min. Finally, the DNA damaging properties of the raw or treated egg yolks on hepatic cells were investigated using the comet assay.

    Results: The residue levels ranged from <LOD to 9.77 ng/g with a mean value of 4.95 ng/g, which was far below the maximum residue level (MRL) of tetracycline in eggs (200 ng/g) established by the EFSA. The concentration of tetracycline residue in the albumin and yolk of the seven most contaminated samples was 4.75 ng/g and 6.83 ng/g, respectively, while boiling reduced it by 20%. Heat treatment induces DNA damage in HepG2 cells. Heating resulted in a marked increase in the comet length, % DNA in the tail, and tail moment parameters by 60%, 3000%, and 5000%, respectively.

    Conclusion: Despite the low concentration of tetracycline residue in samples, heat treatment can create degenerative compounds from tetracycline that can cause DNA damage in an in vitro model.

  • XML | PDF | downloads: 68 | views: 111 | pages: 1364-1371

    Background: Vesicoureteral reflux (VUR) disease is the most common type of urinary tract anomalies in children. Genetic risk factors may be associated with the etiology of VUR.  The role of the Glutathione S‑transferases (GSTs) as multifunctional enzymes is cellular oxidative stress handling. This is the first study aimed at evaluating the relative risk of GSTP1, GSTM1, and GSTT1 polymorphisms in VUR susceptibility in children and provides new important insights into the genetics of affected children.

    Methods: The study was done in 2013 in Sistan and Baluchestan University, eastern Iran. Genotyping of three GSTP1, GSTM1, and GSTT1 genes were determined using the multiplex polymerase chain reaction assay in 216 reactions for 72 VUR children and 312 reactions for 104 healthy controls.

    Results: The presence of GSTT1 deletion was associated with high risk of VUR in children, whereas GSTP1 and GSTM1 genotypes did not show the same effect. Furthermore, the combination of GSTT1/GSTM1 and GSTT1/ GSTP1 genotypes showed a significant influence on lower risk of VUR in children.

    Conclusion: Deletion of GSTT1 functional gene is a genetic risk factor causing VUR in children. Interestingly, the combination of GSTM1 and GSTP1 null genotypes with GSTT1 has shown a protective role against risk of GSTT1 deletion.

Letter to the Editor