Background. Epidemiological studies have reported inconsistent associations between opium use and cancer risk. We therefore conducted a systematic review and meta-analysis to investigate the relationship between opium use and cancer risk. Methods. We searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar until February 2021 and references of retrieved relevant articles for observational studies that reported the risk of cancer in relation to opium use. Random-effects models were used to calculate pooled effect sizes (ESs) as well as 95% confidence intervals (CIs) for the association between opium use and cancer risk by considering opium doses and types, duration of consumption, and routes of opium use. Results. In total, 21 observational articles, with a total sample size of 64,412 individuals and 6,658 cases of cancer, were included in this systematic review and meta-analysis. Ever opium users, compared with never opium users, had 3.53 times greater risk of overall cancer (pooled ES: 3.53, 95% CI: 2.60–4.79, P  ≤ 0.01). This positive association was also seen for some individual types of cancers except for esophageal and colon cancers. Also, we found that higher opium doses and higher duration of consumption were associated with an increased risk of overall and individual types of cancer. However, the associations between opium doses and the risk of head and neck and larynx cancers were not significant. In terms of the routes of opium use, both opium ingestion and smoking were positively associated with the risk of cancer. Regarding opium types, we found that using teriak, but not shireh, could increase the risk of cancer. Conclusions. Our findings showed that opium use, particularly in the form of teriak, is a risk factor for cancer.

BACKGROUND Pancreatic cancer (PC) is a deadly disease with a 5-year survival of less than 5%. Worldwide PC incidence rates are lower among women than men. While this suggests a protective role for steroid hormones in PC risk, results from epidemiological studies are not consistent. METHODS 153 new incident PC cases and 202 controls were recruited from a prospective case–control study, running in a referral center for endoscopic ultrasonography during 2011-2017. A structured valid and reliable questionnaire was used for data collection by a few trained interviewers. Odds ratios and 95% confidence intervals for reproductive factors and PC were estimated using logistic regression methods. RESULTS Mean age (SD) of the cases and the controls were 63.18 (11.4) and 63.37 (12.0) years, respectively. Age at menarche, age at menopause, number of parity, gravidity, and abortion were not associated with PC risk. CONCLUSION This study does not support the hypothesis that menstrual and reproductive factors are associated with PC risk.

BACKGROUND Pancreatic cancer (PC) is a deadly, globally increasing cancer. The causes of PC are still insufficiently known, however smoking, diabetes mellitus (DM), and obesity have been identified as risk factors of PC, mostly in the developed countries. We evaluated these risk factors and their contribution to PC among an Iranian population. METHODS Cases and controls were selected from patients who were registered to a tertiary gastrointestinal diseases referral hospital in Tehran, Iran, from Jan 2012 to Jan 2018. Information on risk factors was collected by personal interview using a structured questionnaire. Logistic regression models were used to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS We recruited 470 new patients with histopathological PC diagnosis and 526 sex and age-matched controls. Cigarette-smoking [AOR: 1.65 (1.15-2.38)], opium use [AOR: 1.58 (1.06-2.35)], DM [AOR: 1.99 (1.31-3.02)], and having a history of any cancer in a first-degree family member [AOR: 1.53 (1.14-2.05)] were associated with an increased risk of PC. We did not find an association between obesity [AOR: 0.99 (0.71-1.38)] and PC. Approximately 4.6%, 5.9%, 8.2%, and 10.9% risk of PC were related to cigarettesmoking, opium use, DM, and family history of any cancer, respectively. CONCLUSION This study supports that DM is associated with PC risk; however, similar to many studies in Asia, obesity is not associated with PC in Iranians. DM has the highest impact on PC development in Iranian women.

Introduction: Addison disease (AD) is a relatively uncommon endocrine disease resulting from adrenal insufficiency. Psychiatric symptoms are rare and observed as AD's primary and particularly isolated clinical symptoms. This report presents a case with adrenal insufficiency manifested by the psychotic syndrome. Case Presentation: A 28-year-old Iranian female teacher with a history of immune thrombocytopenic purpura (ITP) and asthma since childhood presented 13 months history of progressive depression with insomnia and nightmare symptoms. After being prescribed haloperidol, clomipramine, and clonazepam for eight months, the patient started abdominal pain and weight loss due to anorexia. Her physical exam showed skin hyperpigmentation in the elbow, knee, ankle, and in the mouth buccal mucosa. Physical examination and initial lab tests suggested adrenal insufficiency. Addison disease was confirmed according to the lab tests and abdominal CT. The symptoms were significantly improved using intravenous hydrocortisone treatment. The patient remained calm and had a normal sleep without depressive symptoms or psychosis after 72 hours of treatment. During one year of follow-up, the patient was in good general condition without psychological symptoms. Conclusions: This report shows that psychotic disorder can be the first manifestation of Addison disease. Therefore, physicians should be informed about the neuropsychiatric symptoms of adrenal insufficiency, especially when the patient lacks a family or personal history of psychiatric illness.