ABSTRACT
Background: atherosclerosis is involved in inflammatory diseases, and inflammation can be a valuable predictor of cardiovascular disease. On the other hand, an increase in intima-media thickness [IMT] is usually considered as a primary marker of atherosclerotic lesions.Hence, measurement of IMT may be useful for early detection of atherosclerosis in patients with inflammatory bowel disease [IBD]. The aim of this study was to systematically review the literature in which the IMT had been evaluated as diagnostic marker for the detection of atherosclerosis in patients with IBD
Materials and Methods: a systematic literature search was performed in PubMed, Scopus, and Google scholar using the following search method [[inflammatory bowel disease OR IBD OR Crohn's disease OR ulcerative colitis]] AND [intima OR intima media thickness OR intimal medial thickness OR IMT OR carotid intima-media thickness OR CIMT] to evaluate the association between IBD and IMT. After collecting the eligible documents, the desired data were extracted and analyzed
Results: of total 278 collected documents, only 14 relevant articles with total 1333 participants including 720 patients with IBD and 613 healthy controls were included for data assessment. The results of the articles did not support significant association between IMT and IBD. However, in some studies it was shown that IMT was elevated in patients with IBD
Conclusion: the results of this survey showed that there was no significant difference in IMT between the patients with IBD and healthy control groups; therefore, IMT cannot be considered as a predictor of atherosclerosis and future cardiovascular events in patients with IBD
ABSTRACT
Background: Vitamin D deficiency is believed to cause variety of abnormalities such as liver stifihess and fibrosis. It is also shown that vitamin D deficiency may result in chronic liver disease or liver cirrhosis. In this study, we aimed to systematically review the literature wherein the relationship between vitamin D deficiency and the severity of chronic liver disease or liver cirrhosis had been investigated
Materials and Methods: PubMed, Scopus, and Google scholar were searched using the following search method [vitamin D deficiency OR vitamin D insufficiency OR insufficient vitamin D] AND [chronic liver disease OR chronic hepatitis OR cirrhosis OR liver cirrhosis] AND [severity OR intensity] to evaluate the role of vitamin D deficiency or vitamin D inadequacy in the occurrence and severity of chronic liver disease. Articles were collected and the data were extracted
Results: Totally, 641 articles were found through searching the databases and reference list scanning. Of the collected documents, only 19 articles with 4895 studied patients were included and analyzed. The results of this study showed that almost 80% of patients with chronic liver disease had severe vitamin D deficiency
Conclusion: Vitamin D deficiency is associated with the occurrence of chronic liver disease. The severity of liver cirrhosis is also associated with the level of 25 [OH] in progressive liver disease
ABSTRACT
Background: Delay in diagnosis of celiac disease [CD] occurs frequently, although its consequences are mostly not known. One of the presented symptoms in pe-diatric patients with CD is the short stature. However, far too little attention has been paid to physical features including height of adult patients with CD. This study was undertaken to evaluate whether patients suffering from CD are shorter in comparison with the general population without CD. As well, we evaluated probable correlations between demographic and physical features, main complains, serum anti tTG level, and intestinal pathology damage between short [lower quartile] versus tall stature [upper quartile] patients with CD
Methods: This was a retrospective cross-sectional study on 219 adult patients diagnosed as having CD in the Celiac Disease Center, between June 2008 and June 2014 in Mashhad, Iran. The exclusion criteria were ages less than 18 and more than 60 years. Height was compared with a group of 657 age- and sex-matched control cases from the healthy population. The probable influencing factors on height such as intestinal pathology, serum level of anti-tissue trans- flutaminase [anti-tTG], serum vitamin D, and hemoglobin level at the time of diagnosis were assessed and were compared in short [lower quartile] versus tall stature [upper quartile] patients with CD
Results: Both male [n=65] and female [n=154] patients with CD were shorter than their counterpart in the general population [males: 168.5+/-8.6 to 171.3+/-7.2 cm,p<0.01 and females: 154.8+/-10.58 to 157.8+/-7.2 cm, p<0.01. Spearman linear correlation showed height in patient with CD was correlated with serum hemoglobin [p<0.001, r=0.285] and bone mineral density [p<0.001] and not with serum vitamin D levels [p =0.024, r=0.237], but was not correlated with anti-tTG serum levels [p=0.97]
CD patients with upper and lower quartile of height in men and women had no significant difference in the anti-tTG level and degree of duodenal pathology [Marsh grade]
Anemia as main complaint was more prevalent in shorter versus taller men
Conclusion: Adults with CD are shorter compared with healthy adults. There is a direct correlation between height and anemia and bone mineral density This finding highlights the importance of early detection and treatment of CD
ABSTRACT
Background: Duodenal biopsy is required for diagnosis of celiac disease in adults, although some studies have suggested adequate accuracy of serology alone
Objective: We aimed to assess the correlation between anti-tissue transglu-taminase [tTG] titer and pathological findings and to define the specific level of tTG for predicting celiac disease in adults without the need for biopsy sampling
Methods: This descriptive study was done on 299 participants
The tTG titer and pathological findings of duodenal biopsy samples were used for this study Analysis of Receiver operating characteristic [ROC] curve was used to find a cut-off point of anti-tTG antibody for mucosal atrophy
Results: Mean tTG titers was significantly higher in patients graded as Marsh III>/= 3 [p=0.023]. ROC curve analysis showed 89.1% sensitivity for cut-off point>/=76.5 lU/mL of anti-tTG. For Marsh>/= II, specificity was 28% and positive predictive value was 91%
Conclusion: There is a linear correlation between increasing tTG level and Marsh I to III. Specificity of tTG titer more than 200 was 100% for Marsh >2.
ABSTRACT
Introduction: Colorectal cancer [CRC] is the third leading cause of cancer deaths in the world, and hereditary factors and family history are responsible for the incidence and development of the disease in 20 to 30% of cases. Lynch syndrome, or hereditary nonpolyposis colorectal cancer [HNPCC], is the most common hereditary form of CRC that is inherited in an autosomal dominant manner. This study consisted of a systematic literature review of research articles that described the prevalence of HNPCC in Iranian patients with CRC
Methods: A systematic literature search was conducted in the PubMed, Scopus, IranMedex, and Google Scholar databases to identify relevant articles that describe HNPCC or Lynch syndrome in patients with CRC in Iran. For this purpose, a keyword search of the following terms was employed: [[[Hereditary nonpolyposis colorectal cancer OR HNPCC OR Lynch syndrome]] AND [colorectal cancer OR familial colorectal cancer OR colon cancer OR rectal cancer OR bowel cancer]] AND IRAN. All eligible documents were collected, and the desired data were qualitatively analyzed
Result: Of the 67 articles that were found via the initial database search, only 12 were deemed to be of relevance to the current study. These articles included a total population of 3237 and this sample was selected and qualitatively analyzed. The findings of the review revealed that the frequency of mutation in MLH1, MSH2, PMS2, and MSH6 genes varied between 23.1% and 62.5% among the studied families. This indicated that HNPCC is linked with up to 5.5% of the total cases of colorectal cancers in Iran
Conclusion: The results of this study revealed that the hereditary form of HNPCC or Lynch syndrome is significantly high among patients with CRC in Iran
ABSTRACT
It is important to differentiate whether isolated anti-HBc is due to false positive results or the prior exposure to hepatitis B virus, because individuals with false-positive anti-HBc can benefit from vaccination and their blood can be safely transfused. To distinguish between these two conditions, we evaluated the serologic response to hepatitis B vaccine. Ninety subjects with isolated anti-HBc [cases] and 100 subjects with totally negative hepatitis B serologic markers [controls]] were recruited to receive three doses of hepatitis-B [HB] vaccine. Thirty days after the first dose of the vaccine, anti-HBs titers were checked and individuals with anti-HBs titer >50 mlU/mL did not receive additional doses of the vaccine. However, others completed the vaccination course, and another blood sample was collected 30 days after the third dose to measure anti-HBs level. Nineteen [21.1%] cases and three [3%] controls had no sero-conversion [anti-HBs titers <10 mlU/mL] 30 days after the third dose [p<0.000l]. Primary response, defined as the development of anti-HBs antibody titers >10 mlU/mL 30 days after the third dose, was observed in 43 [47.8%] cases and 92 [92%] controls [p<0.000l]. Also, 31.1% of cases developed anti-HBs titers > 50 mlU/mL 30 days after the first dose of vaccine, but the rate was significantly lower [5%] in the control group [P<0.0001]. Furthermore, half of the individuals with positive isolated anti-HBc developed protective levels of anti-HBs after three doses of HB vaccination. More than 75% of individuals with positive isolated anti-HBc can benefit from vaccination and can be included in donor pool. Also, one fifth seemed to have occult HBV infection. So HB vaccination may be used as a diagnostic tool for clarifying the situation of the subjects with isolated anti-HBc
ABSTRACT
Patients with ulcerative colitis [UC] carry autoantibodies such as perinuclear antineutrophil cytoplasmic antibodies [p-ANCA]. The aim of the present study was to evaluate the target antigens for p-ANCA in Iranian patients with UC. p-ANCA target antigens including elastase, lactoferrin, cathepsin G, myeloproxidase, lysozyme, and bactericidal permeability increasing protein [BPI] were determined in 113 patients with UC using enzyme-linked immunosorbent assay [ELISA]. 59.2% of the patients were positive for at least one antigen and p-ANCA directed against lactoferrin, elastase, lysozyme, cathepsin G, Bactericidal permeability increasing protein, and myeloproxidase in 31.5%, 25.9%, 8.3%, 7.4%, 5.6%, and 0% of the patients, respectively. The highest prevalence of p-ANCA was observed against lactoferrin and elastase. Also, myeloproxidase was not an antigen for p-ANCA among our patients
Subject(s)
Animals, Laboratory , Animals , Insecta , Antibodies, Antineutrophil Cytoplasmic , Antigens , Pancreatic Elastase , Lactoferrin , Cathepsin G , Peroxidase , MuramidaseABSTRACT
Recent studies have shown a critical role for HLA-DQ2 and HLA-DQ8 in the pathogenesis of celiac disease. No study has been performed on the prevalence of these two HLA types in Iranian celiac patients. We enrolled 24 celiac patients and 37 first-degree relatives in whom the diagnosis of celiac was excluded by sero-logic tests. HLA typing for HLA-DQ2 [DQB1*02], HLA-DQ8 [DQB1*03], HLA-DQ B1*05 and HLA-DQ B1*06 was performed using polymerase chain [PCR] reaction. Twenty two [91.7%] celiac patients and twenty seven [73%] controls were positive for the HLA-DQ2 and/or HLA-DQ8 heterodimers. There was no significant difference between the two groups p=0.068]. However, celiac patients were statistically more positive for homozygote HLA-DQ2, whereas non-celiac participants were more positive for homozygote HLA-DQ8 [p<0.05]. The total prevalence of HLA-DQ2 and/or HLA-DQ8 allels did not significantly differ between the two groups. Hence, first-degree relatives of celiac patients appear to be more susceptible for developing celiac disease. On the other hand, the higher prevalence of homozygote HLA-DQ2 in celiac patients shows its stronger role in disease pathogenesis. Further studies on larger populations are needed in Iran.
Subject(s)
Humans , HLA-DQ Antigens , Genotyping Techniques , HLA Antigens , Polymerase Chain ReactionABSTRACT
Nonalcoholic Steatohepatitis [NASH] is part of a broad spectrum of nonalcoholic fatty liver diseases that can lead to cirrhosis. To date, there is no effective medical treatment for NASH. We aim to compare the effect of aerobic exercise in conjunction with diet to diet alone on the improvement of metabolic syndrome and insulin resistance in patients with NASH. We enrolled 23 NASH patients, ages 25-50 years, and randomly divided them into two groups, aerobic exercise plus diet [n=12] or diet alone [n=ll]. In this study, diet in both groups included 500 kilocalories of energy less than the estimated daily energy requirement. In addition to diet, the first group participated in aerobic exercises that consisted of walking, jogging and running, for a period of eight weeks, three days a week at a 55%-60% heart rate reserve. For all patients, we measured blood pressure, Waist Circumference, serum ALT, HDL, TG, FBS, insulin levels, and insulin resistance according to HOMA-IR at baseline and after eight weeks. We analyzed data with the paired and independent samples t-test, at a significance level of p<0.05. Although, there was no significant difference noted in patients in the diet only group, HOMA-IR, Systolic Blood Pressure, Diastolic Blood Pressure, FBS, ALT, and insulin levels significantly decreased in patients who underwent both diet and exercise. Serum TG levels and WC decreased significantly in both groups. In a comparison between the groups, there was a significant decrease observed in WC, FBS, and ALT. Aerobic exercise in conjunction with diet may be more effective than diet alone in the treatment of patients with NASH
ABSTRACT
Worldwide, the incidence of inflammatory bowel disease [IBD] is increasing. This study aims to evaluate the diagnostic value of two serological markers, atypical perinuclear anti-neutrophil cytoplasmic antibodies [atypical-P-ANCA] and anti-Saccharomyces cerevisiae antibodies [ASCA], with the intent to determine their relationship to ulcerative colitis [UC] and Crohn's disease [CD], in addition to the location and extent of bowel involvement. There were 97 patients enrolled in this study, 72 diagnosed with UC and 25 with CD. The control group consisted of 40 healthy individuals. ASCA was determined by enzyme-linked immunosorbent assay [ELISA] and atypical-P-ANCA by indirect immunofluorescence assay [IIF]. For data analyses, we used the chi-square and independent t-tests. Significance was considered to be p<0.05. For CD, the sensitivity of ASCA was 16% and its specificity was 97%. ASCA had a specifity of 90% in UC patients. The atypical P-ANCA test had a sensitivity of 44% and specificity of 86% for UC. The positive predictive value [PPV] for atypical P-ANCA in UC patients was 78% and for the negative predictive value [NPV], it was 58%.There was no correlation between ASCA and atypical P-ANCA results and the location of gastrointestinal [GI] involvement in CD [p=0.61] and UC [p=0.28] patients. According to the results, ASCA and atypical P-ANCA markers are not useful for IBD screening. Our study suggests that atypical P-ANCA is a useful parameter to differentiate UC from CD. However, ASCA is of limited value for screening and differentiating UC from CD
Subject(s)
Humans , Female , Male , Saccharomyces cerevisiae/immunology , Antibodies, Antineutrophil Cytoplasmic , Diagnosis, DifferentialABSTRACT
Lead poisoning can present with nonspecific signs and symptoms such as abdominal pain, constipation, irritability, difficulty concentrating, and anemia. A 57-years-old man admitted to the hospital due to abdominal pain of 40 days duration and 9 kg of weight loss. He had addiction to the oral opium from years ago. He had anemia and jaundice in physical exam .His abdominal pain was after eating and we evaluated upper and lower parts of gastrointestinal and we didn't find any clue. All of the other imagings incuding,small bowel follow through,abdominal C.T. angiography and magnetic resonance enterography were normal. Finally,serum lead levels were measured and were 1961 mic/ dl [normal range of 10 mic/dl] elevated;Therefore established diagnosis was lead poisoning. We reported a patient with lead poisoning that was presented with abdominal pain and abnormal liver biochemistries. Because of his addiction to the oral opium agents and some reports, it seems the most probable source of lead poisoning is oral opium agent
Subject(s)
Humans , Male , Abdominal Pain , Transaminases , Lead/toxicity , OpiumABSTRACT
The aim of this study was to report common presentations of Budd-Chiari syndrome [BCS] and the early outcome of different treatment methods in two tertiary hospitals in Iran. This case series study was performed on 21 patients [mean age: 42 +/- 13.09 years; 11 male, 52.4%, and 10 female, 47.6%] admitted for treatment of BCS in two tertiary referral centers in Mashhad, Iran, between 2002 and 2008. All required data of signs, underlying etiology, treatment methods and in-hospital mortality were gathered from patients' medical records. Angiographic and sonographic findings showed that the most frequent isolated location of obstruction was the inferior vena cava [n = 12, 57.1%]. No distinct underlying disease was found in 6 [28.6%] patients. Eleven [52.4%] patients had web obstruction and 4 patients had other related underlying diseases. Treatment modalities consisted of medical follow-up in 12 [57.1%], angioplasty in 6 [28.6%], and surgery in 3 [14.3%] patients. Medical follow-up of 3 patients, 1 with angioplasty and 2 who had undergone surgery, disclosed that they had died before discharge from hospital. Higher age at diagnosis may reflect late diagnosis at an advanced stage of disease. We suggest that the early symptoms of this disease should be taken into account more seriously in differential diagnosis. Balloon angioplasty seems to be a more efficient method for treatment of BCS
Subject(s)
Humans , Male , Female , Age Factors , Early Diagnosis , Diagnosis, Differential , Angioplasty, Balloon , Treatment OutcomeABSTRACT
Coeliac disease [CD] is an autoimmune enteropathy triggered by gluten. Several hepatic disorders have been described in association with coeliac disease. Nodular regenerative hyperplasia [NRH] of the liver is a rare disorder and is a cause of non-cirrhotic portal hypertension. A 22 y/o lady presented with portal hypertension, after all causes of chronic liver disease ruled out we checked for coeliac and it was positive. Liver biopsy was done and was compatible with nodular regenerative hyperplasia [NRH] of the liver. As far as we know this is one of the rare cases of nodular regenerative hyperplasia of the liver in a patient with coeliac. Only three cases have been reported until now and seems we should think about coeliac in any patient suffering from chronic liver disease with unknown cause