ABSTRACT
Aim: To evaluate the association between biochemical, virologic and histologic features in patients with HBeAg-negative chronic hepatitis B [CHB]
Background: Hepatitis-B e-antigen [HBeAg]-negative is common in Iran, is progressive with poor prognosis. Therefore, it seems necessary to perform a comprehensive evaluation of different spectrum of laboratory measurements accompanying histological findings
Methods: HBeAg- negative CHB patients referring to two university hospitals during two years were enrolled. Alcohol consumption, liver mass, fatty liver and positive results of Anti HDV, Anti HCV or Anti HIV were excluded. The relationship between viral loads, liver enzymes [old and new cutoffs] and histopathological features was analyzed using descriptive and analytic statistical methods
Results: A total of 150 HBeAg-negative CHB [males=110, mean age=38.44 +/- 11.34 years] were assessed. ALT had a significant relation with the logarithm of serum HBV-DNA [P<0.0001], grade and stage on liver biopsy [P<0.001, P=0.034, respectively]. Serum viral load, AST and ALT were independent predictors of histological grade, age was the only independent predictor of the stage of liver fibrosis. There was a significant relationship between serum ALT and stage of liver fibrosis [P<0.0001] when new cutoff values for ALT were considered. We found that age had a significant relation with histological grade but it showed a reverse relation with ALT levels [P=0.009]
Conclusion: In HBeAg-negative CHB, AST had a better prediction for liver necrosis and inflammation. Age could be an independent predictor for liver fibrosis. New cutoff values for ALT had superiority over conventional values to identify higher risk of liver fibrosis
ABSTRACT
Celiac disease [CD] is an auto-immune disorder. The prevalence of CD has been estimated mainly based on serological tests. The aim of this study was to evaluate the seroprevalence of celiac disease in the adult general population of Mashhad, northeast of Iran and pitfall of serology in epidemiological studies considering the importance of serology titer
Materials and Methods: 1558 subjects aged 35 to 65 years and 1025 individuals aged between 15 to 35 years were selected randomly from multistage cluster sampling papulation for this cross sectional study. Anti-tissue transglutaminase [tTG]-IgA assay was performed by ELISA[Enzyme-Linked Immunosorbent Assay]. The manufacture's cut-off point of anti tTG was 20 IU/mL and the prevalence of positive serology was estimated based on being just above the upper limit of normal [20 IU/mL], twice or three times above the normal value at 40 and 60 IU/mL, respectively
Results: In both age group 35-65 year-old and 15 to 35 years adults, the prevalence of positive serology was 1.2% for anti-tTG level more than 60 IU/mL, which was three times of the kit references [95% CI: 0.7- 1.9] and [95% CI: 0.7-2.1], and based on our previous study in Mashhad if we consider the cut-off point as 76 IU/mL anti-tTG for mucosal atrophy, the prevalence of CD would be 0.69
Conclusion: Epidemiological data of CD is mainly based on serology and as these tests are to some extent non-specific at lower levels, the accuracy of the previous reported prevalence of CD in some studies are questionable and level of anti-tTG is important
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Introduction: It is long known that vitamin D deficiency was common in patients with liver disease, but little is known on the therapeutic effects of vitamin D, especially in patients with chronic liver disease. In this study, we aimed to systematically review the literatures and study the evidences in which the effects of vitamin D supplementation had been investigated on the severity of chronic liver disease or liver cirrhosis
Methods: A systematic literature search was performed by using the following key terms "vitamin D supplementation" and "chronic liver disease" in the PubMed, Scopus and Google scholar to find relevant articles. After collecting the eligible documents, data were extracted and described based on the purpose of this review
Result: Of total 196 articles found, only 7 relevant documents with 518 studied patients were included. The results of this study showed that the levels of 25[OH] D were considerably lower in patients with chronic liver disease. Findings showed that vitamin D supplementation can rise up the mean serum level of 25[OH] D in patients with severe vitamin D deficiency, especially patients with liver cirrhosis
Conclusion: The results of this review showed that vitamin D deficiency is associated with the severity of liver disease and may have prognostic value in the assessment of liver disease. Also, it was shown that vitamin D supplementation may be helpful for the treatment of liver disease at least in certain groups of patients
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
Celiac disease [CD] has an autoimmune disease in response to ingestion of foods containing gluten sausing damage to the mucosal tissue of small intestine. The disease can severely affect quality of life. This study aims to assess the relationship between behavioral disorders and quality of life [QOL] in patients with celiac disease. 87 celiac patients and 100 healthy individuals are selected and matched for age, sex and education. Patients with Celiac disease were recruited from a subspecialty clinic in Imam Reza [AS] Hospital and clinic in Ghaem in Mashhad. The control group consisted of healthy participants. Participants completed the Beck Depression Inventory, State Anxiety Inventory-Trait Spielberger, Toronto Alexithymia Questionnaire and SF-36 Quality of Life Questionnaire. Research data were analyzed by Pearson correlation and multiple regression analyses. There was no significant difference between the two groups in demographic variables. However significant differences existed between the variables of anxiety, depression and alexithymia. The patient group had higher depression and anxiety levels compared to healthy controls. Multiple regression analysis showed behavioral disorders, explains 43% of the variance in quality of life in patients with CD. Overall, the findings indicate there is a direct link between behavioral disorder and reduced quality of life of celiac patients. Psychotherapy and cognitive behavioral therapy can improve emotional patterns and cognition of celiac patients
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
BACKGROUND: This study aimed to explore demographic characteristics and clinical presentations of celiac disease [CD] in Northeastern Iran
METHODS: This was a cross-sectional retrospective study of 193 adults with CD who presented to Mashhad University Gastroenterology Clinic between 2008 and 2013. Patient data that included mode of presentation and the presence of any concomitant illnesses were collected. Intestinal biopsy and serum anti-tissue transglutaminase [anti-tTG] were used for diagnosis. Mucosal lesions were classified according to modified Marsh classification
RESULTS: Overall, 132 females and 61 males, with a mean age at diagnosis of 32.6 +/- 13.2 years were included
The patient's chief complaints in order of decreasing frequency were dyspepsia [24.6%], diarrhea [20%], anemia [12.8%], and flatulence [7.2%]
Bone disease was seen [osteopenia, osteoporosis] in 30% of patients
A positive family history of CD was found in 17.9% of cases
There were 64% who had serum anti-tTG >200 units/ml and 78% had a Marsh classification grade 3 on duodenal biopsy
The histology grade [Marsh] did not show any correlation with anti-tTG serum levels, age, body mass index [BMI] or hemoglobin levels
CONCLUSION: In Northeastern Iran, CD was seen more commonly in females and with non-diarrheal presentations. Abdominal discomfort, anemia and bone disease were most common primary presentations in this area. Histology grade showed no significant correlation with level of anti-tTG, BMI or hemoglobin levels
We suggest screening for CD in unexplained abdominal discomfort, bone disease and anemia
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
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
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
ABSTRACT
Ulcerative colitis [UC] and Crohn's disease [CD], collectively referred to as inflammatory bowel disease [IBD], present with different histology and cytokine profiles. While the precise mechanisms underlying the development of IBD are not known, sufficient data have been collected to suggest that it results from a complex interplay of genetic, environmental, and immunologic factors. An inappropriate mucosal immune response to normal intestinal constituents is a key feature, leading to an imbalance in local pro- and anti-inflammatory cytokines. Neutrophil and monocyte influx occurs with subsequent secretion of oxygen radicals and enzymes, leading to tissue damage. Here we report three patients with sever symptom of IBD after ovarian stimulation. Cytokine profile after ovarian stimulation may contribute to the altered intestinal permeability due to increase in systemic inflammatory cytokines and neutrophil or macrophage activation. In our hypothesis ovulation induction can induce inflammation in intestinal mucosa or exacerbate previous IBD by different cytokines