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
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: colorectal cancer is one of the most common cancers in terms of morbidity and mortality worldwide. A lot of research has been done in this field in Iran and worldwide, which have positive results. The aims of this study were firstly doing a statistical study on colorectal cancer in Mashhad, Iran, and finally predicting the colorectal location of cancer based on the clinical data by using data mining science and decision tree model
Materials and Methods: the data of 316 patients with colorectal cancer [including 14 features] were extracted from the archive of Imam Reza Hospital, Mashhad. The instrument used in this research was RapidMiner data mining software that would try to be extract the details of the relevant data by statistical surveys and then would do initial simulations and the use of classification and decision tree method have predicteion the location of cancer
Results: male to female ratio of 56% to 44%, family history of 37%, more young patients, and relatively more distally located cancers [39%] compared with the proximal [35%], and rectum [26%] were the striking findings of this study. The final and most important stage of research models were presented, which was able to predict the location of the cancerous tumor with 80% accuracy
Conclusion: similarities with global statistics, such as the ratio of men to women and family history were observed. But there were also differences with global statistics including the Iran's younger patients and relatively more patients with distal cancers. The efficiency of data mining techniques to predict the location of cancer as well as cost reduction was among the most important results of this study
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
The relationship between primary hyperparathyroidism and pancreatitis has yet to be established firmly. We present a patient with acute pancreatitis and a hypercalcemic crisis induced by a parathyroid adenoma. A 72-year-old woman presented with lethargy and a constant pain in the epigastric region. She had a medical history of diabetes mellitus, hypertension, nephrolithiasis, and ischemic heart disease. Blood examination revealed leukocytosis and high serum amylase and lipase levels. Ultrasound exam confirmed the diagnosis of acute pancreatitis with a normal biliary tract and no gallstones. On further evaluation severe hypercalcemia [24 mg/dL] was detected, which was treated with 0.9% sodium chloride solution and calcitonin. The acute pancreatitis and its symptoms resolved after 3 days. Ultrasound exam and technetium 99m sestamibi scan showed a parathyroid lesion. Ultimately the patient underwent right thyroid lobectomy because of refractory hypercalcemia. The pathology report was indicative of a parathyroid adenoma. Subsequently, the parathyroid gland was resected with normalization of calcium, parathyroid hormone, and amylase levels and the patient was discharged in good condition 7 days after surgery. Apart from the acute supportive management, common to all cases of acute pancreatitis, definite management must be tailored to the specific cause. Hypercalcemia during the course of pancreatitis must prompt an investigation for primary hyperparathyroidism with early surgical intervention if a parathyroid source is detected
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
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
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
Hepatitis B and C infections have remained major global health burdens during the most recent century. The viral agents responsible for these diseases share common modes of transmission with human immunodeficiency virus [HIV] such as needle-sharing in IV drug abusers. Coinfection of hepatitis B or C with HIV increases the rate of progression of chronic liver disease. Given the lack of data in Iran, in particular Khorasan Razavi Province, with regards to this coinfection, the present study evaluates the frequency distribution of hepatitis B and C coinfection with HIV infection and their modes of transmission. This was a retrospective study based on available data at the Gastrointestinal and Liver Diseases Center, Emam Reza Hospital, Mashhad, Iran. We used questionnaires to collect demographic data from 749 patients infected with hepatitis B or C who refered to this clinic between 2005 and 2008. The available sera of these patients were tested for the coexistence of HIV infection with hepatitis B or C infections. The results were analyzed with SPSS version 16 software. From 749 patients infected with hepatitis B or C viruses, 650 were infected with hepatitis B [64.9% male and 35.1% female]. There was no HIV antibody detected in any of the patients' sera who had hepatitis B infection. Among the 106 patients with hepatitis C infection [84% male and 16% female], only one [0.9%] who was an IV drug abuser tested positive for HIV infection. Hepatitis B/hepatitis C coinfection was found in 7 [0.9%] patients. With regards to the risk factors of viral transmission among those with hepatitis B infection, the most common was a positive family history of hepatitis B [37.2%]. Other risk factors in order of decreasing frequency included a history of venesection and tattooing [13.8%], transfusions [7.1%], IV drug abuse [2.6%], needle stick accidents [2.3%], and high-risk sexual activity [0.6%]. In those with hepatitis C infection, a history of IV drug abuse was the most common risk factor [40.6%], followed by a history of transfusions [28.3%], venesection or tattooing [16%], surgery [13.2%], needle stick accidents [4.7%], hepatitis C infection in a family member [2.8%], and unsafe sexual contact [0.9%]. There was a significant difference in the transmission risk factor ratio between hepatitis B and C patients [p=0.001, chi[2]=261/590] The most common risk factor for transmission of hepatitis B and C infections in patients who presented to Emam Reza Hospital, a referral center in Mashhad, was a positive family history of hepatitis B infection and IV drug abuse, respectively. The prevalence of HIV coinfection amongst patients with hepatitis B or C infections was low. However, further studies with larger populations are required
ABSTRACT
Splenic artery aneurysm [SAA] is a rare and potentially life-threatening clinical entity that carries a risk of rupture and peritoneal hemorrhage. When ruptured, it typically manifests as abdominal pain with hemodynamic instability. This is a report about a 29-year-old male admitted for evaluation of recent-onset ascites following the spontaneous resolution of a transient episode of severe epigastric and left upper quadrant pain with syncope the preceding day. Paracentesis revealed bloody fluid. Abdominal computed tomographic angiography [CTA] and magnetic resonance venography [MRV] showed a three centimeter SAA. During admission, prompt exploratory laparotomy was performed that revealed excessive intraperitoneal hemorrhage due to a ruptured SAA. The pathology report confirmed that the SAA had developed secondary to atherosclerosis. Careful history taking together with appropriate imaging tests and emergent surgical intervention led to a timely diagnosis and the patient's survival.