[Role of gut microbiota on weight regulation]

Diet is a source of microbiota. Different food consumption can affect the composition of gut microbiota. The gut microflora plays a main role in energy hemostasis from the diet and also has a key role in maintaining human health. Imbalance in the gut microbiota is associated with weight gain and several mechanisms are proposed in this issue. The influences of the gut microbiota composition extent to multiple systems including glucose and lipid hemostasis, and inflammation and fat mass related diseases. The gut microflora composition is different in lean and obese humans. Manipulation of host diet may lead to new treatments of obesity. Antibiotics, prebiotics, and probiotics modify the gut microbiota. The effect of probiotics on the gut microflora depends on the strain and could be associated with weight loss. Weight loss is also associated with changes in the gut microflora. Dietary properties and specific strategies can modulate metabolism by regulation of gut microbiota. In this article, we reviewed the effects of gut microbiota on weight regulation and their potential abilities for weight loss. Currently, the gut microflora is known as a microbial organ placed within the human. Thus, it is useful to improve strategies for gut microbiota manipulation to control metabolic disorders. Further studies are needed to clarify the underlying mechanisms of microbe-host interactions

Effects of repeated cycles of weight loss and regain in obese individuals

Most of obese persons have repeated attempts to weight loss throughout life. Failure to maintain weight loss leads to weight regain. Repeated cycles of weight loss and regain are called weight cycling [WCy], weight fluctuation, or weight instability. WCy is the most challenging issue of weight regulation in obesity. Some recent studies have indicated the potential association between WCy, metabolic profile, and fat composition. Animals with WCy history had up to the five-fold increase in weight gain compared to the obese with stable weight. WCy can alter hormones involved in energy hemostasis, decrease resting metabolic rate, and increase food efficiency. Studies have suggested that WCy can lead to more difficult weight loss in the next attempt than before. This issue is a poor prognostic sign due to unfavorable metabolic and psychological parameters. WCy has been associated with increased risk of metabolic syndrome, fatty liver, bone fracture, cardiovascular disease, and cancers in the recent studies. An accelerated immune response due to WCy can increase the negative effects on metabolism. The aim of this review article was to highlight the negative consequences of WCy on the health status of obese subjects

Type II enteropathy-associated T-cell lymphoma: a rare report from Iran

Type II enteropathy-associated T-cell lymphoma [EATL] is a rare disease that is reported from Asia, especially from Taiwan. In this paper, we present a patient from Iran [Arab] with Type II EATL whose disease was not associated with celiac disease or Epstein-Barr virus [EBV] infection. The patient died due to intestinal perforation during the first chemotherapy. Type II EATL is a gastrointestinal lymphoma with poor prognosis and a high affinity for intestinal perforation. Early detection of EATL II is essential for chemotherapy prior to the onset of malnutrition symptoms

Menstrual and reproductive factors and risk of pancreatic cancer in women

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

Appendicitis as a complication of acute pancreatitis; a case report

Large bowel complications of acute pancreatitis are rare and always occur in the adjacent colon including transverse colon and splenic flexure colon. In this article, we report a 35-year-old man with acute pancreatitis [Ranson's score 2] who presented with severe abdominal pain in the emergency department. He had a history suggesting recent acute pancreatitis and also symptoms and signs of acute appendicitis at the time of admission. After primary cares, he underwent open appendectomy according to the computed tomography results. The report of pathology and analysis of the exudate around the appendix confirmed appendicitis as a complication of acute pancreatitis. This rare case report denotes that acute appendicitis was a complication of acute pancreatitis. However, more studies are required to define the relationship between pancreatitis and appendicitis

[Review of the clinico-pathological features of pancreatic neuroendocrine neoplasms in Iran]

Pancreatic neuroendocrine neoplasms [PNENs] were increasing in the world. The annual incidence of PNETs was nearly 0.25 per 100 000 population. 1-2% of pancreatic neoplasms are PNENs. This article reviewed the available original and review literatures which had been published in Persian and English in websites of Google scholar, Iran doc and Pub Med with keywords neoplasm, pancreas, neuroendocrine and Iran since 1995 to 2014 year. The aim of this article was to compared the clinic co-pathological characteristics of Iranian studies [seven articles] with other studies. Prevalence of PNENs was among 30-60 year and there was not gender preference in some studies. Abdominal pain was the most common manifestation of PNENs.60-70% of PNENs was functional in Iran. In mostly of imaging procedures, neoplasm was reported in pancreatic head. These neoplasms were different rates of growth and aggressive behaviors. The clinical behavior of PNENs could be predicted according to clinical stage, grade and evidence of hormone syndromes. Neoplasm resection could be a cure for PNENs. Mean survival time depended on the extent of disease at diagnosis time and the differentiation of neoplasm. In one report of Iran, survival rate was 48% in non-functional PNENs versus nearly 100% in functional PNENs [Insulinoma] during 3 years follow up. A team of specialists is necessary for successful and efficient treatment in PNENs field. Mean survival time in non-functional PNENs is shorter than functional form. Different results in clinical characteristics and neoplasm behavior in several studies maybe due to PNENs heterogeneity in the world. It's unlikely that could present a prognostic model for PNENs

[Review of current anti-obesity drugs in obese adults]

Obesity was a dangerous chronic disease. Physicians recommended drug therapy just in a few of obese patients in spite of many health risks. Weight control can be improved comorbidities of obesity like hyperlipedemia, hyperinsulinoma, acanthosis nigricans and hypertension. This article reviewed the available original and review literatures which had been published in English in websites of Google scholar and Pub Med with keywords drug, obesity and adults during 2002 - 2014. Drug therapy could improve obesity treatment after an unsuccessful combination of diet, exercise, and behaviour modification. Choice of treatment was based on multiple factors including the degree of obesity and patient preference. Drug therapy should be selected for a BMI] Body Mass Index [greater than 30 kg/m[2], or a BMI of 27 kg/m[2] with comorbid conditions including diabetes mellitus, hypertension, dyslipidaemia and heart disease.Prescription of anti-obesity drugs should be monitored carefully. Orlistat was the only drug for the long-term treatment of obesity. The efficacy of lorcaserin appears more than orlistat. Phentermine and diethylpropion are only approved for the short term treatment of obesity. Some antidepressant, antiepileptic, and antidiabetic drugs could be caused weight loss. New generation of anti-obesity drugs were under developing and more focus on the safety and efficacy combination treatments. Weight loss > 12kg reported in few investigational drugs. Some of them were discussed in this article. Obesity treatment is selected based on the side effects risks. Mostly of the available drugs have few side effects which decrease with treatment. There isn't a cure drug treatment for obesity now

Report of a rare case of nasal mucosa pyoderma vegetans in a patient with ulcerative colitis

Some dermatologic manifestations are common in ulcerative colitis [UC]. Herein, we present a 36-year-old woman with ulcerative colitis and uncommon nasal mucosa pyoderma vegetans. The patient presented to our hospital with symptoms of active colitis and a concomitant 3×4×5 cm dermato-mucosal lesion in her left nasal lumen. After surgery of the mucosal lesion, the treatment for her active colitis was initiated with intravenous infliximab and oral asacol. After a 1-year follow-up, no sign of recurrence favoring mucosal lesion was noted and symptoms of ulcerative colitis were managed properly

[Clinical findings of patients with pancreatic insulinoma in Shariati Hospital, Tehran, Iran [2010-2013]]

Insulinoma was a rare pancreatic neuroendocrine tumor. Insulinoma was more likely to present as one small size tumor in head of pancreas in middle age. Surgery was a curative treatment. The aim of this study was to present clinical characteristics of insulinoma tumors in pancreas and their outcomes after tumor resection from a referral endosonography center in Iran. This was cross sectional study from Nov 2010 to Nov 2013, all patients with clinical and biochemichal diagnosis of insulinoma entered to the study. Various characteristics likes, symptoms, laboratory and imaging findings, pathologic reports and their outcomes after surgery were recorded in a standard check list. Patients were followed for up to three years. All statistical analyses were performed SPSS software. A total of 42 patients [62% women: mean of age 40 years] were identified. All of patients reported Whipple's triad. Mean time from initiating of symptoms until diagnosis time was 14 months. The common blood type was 0 [n22, 52.3%].The mean tumor size was 2.7cm. 33.4% of endosonography reports show a solid tumor in the head of pancreas. Finding shows [n-36, 85%] of patients were treated surgically. Insulinoma tumor was confirmed in the pancreatic sample. Insulinoma recurrence have not report during the mean follow-up of 343 days in patients after tumor resection. In this study, insulinoma tumors of pancreas [non-familial] were single with tumor size of less than 3 cm. Most of them located in the head of pancreas. Outcomes following complete resection of tumor were satisfactory and have not report tumor recurrenceduring up to 3 years follow up. These results were the same as reports from other countries

Gastroenterologist role in bariatric surgeries

The prevalence of bariatric surgery procedures has increased dramatically in recent years and multiple specialties encounter bariatric patients. In this article, we outline the different options in bariatric surgery and summarized the recommendations for gastrointestinal assessment of candidates before and after bariatric surgery. The role of routine endoscopy was controversial in pre surgical evaluation but may alter the operation performed. Comprehensive pre-operative screening conducted by a multidisciplinary team including gastroenterologist was essential to prepare obese patients for successful outcome following surgery. The most commonly performed procedures were Roux-en-Y gastric bypass and adjustable gastric banding. We presented the early and late complications of bariatric surgery and recommendations for post-operative cares by gastroenterologist in this review article

Abdominal pain crisis in a young patient with B12 deficiency: a case report

Vitamin B12 deficiency is an unusual disease in younger individuals. This case report has demonstrated how a patient with vitamin B12 deficiency can present with unusual symptoms. Two episodes of severe abdominal pain were identified in a 35-year-old man in the emergency ward. During both episodes surgical consultations were requested. A gastroduodenoscopy revealed macroscopic atrophic gastritis and pathology reports showed mucosal atrophy in the gastric corpus with evidence of intestinal metaplasia. Laboratory data showed a low level of vitamin B12 in the patient's serum. In rare cases? vitamin B12 deficiency can present with severe abdominal pain associated with abdominal rigidity

[Assessing and managing the risk of surgery in patients with liver disease]

Advancements in medical science have led to the development of complex surgeries that improve survival in patients with liver disease. Assessments of the indications and contraindications for surgery and risk factors are the most important steps prior to any surgery in this population. Particular attention is essential to assess for the presence of pre-surgical ascites, hepatic encephalopathy and renal dysfunction. The most important risk factors for that increase mortality include anemia, ascites, hepatic encephalopathy, hypoalbuminemia, hypoxemia, concurrent infections, malnutrition, elevated Child Pugh and MELD scores,portal hypertension, prolonged prothrombin time and type of surgery. Advancements in anesthesiology have prevented surgical complications among patients with liver disease. Increased symptoms of liver failure and complications result in high mortality following surgery. This review article presents useful recommendations for safe surgery among patients with liver disease who are surgical candidates

Clinical and pathological features of non-functional neuroendocrine tumors of pancreas: a report from Iran

Pancreatic neuroendocrine tumors [PNETs] are rare tumors with variable malignant potential, prognosis, and survival. We aimed to assess the characteristics of patients with non- functional PNET in our hospital. From Nov 2010 to Nov 2013, all patients who came to endosonography unit of Shariati hospital, Tehran, Iran, and had pancreatic lesions were assessed. Tumor samples were obtained through fine needle aspiration. Various characteristics of the non- functional PNET were recorded and patients were followed up to three years. Twenty eight non func-PNET cases, aged 37-72 years were identified, 15 [53.6%] of whom were men. Fifteen [53.6%] tumors were located in the head and 5[17.8%] in the body of the pancreas. The mean tumor size was 3.9 Cm and 10.7%, 28.6%, 32.1%, and 28.6% of the patients were at stages I, II, III and IV, respectively. Of the patients, 12 [43%] underwent surgery, 3 [10.7%] received chemotherapy, and 13 [46.4%] received no treatment. During the mean follow-up of 16 months, the disease had progressed in 3 [10.7%] patients and 10 [35.7%] had died. In univariate analysis, tumor size>3Cm and Ki-67>20% were correlated with survival rate but not in multivariate analysis. Iranian patients with non- functional PNET present similar characteristics to world patients. There is a need to establish efficacy of tumor samples which are obtaining through fine needle aspiration for assessing tumor grading

Systemic lupus erythematosus presenting with a fatal intestinal vasculitis: a case report

This case report demonstrates fatal gastrointestinal vasculitis as a rare presentation of systemic lupus erythematosus. A 34-year-old woman presented with abdominal pain and diarrhea. Anti nuclear antibody was positive and high titre of anti-ds DNA antibody was also reported. Treatment with corticosteroid and supportive cares were started; however, her condition worsened. Eventually, she was considered as a candidate for diagnostic laparoscopy. Immediately after laparoscopy, she developed respiratory distress along with upper gastrointestinal bleeding. Soon after, the patient died because of disseminated intravascular coagulation

Long-term outcome of Budd-Chiari syndrome: a single center experience

Budd-Chiari syndrome [BCS] is defined as hepatic venous outflow obstruction [HVOO]. BCS is an uncommon, life-threatening liver disorder. This study describes the clinical and etiological characteristics in addition to the long-term outcome of BCS in a single referral center in Tehran, Iran. We reviewed long-term outcome of patients who were diagnosed with BCS between 1989 and 2012 at Shariati Hospital, a tertiary hospital affiliated with Tehran University of Medical Sciences, Tehran, Iran. The diagnosis was confirmed by at least two imaging techniques. A comprehensive analysis of the clinical and paraclinical manifestations, etiology and long-term outcome of the disease was conducted. Seventy one patients [43 female] with a diagnosis of Budd-Chiari syndrome were identified during the 22 year period of study. The age were ranged from 17 to 64 years [median: 29 years]. We excluded 16 patients because of incomplete information or follow up. The remaining 55 cases were the subjects of this study. Underlying etiologies consisted of congenital thrombophilia factors in 50% [28 cases] which was defined as protein C deficiency [12 cases], protein S deficiency [3 cases], antithrombin deficiency [3 cases] and factor V Leiden mutation [10 cases]. Etiology was unknown in 18% [10 cases]. Acquired causes of thrombophilia were observed in 25% [14 cases] that consisted of 9 cases of myeloproliferative disease and 5 cases of autoimmune diseases. In 3 cases pregnancy was the only etiology. The main clinical presentations were abdominal pain in 33 [60%], abdominal distention in 21 [38.2%], and jaundice in 10 [18%] cases. The main clinical signs were ascites [76.4%], splenomegaly [34%], hepatomegaly [25.5%] and deep vein thrombosis [1.8%]. All 55 patients were treated with anticoagulants [heparin followed by warfarin] and supportive care. Two cases underwent mesocaval shunt surgery, 2 patients required transjugular portosystemic shunt [TIPS] and 5 were referred for liver transplantation. A total of 17 [30%] patients died during 22 years of follow up. BCS, although uncommon in Iran, is a challenging liver disease with an important burden. Medical therapy that includes anticoagulation seems to be effective in most cases although the prognosis is guarded. In long-term follow up, 40% of cases will need liver transplant or die from end stage liver disease

[Gastroduodenal sarcoidosis: a case report]

Sarcoidosis is a systemic granulomatous disease of unknown etiology. Sarcoidosis involving the gastrointestinal [GI] tract is extremely rare. This is a rare case report of an individual with symptomatic gastroduodenal sarcoidosis. A 34-year-old male with a six-month history of epigastric pain, nausea, early satiety and weight loss presented to our clinic. An upper endoscopy was performed which showed a cardia ulcer that measured approximately 10 mm along with multiple superficial erosions and patchy erythema in all parts of the gastroduodenal mucosa. Biopsies of the stomach and duodenum revealed severe active chronic noncaseating granulomatous gastritis and duodenitis. Stains for Helicobacter pylori, acid fast bacteria, and fungi were negative. An upper GI series showed thickened gastric folds with narrowing of the gastric body and antrum with lack of distensibility. The plasma level of angiotensin converting enzyme [ACE] was elevated. Corticosteroid therapy was started with rapid abatement of his symptoms. In cases of refractory epigastric pain, especially if other organ involvement, gastroduodenal sarcoidosis should be considered