Mesalazine has no effect on mucosal immune biomarkers in patients with diarrhea-dominant irritable bowel syndrome referred to Shariati Hospital: a randomized double-blind, placebo-controlled trial

Intestinal mast cells may cause gastrointestinal symptoms in patients with diarrhea-dominant irritable bowel syndrome [IBS]. The objective of this study was to determine the effect of mesalazine on the number of lamina propria mast cells and clinical manifestations of patients with diarrhea-dominant IBS referred to Shariati Hospital affiliated to Tehran University of Medical Sciences

Methods: This was a randomized placebo-controlled double-blind trial conducted on 49 patients with diarrhea-dominant IBS. The patients were randomly assigned to one of the experiment or control groups. The patients in experiment group took 2400 mg mesalazine daily in three divided doses for 8 weeks and the patient in control group took placebo on the same basis. Our first targeted outcome was an assigned downturn of mast cells number to the safe colonic baseline and the next one was a marked palliation of disease symptoms. Data were analyzed conforming intention-to-treat method. We used MANCOVA test to compare our both assigned outcomes in the two groups. We also compared the data with baseline values in both groups. All statistical tests were performed at the significance level of 0.05

Results: There was no significant difference between Mesalazine and placebo groups regarding the number of mast cells [p value=0.396], abdominal pain [p value=0.054], bloating [p value=0.365], defecation urgency [p value=0.212], and defecation frequency [p value=0.702]

Conclusion: Mesalazine had no significant effect either on the number of mast cells or on the severity of disease symptoms. This finding seems to be inconsistent with the hypothesis indicating immune mechanisms as potential therapeutic targets in IBS. The possible difference in this effect of Mesalazine should be evaluated in further studies among populations varying in race, ethnic, and geographical characteristics

Nonadherence to medication in inflammatory bowel disease: rate and reasons

Background: This study is the first study to evaluate the nonadherence rate and reasons of same patient with inflammatory bowel disease [IBD] in Iran

Method: During 9 months, 500 patients with IBD were enrolled in the study. Patients were interviewed about their nonadherence behaviors. Factor analysis was used to analyze the collected answers

Results: The overall rate of nonadherence was 33.3% [27.6% intentional nonadherence and 5.7% unintentional nonadherence]. 33.6% of the patients had at least one relapse after discontinuing treatment. The most frequent reason for intentional nonadherence was discontinuing the treatment after recovering from symptoms [42.7%]. The most frequent reason for unintentional nonadherence was forgetfulness [5.2%]. 19.8% of the patients did not visit their gastroenterologist on time and they purchased drugs from the drugstore. These patients reported that their clinics were too far and difficult to access. There was no significant relationship between nonadherence and demographic variables

Conclusion: Multiple reasons are suggested as factors of medication nonadherence and they seem to be different among different populations. Determining these possible reasons, could lead to finding suitable strategies to overcome or reduce them

Efficacy of endoscopic ultrasonography in evaluation of undetermined etiology of common bile duct dilatation on abdominal ultrasonography

Background: The cause of common bile duct [CBD] dilatation cannot be determined by imaging modalities in many patients. The aim of this study was to assess the value of endoscopic Ultrasonography [EUS] in detecting the cause of CBD dilatation in patients in whom Ultrasonography could not demonstrate the cause of dilation

Methods: Prospectively, 152 consecutive patients who were referred for evaluation of dilated CBD [diameter >7 mm] of undetermined origin by Ultrasonography were included in this study. All the patients underwent EUS. Final diagnoses were determined by using endoscopic retrograde cholangiopancreatography [ERCP], EUS-guided fine needle aspiration [FNA], surgical exploration, or follow-up for at least 10 months. Patients with choledocholithiasis were referred for ERCP and sphincterotomy, and patients with operable tumors were referred for surgery. Patients with inoperable tumors underwent biliary stenting with or without chemoradiotherapy

Results: 152 patients [54% female] with dilated CBD were included. Mean [+/-SD] age of the patients was 60.4 [+/-17.3] years. The mean CBD diameter for all study group in transabdominal Ultrasonography and EUS were 11.7 millimeter and 10.1 millimeter, respectively. Most of the patients with dilated CBD and abnormal liver function test [[LFT] had an important finding in EUS and follow-up diagnosis including peri-ampullary tumors. Mean diameter of CBD in patients with and without abnormal LFT were 10.5 IU/L and 12.1 IU/L, respectively. Final diagnoses included choledocholithiasis in 32 [21.1%], passed CBD stone in 35 [23%], opium-induced CBD dilation in 14 [9.2%], post-cholecystectomy states in 20 [13.1%], ampullary adenoma/carcinoma in 15 [15.8%], cholangiocarcinoma in 14 [9.2%], and pancreatic head cancer in 9 [5.9%] patients

Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS for patients with abnormal EUS were 89.5%, 100.0%, 100.0%, 91.2%, and 90.9%, respectively

Conclusion: After diagnosis of CBD dilation by transabdominal Ultrasonography, EUS may be a reasonable choice for determining the etiology of dilated CBD and tumor staging

Is the prevalence of celiac disease higher than the general population in inflammatory bowel disease?

In some studies inflammatory bowel disease [IBD] and celiac disease were considered to be associated and some believe that this association may influence the prognosis of IBD. However, there is a considerable controversy regarding this association. Therefore ,we aimed to assess the association of these two common digestive diseases and evaluate the complications of this association. In this comparative study, 200 patients with ulcerative colitis [UC] and 206 patients with Crohn's disease [CD] were evaluated for celiac disease using relevant diagnostic tests and pathologic studies. Total IgA, IgA tissue transgulaminase antibody and specific IgA anti endomysial antibody were asseyed. In cases of IgA deficiency, total IgG and IgG tissue TG and IgG anti endomyseal Ab were measured. Patients with increased specific IgA and IgG antibodies for celiac disease, underwent endoscopy and 4 standard samples were obtained. Our results were compared with the results of the prevalence study of celiac disease in the general population. Data were analyzed using analytic and descriptive statistics at a significance level of 5%. Among the studied patients, 1 patient with UC had elevated IgA anti tTG antibody and IgA anti-endomysial antibody who underwent endoscopy and celiac was confirmed on pathology. Hence, of the 200 patients with UC, the diagnosis of celiac disease was confirmed in 1 patient [1:200] with no significant difference with the prevalence of celiac disease in the general population [1:166]. However, none of our patients with Crohn's disease had celiac disease [0:206]. We found no significant difference in the prevalence of celiac disease between patients with UC and the general population. Since most of our participants had a mild level of Crohn's activation, none of those with Crohn's disease had celiac disease. Complications of IBD including sclerosing cholangitis, may be more common in patients with concurrent celiac disease. Therefore, it is recommended that celiac disease be considered in patients with severe and complicated IBD

Body mass index and ABO blood groups among different ethnicities of the Golestan cohort study subjects

ABO blood groups are associated with some important chronic diseases. Obesity as a major risk factor of chronic non-communicable diseases is rising rapidly in Iran as well as in developing countries. Understanding the risks for obesity is important for its control. This study seeks to determine if there is any association between ABO blood groups and body mass index [BMI]. Weight, height and blood groups were determined for participants of the Golestan Cohort Study in order to find any association between ABO blood groups and BMI. Prevalences of overweight and obesity in participants [mean age: 52.1 +/- 8.0 years] were 33.9 and 25.4, respectively. Mean weight and BMI were significantly higher in blood group A, females and those of Turkman ethnicity. After adjustments for age, sex and ethnicity, there was no association noted between VMI and ABO blood group. The prevalence of obesity and overweight in Iran is high, as seen in developing countries. There is no association between BMI and ABO blood groups in the Golestan cohort population, but Turkman ethnicity and female gender are associated with higher BMI

Critical assessment of progress of medical sciences in Iran and Turkey: the way developing countries with limited resources should make effective contributions to the production of science

Scientific progress is an important indicator for the social and economic developments of any country. According to various reports, worldwide, Iran has the most growth in the field of science due to a high increase in the numbers of publications during the past decade. The aim of this study is to assess not only the quantity, but also the quality of publications of indexed Iranian journals and compare them to Turkey, as an Islamic neighboring country, in addition to the contributions of these two countries to our Knowledge. A number of international journals with high impact factors were selected to assess the contributions of scientists from Iran and Turkey to the medical sciences. English medical journals from Iran and Turkey indexed by the ISI Web of Sciences with known impact factors [IF] announced at the beginning of 2010 were included for evaluation. We calculated the number of all articles published from the beginning of 2007 until the October 2010, the number of total citations, and citations from authors outside both countries for each journal. In addition, we selected all articles cited at least six times by authors outside of both countries and discussed their content with regard to originality and novelty, as well as their contributions to current knowledge. Furthermore, 60 international journals in basic or clinical research with IF greater than 6 were selected for the magnitude of contributions of both countries to our scientific Knowledge. In 2010, out of a total of 21 Iranian journals indexed in ISI since 2007, only 12 have a known IF with a mean of 0.39 [range: 0.07 - 0.97], whereas out of 28 Turkish medical journals indexed in ISI, 15 have a known IF [mean: 0.35, range: 0.05 - 0.82]. The total number of articles published since 2007 from Iran, total citations and total citations by authors from outside Iran were 2080, 1218, and 463, respectively. The same data related to Turkish journals were 4876, 2036, and 1331, respectively. Indeed, the mean citations per article by foreign authors for Iranian and Turkish researchers were 0.19 and 0.3, respectively. Of the total articles during this period, only seven from Iran and nine from Turkey have been cited at least six times by authors outside the two countries. Iran had 23 and Turkey 37 original publications in highly reputable international journals. Turkey was more represented in basic research and clinical observational studies than Iran. Despite high numbers of published articles, both countries have medical journals with very low comparable citation rates and IF. Only one out of three Turkish articles is cited once by authors outside of Turkey and one of five Iranian articles is cited by authors outside Iran. The few high-cited articles address new therapies and interventional studies or diseases commonly encountered regionally, and are the results of the efforts of a few individuals in highly specialized fields. Turkish scientists are inclined to publish their scientific works more than Iranians in distinguished international journals. These articles deal more with regional diseases that are not common in Western countries. Developing countries can only contribute to world science when they focus their efforts on teamwork in order to research ways to solve country-specific diseases and their own health problems

Five common cancers in Iran

Iran as a developing nation is in epidemiological transition from communicable to non-communicable diseases. Although, cancer is the third cause of death in Iran, it's mortality are on the rise during recent decades. This mini-review was carried out to provide a general viewpoint on common cancers incidence in Iran and to explain incidental differences that may help us to establish early detection programs and investigate population risk factors. A detailed Pub Med, Scopus and Google scholar search were made from 2000 to 2009. The basic inclusion criteria were all relevant studies focused on cancer epidemiological data from Iran. Overall age-standard incidence rate per 100,000 population according to primary site is 110.43 in males and 98.23 in females. The five most common cancers [except skin cancer] are stomach, esophagus, colon-rectum, bladder and leukemia in males, and in females are breast, esophagus, stomach, colon-rectum and cervix uteri. The incidence rates of gastrointestinal cancers are high in Iran [it is one of the known areas with a high incidence of Gl cancers]. Breast cancer mainly affects Iranian women about a decade earlier than Western countries and younger cases are affected by an increasing rate of colorectal cancer in Iran, near the Western rates