Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome

Purpose@#Hemorrhoids are the most common benign anorectal diseases. Mucopexy strengthens the anal canal mucosa, which can be performed alone or in combination with Doppler-guided hemorrhoidal artery ligation (DG-HAL). In this study, we compared the postoperative complications between simple mucopexy plus HAL with and without a Doppler guide. @*Methods@#This study was performed as a single-blinded randomized clinical trial. Patients referred to a tertiary colorectal referral clinic with grades 3 and 4 hemorrhoids who were candidates for surgical intervention entered the study. Thirty-six patients were randomly divided into 2 groups. Group A including 18 patients underwent mucopexy and DG-HAL and the other 18 patients (group B) underwent standard mucopexy and HAL without a Doppler guide. Postoperative pain score and the duration of oral analgesic consumption were recorded. Additionally, postoperative symptoms and complications were recorded and compared between the 2 methods. @*Results@#There was no significant difference between the 2 groups in terms of pain score and the duration of postoperative analgesic consumption as well as the incidence of postoperative complications. Besides, the primary grade of hemorrhoids was not significantly associated with recurrence, but there was a significant association between body mass index and Wexner score (WS) with recurrence. The mean WS of patients showed a significant decrease in both groups postoperatively. However, the rate of WS reduction was not remarkably different between the 2 groups. @*Conclusion@#Simple mucopexy with blind HAL (without Doppler guide) might be considered for the treatment of grades 3 and 4 hemorrhoids effectively.

role of MicroRNA signature as diagnostic biomarkers in different clinical stages of colorectal cancer

Objective: Colorectal cancer [CRC] is one of the most common cancers and a major cause of cancer-related death worldwide. The early diagnosis of colorectal tumors is one of the most important challenges in cancer management. MicroRNAs [miRNAs] have provided new insight into CRC development and have been suggested as reliable and stable biomarkers for diagnosis and prognosis. The aim of this study was to analyze the differential expression of miRNAs at different stages of CRC searching for possible correlation with clinicopathological features to examine their potential value as diagnostic biomarkers

Materials and Methods: In this case-control study, plasma and matched tissue samples were collected from 74 CRC patients at stage II-IV as well as blood samples from 32 healthy controls. After exhaustive study of the current literature, eight miRNAs including miR-200c, 20a, 21, 31,135b, 133b,145 and let-7g were selected. The expression level of the miRNAs was assayed by quantitative reverse transcriptase-polymerase chain reaction [qRT-PCR]. Statistical analysis, including t test , Mann-Whitney U, Kruskall-Wallis tests and receiver operating characteristic [ROC] curve was applied, where needed

Results: Significantly elevated levels of miR-21, miR-31, miR-20a, miR-135b, and decreased levels of miR- 200c, miR-145 and let-7 g were detected in both plasma and matched tissue samples compared to the healthy group [P<0.05]. However, no significant differences were observed in the expression level of plasma and tissue miR-133b [P>0.05]. ROC for tissue miRNAs showed an area under the ROC curve [AUC] of 0.98 and P<0.001 for miR-21, 0.91 and P<0.001 for miR-135b, 0.91 and P<0.001 for miR-31, and 0.92 and P<0.001 for miR-20a

Conclusion: Our results indicate that the expression levels of microRNAs are systematically altered in CRC tissue and plasma. In conclusion, detection of miR-21, miR-135b, miR-31 and miR-20a levels in the tissue might be helpful to illuminate the molecular mechanisms underlying CRC carcinogenesis and serve as tumor-associated biomarkers for diagnosis

Association between Helicobacter pylori infection and alopecia areata: a study in Iranian population

Background: alopecia areata is an immune mediated inflammatory hair loss, which occurs in all ethnic and age groups, and both sexes. However no significant etiology has been known for this disease.Helicobacter pylori [H. pylori], is an organism colonized in gastric mucosa. This bacterium has been associated with certain extra-digestive dermatological conditions. The causal relationship between alopecia areata and H. pylori infection has been discussed in literature. Therefore, we conducted this study to evaluate the prevalence of H. pylori infection in patients with alopecia areata and assess the risk of this infection in patients with this disease in order to determine its potential roles in the physiopathology of this disease

Methods: between 2014 and 2015, we prospectively studied 81 patients with alopecia areata and 81 healthy volunteers with similar age and sex. Patients without any history of H. pylori infection were included in the study and underwent urease breath test. All results were analyzed using SPSS software [version 21.0] and p value<0.05 was considered as statistically significant

Results: 81 patients and 81 controls with the mean age of 34.9+/-11.6 and 38.2+/-13.4 years were studied [p=0.097]. 48 [59.3%] and 45 [55.6%] individuals were male, in cases and control groups respectively [p =0.634]. The result of urea breath test [UBT] was positive in 43 [53.1%] patients in cases and 27 [33.3%] individuals in control group, which was significantly different [p =0.011]. The risk of H. pylori infection in alopecia areata was 2.263 [95% CI: 1.199-4.273]

Conclusion: the results of our study showed significant difference between H. pylori infection in individuals with and without alopecia areata, which shows that H. pylori contamination may be effective in physiopathology of alopecia areata. Therefore these results should be tested in large multivariable cohorts and controlled trials to reach more accurate evidence in the future and to generalize this idea to larger population

Reliability and validity of the Persian version of patient assessment of constipation- quality of life [PAC-QOL] questionnaire

Aim: The present study aimed to assess the reliability and validity of Persian version of patient assessment of constipation: quality of life [PAC-QOL] questionnaire in Iranian patients

Background: Chronic constipation has significant effects on daily living, wellbeing and individuals' quality of life [QOL]. Validated tools can help us to assessing QOL in affected ones and facilitating clinical management of them

Methods: The English version of Patient Assessment of Constipation: Quality of Life [PAC-QOL] was translated into the Persian language and was confirmed by back-translation. One hundred and forty patients with functional constipation, according Rome III criteria, completed the questionnaires .The questionnaires were analyzed using Cronbach's Alpha internal consistency score to determine the reliability. Twenty medical experts were then asked to evaluate the PAC-QOL and the results were used to calculate the Content Validity Ratio [CVR] and Content Validity Index [CVI]

Results: Due to obtained value for Cronbach's alpha [0.975] and also for the subscale of physical discomfort [0.930], psychosocial discomfort [0.975] and worries and concerns [0.915], the internal consistency is established. According to medical experts' opinions, the value of CVR ranged from 0.5 to 0.8 and the value of CVI was 0.81

Conclusion: The Persian version of PAC-QOL questionnaire is shown to have acceptable reliability and validity to be used for psychometric evaluation in Iranian patients complaining of functional constipation

association between modulating inflammatory cytokines and constipation of geriatrics in Iran

Background: The effect of changes in intestinal microbiota on constipation is contraversial. Constipation is more prevalent in elderly. Therefore, the current study was designed to assess the role of modulating inflammatory cytokines in old age patients with constipation by evaluating the serum levels of tumor necrosis factor alpha [TNF-alpha], interleukin 1 [IL-1], and interleukin 6 [IL-6]

Methods:This case-control study was done on 100 participants, aged 65 years or higher, with and without functional constipation according to ROME III criteria [50 participants in each group]. Baseline demographic, clinical characteristics, and serum levels of TNF-alpha, IL-1, and IL-6 were compared between the case and control groups. Independent t test and Chi-square test were used for analysis of data

Results:Mean levels of TNF-alpha, IL-1, and IL-6 were [666.80 +/- 101.40 pg/mL vs. 489.20 +/- 53.68 pg/mL, p < 0.001], [435.96 +/- 52.31 pg/mL vs. 296.44 +/- 45.50 pg/mL,p < 0.001] and ]438.18 +/- 59.57 pg/mL vs. 290.14 +/- 36.39 pg/mL,P < 0.001] in the case and control groups, respectively. A reverse correlation was found between the aging process and TNF-a [r = -0.26; p = 0.04], as well as IL-1 level [r = -0.41; p = 0.003] in the control group. A direct correlation was observed between the aging process and TNF-alpha [r = 0.40; p = 0.004] and IL-6 [r = 0.44; p = 0.002] levels in the case group

Conclusion: This study showed a significant association between the serum level of modulating inflammatory cytokines and age-related constipation in Iranian subjects. It seems that the serum level of modulating inflammatory cytokines can be affected by diversity and abundance in the gut microbiota. The role of diversity in microbial population and their abundance in gut must be evaluated in further studies

Fatal idiopathic hypereosinophilic syndrome presenting with refractory ascites: case report study

Hypereosinophilic syndromes were a group of divergent disorders united by overproduction of eosinophils and the several organ damages ascribed to this persistent eosinophilia. Among all the presenting symptoms, gastrointestinal symptoms were the least common. We were reporting a 21 year old man with a 2 year history of refractory ascites, hepatomegaly, portal and hepatic veins thrombosis and cutaneous lesions. Bone marrow aspiration and biopsy revealed granulocytic hyperplasia with marked eosinophilia. After ruling our common causes of eosinophilia, a diagnosis of idiopathic hypereosinophilic syndrome was made. The patient was treated with corticosteroids and imatinib but due to the advanced progression of the disease, resulted in a fatal outcome. Since early diagnosis and treatment is the key for improving the prognosis of HES patients, a high clinical suspicion is necessary in the diagnosis of this condition

Fever ,weight loss and early satiety due to gastric inflammatorymyofibroblastic tumor; case report and literature review

Gastric inflammatory myofibroblastic tumor [IMT] is a rare tumor with and unpredictable prognosis usually find in young adults. We present an 18-year-old man with gastric IMT. He complained of epigastric pain, intermittent fever and night sweating associated with weight loss since two years ago. Physical examination showed anemic and cachestic features with mild abdominal tenderness in palpitation as well as an abdominal mass in epigastrium. Abdominal CT scan revealed a huge mass that was arising from the stomach. Upper endoscopy revealed a submucosal lesion in fundus of stomach of approximately 8cm. Endoscopic ultrasound showed a large sub-mucosal non homogenous fundal mass with areas of calcification. The patient underwent laparoscopic partial gastrectomy. Histopathologyand immunohistochemistryevaluation revealed an IMT

Comparison of the effects of eicosapentaenoic acid and docosahexaenoic acid on the eradication of Helicobacter pylori infection, serum inflammatory factors and total antioxidant capacity

Helicobacter pylori infection, the most common chronic bacterial infection in the world, and an important cause of gastrointestinal disorders, may be involved in the pathogenesis of some extra-gastrointestinal disturbances, as well as an increase in blood levels of certain inflammatory markers. Anti-bacterial activity against Helicobacter pylori and anti-inflammatory properties of omega-3 fatty acids have been studied in several research studies. The purpose of the present study was the comparison of the effects of Eicosapentaenoic Acid and Docosahexaenoic Acid supplementation on Helicobacter pylori eradication, serum levels of some inflammatory markers and total antioxidant capacity. In a randomized, double-blind, placebo-controlled clinical trial, 97 Helicobacter pylori positive patients [64 patients in the two intervention groups and 33 in the control group], received 2 grams daily of Eicosapentaenoic Acid, Docosahexaenoic Acid or Medium Chain Triglyceride oil as placebo, along with conventional tetra-drug Helicobacter pylori eradication regimen, for 12 weeks. Helicobacter pylori eradication test and measurement of concentration of interleukine-6, interleukine-8, high-sensitivity C-reactive protein and total antioxidant capacity were performed after the intervention. There was no significant difference in eradication rate of the infection, levels of interleukine-6 and total antioxidant capacity among the three groups, while the levels of interleukine-8 and high-sensitivity C-reactive protein were statistically different. Eicosapentaenoic Acid or Docosahexaenoic Acid supplementation had no significant differential impact on the eradication of Helicobacter pylori infection, and serum levels of interleukine-6 and total antioxidant capacity. However, it had a desirable effect on the levels of interleukine-8 and high-sensitivity C-reactive protein in Helicobacter pylori positive patients

Efficacy of clarithromycin containing bismuth-based regimen as a second-line therapy in helicobacter pylori eradication

The eradication of Helicobacter pylori infection, commonly prevailing in the stomach, has been important since its introduction. Adequate preparations should be made in finding alternatives when faced with first-line treatment failures. Currently, ideal second-line treatments are indistinct and varied among countries as result of different antibiotic resistance patterns. We aimed to evaluate the safety and efficacy of a clarithromycin-containing bismuth-based quadruple regimen as a second-line treatment. Forty-eight H.pylori-positive patients with proven gastric or duodenal ulcers and/or erosions who had previously failed to respond to furazolidone-containing regimens were enrolled. They received pantoprazole [40 mg-bid], amoxicillin [1gr-bid], bismuth subcitrate [240 mg-bid], and clarithromycin [500mg-bid] for 10 days. Eight weeks after treatment, a 14C-urea breath test was performed for the re-evaluation of H. pylori eradication. Forty-three patients completed the study. H.pylori eradication rates were 79.2% [95% CI=65.00-89.53] and 88.4% [95% CI=74.91-96.11] according to intention-to-treat and per-protocol analyses, respectively. All patients had excellent compliance to treatment and one did not continue therapy because of adverse effects. In developing countries such as Iran, a ten-day clarithromycin-containing bismuth-based quadruple regimen is encouraged as a second-line treatment because of the acceptable rate of eradication and low adverse effects

Clarithromycin vs. gemifloxacin in quadruple therapy regimens for empiric primary treatment of Helicobacter pylori infection: a randomized clinical trial

Eradication of Helicobacter pylori infection plays a crucial role in the treatment of peptic ulcer. Clarithromycin resistance is a major cause of treatment failure. This randomized clinical trial aimed at evaluating the efficacy of a clarithromycin versus gemifloxacin containing quadruple therapy regimen in eradication of H.pylori infection. In this randomized double blind clinical trial [RCT 2012102011054N2], a total of 120 patients were randomized to two groups of 60 patients each. Patients with proven H.pylori infection were consecutively assigned into two groups to receive OBAG or OBAC in gastroenterology clinic in Rasoul-e-Akram General Hospital in Tehran, Iran. The patients in the OBAG group received omeprazole [20 mg] twice daily, bismuth subcitrate [240 mg] twice daily, amoxicillin [1 gr] twice daily, and gemifloxacin [320 mg] once daily, and those in the OBAC group received omeprazole [20 mg] twice daily, 240 mg of bismuth subcitrate twice daily, amoxicillin [1 gr] twice daily, and clarithromycin [500 mg] twice daily for 10 days. Five patients from each group were excluded from the study because of poor compliance, so 110 patients completed the study. The intention-to-treat eradication rate was 61.6% and 66.6% for the OBAC and OBAG groups, respectively. According to the per protocol analysis, the success rates of eradication of H.pylori infection were 67.2% and 72.7% for OBAC and OBAG groups, respectively [p=0.568]. The results of this study suggest that gemifloxacin containing regimen is at least as effective as clarithromycin regimen; hence, this new treatment could be considered as an alternative for the patients who cannot tolerate clarithromycin

Cumin extract for symptom control in patients with irritable bowel syndrome: a case series

Irritable bowel syndrome is one of the most common gastrointestinal disorders characterized by chronic abdominal pain, altered bowel habits or changes in stool consistency. Unfortunately, no specific treatments for relieving IBS symptoms have been suggested yet. This pilot study was conducted to evaluate the efficacy of the Cumin extract, a kind of herbal used in the treatment of gastrointestinal disorders like bloating, and other symptoms of IBS. Fifty seven patients with IBS [according to the ROME II diagnostic criteria] with no nay other accompanying illness enrolled in study. Patients were advised to discontinue their other treatments during the study course, then 20 drops per day of Cumin essential oil was administered for included patients. IBS-associated symptoms including abdominal pain, nausea, painful defection, presence of mucosa in stool, changes in stool consistency and defecation frequency were evaluated using a questionnaire before treatment, 2 and 4 weeks after beginning treatment and 2 and 4 weeks after stopping treatment. Abdominal pain, bloating, incomplete defecation, fecal urgency and presence of mucus discharge in stool were statistically significant decreased during and after treatment with Cumin extract. Stool consistency and defecation frequency were also both statistically significant improved in patients with constipation dominant pattern of IBS. Cumin extract can be effective in improving all IBS symptoms. Considering its low cost and easy availability Cumin administration in patients with IBS may have economic benefits

[ effects of docosahexaenoic acid [DHA] on helicobacter pylori eradication, some serum inflammatory factors and total antioxidant capacity]

As regard to high prevalence of Helicobacter pylori infection and complications of it's persistence, as well as anti-bacterial activity against of Helicobacter pylori and anti-inflammatory properties of omega-3 fatty acids, this study was conducted to evaluate the effects of supplementation with Docosahexaenoic Acid [DHA] on the eradication of Helicobacter pylori infection, some serum inflammatory markers and total antioxidant capacity. In a double-blind, placebo-controlled clinical trial, 66 H. pylori positive patients [33 in the intervention group and 33 in the control group], along with tetradrugs H. pylori eradication regimen, randomly received daily two grams morDHA supplement or Medium Chain Triglyceride [MCT] oil as placebo for 12 weeks. Dietary intake data was collected by 24 hour food recall and analyzed by Nutritionist IV software. Sampling from fasting blood and measuring weight, height, body mass index [BMI] and level of physical activity were done at the first and the end of the study. As well as, eradication test of the infection was performed for all patients at the end of the intervention. Eradication rate of the infection, the level of interleukin-6 [IL-6], high sensitivity C-reactive protein [hs-CRP] and total antioxidant capacity [TAC] didn't have significant difference between two groups at the end of the study [P>0.05], while the level of interleukin-8 [IL-8] was different between two groups [P=0.008]. Difference of the concentration between the beginning and the end of the study was not significant in any factors between two groups [P>0.05]. Intake of morDHA supplement didn't have significant effect on the eradication of H. pylori, serum levels of IL-6, hs-CRP and TAC, while it was effective on the level of IL-8.

immunohistochemistry and toluidine blue roles for helicobacter pylori detection in patients with gastritis

Background: helicobacter pylori, which is associated with many upper gastrointestinal diseases, is found in half of the population of the world. Several special stains and immunohistochemistry stain for H. pylori are available. The need for and usefulness of immunohistochemical [IHC] technique has been debated for years. Toluidine blue is a simple stain for microbiological studies and is easily available in laboratories. Therefore, this study was conducted to compare hematoxylin and eosin [HandE], Giemsa and toluidine blue staining with immunehistochemistry for detection of H. pylori in patients with gastritis and also to correlate the results of these staining methods with pathological grading

Methods: we reviewed 54 consecutive gastric biopsy specimens stained by HandE and Giemsa as well as by toluidine blue and immunohistochemistry stains for H. pylori

Results: H. pylori was positively identified by IHC in 43 [79.63%] patients, while positive samples were found in 18 [33.33%], 24 [44.44%] and 33 [61.11%] patients using HandE, Giemsa and toluidine blue staining methods. Our results showed that classical histological staining methods are not sensitive enough to identify low numbers or coccoid forms of organism, while toluidine blue and immunohistochemistry play an important role in detection of H. pylori infection

Conclusion: toluidine blue has been proved to be much more reliable than HandE and Giemsa in detection of H. pylori. In addition, in post treatment biopsies and in biopsies with unexplained chronic active gastritis without histological evidence of H. pylori should have immunohistochemistry done to detect possible low density or coccoid form of organisms. Iran. Biomed. J. 17 [1]: 36-41, 2013

[Accuracy of urea breath test to detect Helicobacter pylori infection among patients with chronic renal failure candidate for renal transplantation]

There are few studies to evaluate diagnostic accuracy of urea breath test [UBT] in patients with chronic renal failure [CRF]. In this study, accuracy of urea breath test to detect Helicobacter pylori [H. pylori] infection among patients with chronic renal failure candidate for renal transplantation was studied. In this descriptive-analytic study, 40 patients with CRF were studied. Upper GI endoscopy and UBT were requested for all patients. Clinical data and histologic findings and UBT results were analyzed by chi-square using SPSS ver.12 software. P< 0.05 was considered statistically significant. Forty patients with mean age of 33.56 +/- 11.22, including 20 male and 20 female, were studied. Both sensitivity and specificity of UBT were 80 percent, but with cut-off point of 5, its specificity increased to 100 percent. Positive and negative predictive values of UBT were 92.30 percent and 57.14 percent, respectively, but with cut-off point of 5, they increased to 100 percent and 71.42 percent, respectively. In according to relatively low sensitivity of UBT in CRF patients and higher risk of peptic ulcer and its bleeding, it is suggested that histologic examination must be done for all patients with negative UBT. Furthermore, diagnostic accuracy for H. pylori detection could be improved by assessing the UBT with a cut-off value of 5

Comparison of Azithromycin and Metronidazole in a quadruple-therapy regimen for Helicobacter pylori eradication in dyspepsia

Helicobacter pylori [H pylori] plays an important role in the pathogenesis of chronic gastritis, peptic ulcer disease, and gastric neoplasms. Therefore, it is necessary to select an effective regimen for H pylori eradication. The aim of this study was to compare the efficacy of two quadruple-therapy regimens-one with azithromycin and the other with metronidazole-for H pylori eradication in patients with dyspepsia. In this double-blind randomized clinical trial conducted in Rasoule-Akram Hospital in 2006, we included 60 patients [aged 15-70 years] who had dyspepsia and H pylori infection as diagnosed by upper gastrointestinal endoscopy and rapid urease test. Patients were randomly assigned to receive a quadruple-therapy regimen for 2 weeks: 1] the MAO-B group [n = 30] received metronidazole 500 mg b.i.d, amoxicillin 1g b.i.d, omeprazole 20 mg b.i.d, and bismuth 240 mg b.i.d and 2] the AAO-B group [n = 30] received azithromycin 500 mg once daily for 1 week and amoxicillin 1g b.i.d, omeprazole 20 mg b.i.d, and bismuth 240 mg b.i.d for 2 weeks]. H pylori eradication was assessed by the rapid urease test [RUT] 2 months after the cessation of treatment. H pylori was eradicated in 68% and 69% of patients in the MAO-B and AAO-B groups, respectively. There was no significant difference in H pylori eradication rates between the two groups [P = 0.939]. No significant difference exists between the two quadruple-therapy regimens that were tested