Evolutionary dynamics of Helicobacter pylori cagA and vacA genes in Iran and their association with clinical outcomes

There is a relationship between specific genotypes of Helicobacter pylori cagA and vacA genes and the increased risk of peptic ulcer diseases and gastric cancer. These genes also possess strong patterns of geographical differentiation. The present study aims to determine the patterns of variation of the virulence genes in Iran and their association with clinical status. Sequence fragments for cagAand vacA were obtained from a total of 147 H. pylori isolates from diverse geographical and ethnic sources within Iran. We used phylogenetic methods to determine the patterns of allelic diversity, and the relationship between evolutionary lineages and clinical status. Phylogenetic analyses of Iranian cagA gene disclosed four lineages, whereas the vacA gene had two distinct lineages. The cagA lineage II showed extensive genetic diversity compared with lineage I. cagA lineages III and IV disclosed mixed ancestries with recombinant nucleotides that originated from lineages I and H Iranian strains with vac A lineage II genotype were significantly cagA+ [> 90%, p = 0.0] and correlated with a higher rate of peptic ulcers in infected individuals [p =0.003]. Most strains in the cagA lineage I showed a vacA lineage II genotype [p = 0.003] and significantly correlated with an increased risk of peptic ulcers in infected individuals [p = 0.022]. Strains with cagA lineage III genotype significantly correlated with gastritis [p = 0.0]. The increased level of allelic diversity in the virulence genes shows strong evolutionary dynamics, resulting in the emergence of new clonal genealogies of the cagA gene within Iran. Particular lineages of the Iranian cagA and vac A genes correlate with peptic ulcer diseases

[Evaluation of the correlation between anxiety, depression and personality traits with immunologic markers [ANCAS] in ulcerative colitis]

Background: many studies have investigated the effects of psychological factors on disease activity in patients with ulcerative colitis [UC]. However, the number of studies that have assessed the correlation between immunologic markers of UC and psychological distress are few. Therefore, we designed a study to determine the association between two immuno-biological markers, peripheral/central anti-neutrophilic cytoplasmic antibodies [c-ANCA and p-ANCA], and depressive symptoms, healthy anxiety and personality traits

Materials and Methods: a total of 108 patients with UC entered the study. P-ANCA and c-ANCA were determined by enzyme linked immunosorbent assay [ELISA] and reconfirmed by indirect immunofluorescence. Severity of UC was classified based on Truelove criteria. Depressive symptoms were measured by the Center for Epidemiologic Studies-Depression [CES-D] Scale, anxiety symptoms by the Hospital Anxiety Depression [HAD] Scale and personality traits were assessed by the Revised Eysenck Personality Questionnaire. Pearson correlation was used to assess the relationship between p-ANCA/c-ANCA and psychological distress

Results : our results showed that 81.5% of the patients suffered from anxiety, 43.5% suffered from depression and 75% suffered from introvert personality. No patient was positive for p-ANCA. There were 16 patients [14.8%] who tested positive for c-ANCA; 85.2% were negative for c-ANCA. Anxiety was significantly higher in the c-ANCA negative patients

Conclusion: according to our results, only testing negative for c-ANCA correlated with anxiety. However, the high prevalence of anxiety, depression and introversion and their roles in the clinical course and outcomes of the UC shows the need for early psychological intervention in those patients

Evaluation of the correlation between non-alcoholic fatty liver disease and insulin resistance

Non-alcoholic fatty liver disease [NAFLD] is one of the most prevalent liver diseases, being associated with type II diabetes mellitus, obesity and dyslipidemia. It seems that insulin resistance observed in those with type II diabetes or in obese persons plays an important role in the pathogenesis of NAFLD. The aim of this study was to evaluate the relationship between NAFLD and insulin resistance, disregarding obesity and diabetes. This case-control study was performed on those patients with NAFLD referring to Sari Imam Khomeini Hospital in 2007 after obtaining informed consent from patients. After repeated sonography and proved fatty liver, 80 patients were enrolled [34 cases and 46 controls] matched for age, gender and body mass index [BMI]. NAFLD was documented in the case group, using ultrasonographic indices. Those in the control group were healthy. ALT and AST were normal in both groups. Fasting plasma glucose, fasting insulin, 2-hour oral glucose tolerance test [OGTT] and insulin-resistance were compared between the two groups. Insulin resistance was calculated using HOMA-IR formula. There were 20 men [58.8%] and 14 women [41.2%] in the case group with the mean age of 38.0 +/- 9.4 years. Those in the control group were 27 men [58.7%] and 19 women [41.3%] with the mean age of 39.4 +/- 10.5 years. There was no significant difference between the two groups concerning their age, gender or BMI. The mean level of FPG was 91.8 +/- 8.4 mg/dl in the case and 92.5 +/- 10.1 mg/dl in the control group. The mean level of OGTT was 110.9 +/- 18.8 mg/dl in the case group and 103.1 +/- 25.8 mg/dl in the control group and the difference was not significant. The mean levels of fasting insulin were 16.1 +/- 4.2 mg/dl and 10.3 +/- 4.8 mg/dl in the case and control groups, respectively [p<0.001]. Insulin resistance was 3.6 +/- 0.8 micro u/l.mmol/l in the case and 2.3 +/- 1.2 micro u/l.mmol/l in the control group. Since the intervening factors were identical in both groups, we can conclude that the role of insulinresistance in the pathogenesis of NAFLD is not dependent on age, gender and BMI

[Pancreatobiliary cancers in Iran: a population- based study]

Our knowledge regarding the epidemiology of pancreatobiliary cancers in Iran is limited. This study presents the first population-based report on pancreatobiliary cancers performed in five provinces of Iran. Data used in this study were retrieved from population-based cancer registries in five provinces of Iran [Gilan, Mazandaran, Golestan, Ardabil and Kerman] from 1996 to 2000. Crude incidence rate, age standardized incidence rate [ASR] and age specific incidence rate were calculated for each cancer sites using the direct method. Overall ASR of pancreatic cancer in five provinces was 1.18 and 0.84 per 100, 000 person-years for men and women, respectively. These values for gallbladder and biliary tract cancers were 0.42 and 0.27 per 100, 000 person-years for men and 0.93 and 0.22 per 100, 000 person-years for women, respectively. ASR of pancreatobiliary cancer is low in Iran compared to western countries

[Evaluation of topical L-arginine gel and comparison with lateral internal sphincterotomy in treatment of chronic anal fissure]

At present, surgery is the best method for chronic anal fissure, but by acquiring more knowledge about the pathogenesis and function of internal anal sphincter, non surgical treatment such as using of Glycerin trinitrate, Isosorbide, Bethancol, Diltiazem and Butilinum toxin has been suggested. There is controversy about using of L-Arginine. The aim of the present study was to compare the effect of L-Arginine [chemical Sphincterotomy] with lateral internal Sphincterotomy [surgical Sphincterotomy] in treatment of chronic anal fissure. This clinical trial study was performed on 60 patients referring to our hospital complaining for chronic anal fissure. They were randomly divided in tow groups of equal number: patients undergoing internal Sphinctrotomy [control], and using of topical L-Arginine gel [case]. All of the patients under study where followed for three months, data about pain, bleeding, and wound healing were recorded, and analyzed by SPSS 11 software, chi- square and t-test. The results observed in this study showed that in case group, rectal bleeding discontinued in 70% and pain controlled in 70%, while wound healing occurred in only 26.7%. in control group, 100% had no pain and no bleeding after treatment and wound healing occurred in 56.7% . Local application of L-Arginine can not replace internal sphinctrotomy, but can be used when patient is unwilling for surgery and in cases with underlying disease

[Ecologic study of serum selenium and upper gastrointestinal cancers in Iran]

Both observational and experimental studies have shown that higher selenium status reduces the risk of upper gastrointestinal cancers in selenium deficient populations. Recent cancer registry data have shown very different rates of esophageal cancer [EC] and gastric cancer [GC] in four provinces of Iran, namely Ardabil, Mazandaran, Golestan, and Kerman. The aim of this study was to have a preliminary assessment of the hypothesis that high rates of EC in Golestan and high rates of GC in Ardabil may be partly attributable to selenium deficiency. We measured serum selenium in 300 healthy adults from Ardabil [n=100], Mazandaran [n=50], Golestan [n=100], and Kerman [n=50], using inductively coupled plasma, with dynamic reaction cell, mass spectrometry [ICP-DRC-MS] at the US Centers for Disease Control [Atlanta, Georgia]. The median serum selenium concentrations were very different in the four provinces. The medians [IQR] for selenium in Ardabil, Mazandaran, Golestan, and Kerman were 82 [75-94], 123 [111-132], 155 [141-173], and 119 [110 -128] micro g/L, respectively [p<0.001]. The results of linear regression showed that the province variable, by itself, explained 76% of the variance in log selenium [r2=0.76]. The proportion of the populations with a serum selenium more than 90 micro g/L [the concentration at which serum selenoproteins are saturated] was 100% in Golestan, Kerman, and Mazandaran but only 29% in Ardabil. Our findings suggest that selenium deficiency is not a major contributor to the high incidence of EC seen in northeastern Iran, but it may play a role in the high incidence of GC in Ardabil province

relationship between helicobacter pylori colonization in dental plaque and gastric infection

With regard to the presence of Helicobacter pylori [H. pylori] in Dental Plaque [DP] and its association with gastric infection, data from the literature are variable. The aim of this study was to determine the prevalence of H. pylroi in DP of dyspeptic patients who underwent upper gastrointestinal endoscopy and to investigate its relationship to gastric infection and oral hygiene. Dental plaque samples were taken from tooth surfaces of molars, premolars and incisors of 180 dyspeptic patients. DP samples were subjected to rapid urease test, histological examination, gram stain and culture for identification of H. pylori. During endoscopy six biopsies were taken to visualize H. pylori. Information concerning oral hygiene protocol were recorded. For statistical analysis of data chi square test was used. Clinical diagnoses included 11.3% duodenal ulcer, 46% active chronic gastritis without ulcer, 22.7% chronic gastritis with ulcer and 20% normal gastro-duodenal mucosa. Patients were divided into two groups of infected and uninfected according to H. pylori infection. Our study proved the presence of H. pylori in DP of infected and uninfected patients including subjects with normal gastric mucosa. H. pylori was identified in all three locations with different prevalence: 87% in the molars, 69% in the premolars and 61% in the incisors. There was no significant association between H. pylori colonization in DP and gastric infection. In this study oral hygiene did not have significant influence on the presence of H. pylori in dental plaque. There was no significant relationship between the presence of H. pylori in DP and gastric infection supporting the hypothesis that H. pylori may belong to the normal microflora of the oral cavity. However, factors that influence the growth and distribution of H. pylori and conditions that favour gastric infection are still unknown