rapid and sensitive assay to identify HLA-DQ2/8 risk alleles for celiac disease using real-time PCR method

Aim: To perform a simple, rapid and sensitive Real-time PCR based SYBR Green method to determine the human leukocyte antigen [HLA]-DQ 2/8 alleles in celiac disease [CD] patients

Background: Many molecular techniques are available to determine the HLA-DQ2 and DQ8 alleles, but they are too expensive and have many steps that make them difficult to use

Methods: To determine the HLA-DQ 2/8 alleles we have developed a new real-time PCR assay, using SYBR Green technique with melting curve analysis on genomic DNA isolated from 75 CD patients and 94 healthy controls. The specific primers to examine HLADQA1* 05, HLA-DQB1*02 and HLA-DQB1*0302 alleles were used and results were compared with commercially available kits

Results: Using this method, the presence of HLA-DQ2 and HLA-DQ8 alleles were determined with sensitivity and specificity 80% and 100% respectively and compared to low resolution commercially available kits, the results of this method were more efficient. The frequency of DQ2 and DQ8 in patients was 76% and 29%, respectively and overall 96% of patients were carries DQ2 and/or DQ8 alleles

Conclusion: The result of this study showed that Real-time PCR using SYBR Green method with melting curve analysis has good efficiency to identify the HLA-DQ2/8 risk alleles

Person centered prediction of survival in population based screening program by an intelligent clinical decision support system

Aim: To survey person centered survival rate in population based screening program by an intelligent clinical decision support system

Background: Colorectal cancer is the most common malignancy and major cause of morbidity and mortality throughout the world. Colorectal cancer is the sixth leading cause of cancer death in Iran. In this survey, we used cosine similarity as data mining technique and intelligent system for estimating survival of at risk groups in the screening plan

Methods: In the first step, we determined minimum data set [MDS]. MDS was approved by experts and reviewing literatures. In the second step, MDS were coded by python language and matched with cosine similarity formula. Finally, survival rate by percent was illustrated in the user interface of national intelligent system. The national intelligent system was designed in PyCharm environment

Results: Main data elements of intelligent system consist demographic information, age, referral type, risk group, recommendation and survival rate. Minimum data set related to survival comprise of clinical status, past medical history and socio-demographic information. Information of the covered population as a comprehensive database was connected to intelligent system and survival rate estimated for each patient. Mean range of survival of HNPCC patients and FAP patients were respectively 77.7% and 75.1%. Also, the mean range of the survival rate and other calculations have changed with the entry of new patients in the CRC registry by real-time

Conclusion: National intelligent system monitors the entire of risk group and reports survival rates by electronic guidelines and data mining technique and also operates according to the clinical process. This web base software has a critical role in the estimation survival rate in order to health care planning

Comparison of half-dose and full-dose triple therapy regimens for Helicobacter pylori eradication in patients with end-stage renal disease

The aim of this study was to compare the half-dose and full-dose triple therapy regimens for Helicobacter pylori [Hp] eradication in patients with end-stage renal disease. H. Pylori is one the most important causes of dyspepsia in patients with end-stage renal disease [ESRD]. Sixty-six patients with ESRD were enrolled in the study with Hp infection and peptic disease with a need of Hperadication. Patients were randomly assigned to full-dose [A=35 patients] or half-dose group [B=31 patients]. Patients received clarithromycin 500 mg, amoxicillin 1000 mg and omeprazole 20 mg twice daily in group A and clarithromycin 250 mg and amoxicillin 500 mg twice daily and omeprazole 20 mg once daily in group B for two weeks. Patients provided stool samples 4 weeks of completing study to assess the success of Hp eradication by Hp-specific stool antigen. Finally, the rate of eradication and complications were compared between two groups. The successful Hp eradication was achieved in 26 patients [74%] in group A and in 22 patients [74%] in group B. The difference between 2 groups was not statistically significant [p=0.973] [per protocol analysis]. Half-dose triple-therapy with clarithromycin, amoxicillin and omeprazole is as effective as full-dose triple-therapy to eradicate the Hp in patients with ESRD. According to lower toxicity level, complications and cost in half-dose regimen in this subset of patients, this protocol is advised

Evaluation of the benefit of addition of clidinium C to a Helicobacter pylori eradication regimen

This study aimed to evaluate the success of H.pylori eradication therapy in patients with dyspepsia by therapeutics regimes with and without clidinium C. Helicobacter pylori infections are reported in all parts of the world. Appropriate antibiotic therapy can treat infection. The ideal treatment regimen has not been specified. In a randomized, double blind clinical trials study, 250 patients with dyspepsia were enrolled. All patients were treated by Omeprazole, Metronidazole, Amoxicillin and Bismuth [OMAB] for two weeks. One tablet clidinium C before each meal was added to this regimen in the intervention group [A]. Urea Breath Test [UBT] was carried out after 8-12 weeks after treatment for evaluation of H.pylori eradication. 132 patients in the intervention group [A] and 118 patients in the control group [B] were enrolled to the study. The rate of eradication in group A was significantly higher than group B [62.1% vs. 50%, p=0.04]. The results supported the effect of clidinium C for increasing of helicobacter pylori eradication, but further studies need to be performed

effects of gluten-free diet on hypertransaminasemia in patients with celiac disease

Celiac disease [CD] is an immune mediated condition that leads to small bowel atrophy that resolves with a gluten free diet [GFD]. Extra-intestinal manifestations of CD include hypertransaminasemia. In this study, the effects of a GFD on hypertransaminasemia in patients with newly diagnosed CD were studied. Ninety eight new diagnosed consecutive patients with CD 40 males and 58 females] with mean age of 32 +/- 17.1 were studied. All patients with CD were treated with a GFD. Patients with hypertransaminasemia, at diagnosis, had a cirrhosis screen performed. Patients with a negative cirrhosis screen were reviewed, 6 months after the introduction of a GFD, and serum levels of liver transaminases were measured again. Nine patients had hypertransaminasemia. One patient was Hepatitis B surface antigen positive and was excluded from this study. The 8 remaining patients had no obvious cause for the hypertransaminasemia. Mean [ +/- SD] of baseline aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels were 42.6 +/- 16.5 IU/L [range: 16-66 IU/L] and 69.3 +/- 9.3 IU/L [range: 52-81 IU/L]. Six months after treatment with a GFD, mean AST and ALT levels decreased to 24.5 +/- 5.1 IU/L [range: 18-31 IU/L] [P: 0.04] and 24.6 +/- 6 IU/L [range: 17-32 IU/L] [P: 0.01], respectively. In 7 patients the hypertransaminasemia, at diagnosis had resolved. This study provides further evidence that some patients with CD have a reversible hypertransaminasemia that resolves with a GFD

Erythromycin decreases the time and improves the quality of EGD in patients with acute upper GI bleeding

To evaluate the efficacy of erythromycin to decrease the time and improves the quality of EGD in patients with acute upper GI bleeding. The diagnostic and therapeutic value of esophagogastroduodenoscopy [EGD] in patients with upper GI bleeding is often limited by the presence of residual blood or clots. Infused erythromycin [3 mg/kg] before EGD, a potent gastro kinetic drug, might improve the quality of EGD in patients with upper GI bleeding and decrease the time of EGD and second- look EGD. In a prospective, randomized, double-blind controlled trial, 40 patients with acute upper gastrointestinal bleeding in Taleghani hospital, Tehran, Iran were studied. The patients were randomized into 2 groups: 1] nasogastric tube placement receiving placebo, and 2] intravenous erythromycin infusion [3mg/kg at 30 min] combined with nasogastric tube placement. The primary end point was endoscopic yield, as assessed by objective and subjective scoring systems and endoscopic duration. Secondary end points were the need for a second look, blood units transfused, and length of hospital stay and mortality. A clear stomach was found more often in the erythromycin group [100% vs. 25%; P< 0.001]. Erythromycin shortened the endoscopic duration [14 vs. 32 minutes in the placebo group; P< 0.001] and reduced the need for second-look endoscopy [1 vs. 3; P< 0.001], admission duration [2 vs 5; P< 0.001] and reduced the blood units transfused [2 vs 4; P< 0.001]. In patients with acute upper GI bleeding, infusion of erythromycin before endoscopy significantly decreases the time and improves the quality of EGD

Polymorphism in two short tandem repeat loci [R-R and S -Q] linked to tRNA genes in entamoeba dispar isolates

In this study, genetic polymorphism of two tRNA-liked short tandem repeat [STR]-containing loci, R-R and S-Q, was analyzed in order to clarify further the genotypic differences among E. dispar isolates. Entamoeba dispar is closely related to the human pathogen E. histolytica, the agent of amebic dysentery and amebic liver abscesses. E. dispar is, to some extent, capable of producing variable focal intestinal lesions in animals and of destroying epithelial cell monolayers in vitro, and some have reported it to be capable of producing amoebic liver abscess in hamsters. However no evidence exists at present to link E. dispar with human disease. A total of 28 E. dispar samples from gastrointestinal disorder patients were characterized using PCR and sequencing. The sequences obtained were edited manually and aligned. Sequence analysis showed 9 and 6 different patterns of units in the repeat-containing region of R-R and S-Q, respectively. The repeat-containing regions of R-R and S -Q loci were found to be extensively polymorphic, varying in size, number and order of repeat units. The results demonstrate extensive genetic variability among Iranian E. dispar clinical isolates. The genetic diversity of tRNA gene-linked STR loci shows them to be suitable for epidemiological studies such as the characterization of the routes of transmission of these parasites in Iran

Frequency of hepatitis C in patients with rheumatoid arthritis

Hepatitis C virus [HCV] infection has been explained as a disease that sometimes present with rheumatic manifestations indistinguishable from rheumatoid arthritis. This study has been performed to evaluate the frequency of hepatitis C virus infection in a group of patients with rheumatoid arthritis. In this study, during one year, serum samples collected from two hundred consecutive patients with rheumatoid arthritis in all affiliated hospitals of Shaheed Beheshti University, MC., were examined for anti-HCV antibody and HCV-RNA by ELISA and RT-PCR method, respectively. Using a questionnaire, the frequency of HCV infection, age and sex distribution, duration of rheumatoid arthritis, associated immune mediated disorders and risk factors for hepatitis C virus infection were assessed. A total of 200 patients [M/F=26/174] who were mainly aged 51-70 years were studied. The frequency of HCV was found to be 2% [95%CI: 0.6-7%]. All of the infected persons have had a low risk occupation in terms of exposure to the virus and none of them had HCV risk factors. No associated immune mediated disorder was found in HCV infected patients. Our results did not support any contribution of HCV infection in the pathogenesis of rheumatoid arthriti

Hepatic steatosis in Iranian patients with chronic hepatitis C

To evaluate the frequency and severity of fibrosis, and also the association of various viral and host factors of steatosis in Iranian patients with hepatitis C [CHC]. Eighty treatment-na‹ve CHC patients, age 37.6 +/- 11.77 years, were studied. Percutaneous liver biopsy was performed for all patients. Based on pathology reports, patients were divided into two groups: with and without significant steatosis. Hepatitis C virus RNA [HCV-RNA], various viral and host factors, and biochemical findings and genotyping of HCV were compared in the two groups. Of the 80 patients, 42 [52.5%] had pathologic evidence of significant steatosis. The mean serum level of cholesterol, triglyceride, glucose, and Gamma-glutamyl transpeptidase as well as the mean body mass index, viral load, stage of fibrosis and frequency of genotype 3 were significantly higher in the patients with than those without steatosis [p < 0.05]. In multivariate analysis, only genotype 3 and viral load had significant association with steatosis. In patients with genotype 3 infection, the mean viral load in those with and without steatosis was 1,623,357 +/- 833,543.46 and 821,262.1 +/- 924,480 copies/ml, respectively, and the difference was statistically significant [p = 0.009]. The mean viral load in patients with genotype 1 infection was not significantly different between the two groups. The mean stage of fibrosis was higher in the group that had significant steatosis [p < 0.05]. Steatosis is a common finding in Iranian patients with CHC. Infection with HCV genotype 3 and high viral load in these patients are associated with significant steatosis