Is treatment of fatty liver effective on reducing carotid intima media thickness; a cohort study

Aim: This study was intended to explore the effect of various drugs used to treat fatty liver on intimal-media thickness in patients with NAFLD

Background: Nonalcoholic fatty liver disease [NAFLD] is an indicator of a broad spectrum of pathologic disorders, which is characterized with macro vesicular steatosis in the absent of alcohol use. It has a wide range of laboratory, clinical and pathological presentations such as simple steatosis to the diseases like non-alcoholic steatohepatitis, fibrosis, and cirrhosis and hepatocellular cancer

Methods: In this cross - sectional study, as a part of a 10-year cohort study [from 2007-2017] at Tabriz University of Medical Sciences, a group of 100 patients with NAFLD were studied. They were examined by color doppler sonography of the carotid arteries to detect any carotid intima- media thickness, before and one year after treatment with various drugs. The effect of treatment on right and left carotid intima- media thickness [IMT] was examined by using SPSS. V21

Results: Over all, 36 [36%] patients were male and 64 [64%] were female. The mean age of the patients was a 43.5±10.3 year, ranging from 16 to 64. The decrease in patients' intima- media thickness in both right and left carotids was statistically significant [P<0.0001]

Conclusion: Treatment of patients with nonalcoholic fatty liver has a significant role in reduction of their carotid intima -media thickness and consequently in reducing cerebrovascular events such as stroke

causal relationship between interns' knowledge and self-efficacy and their value in predicting the interns' communication behavior with patients

After many years of teaching, both the efficiency and efficacy of communication skills programs are under question because patients' dissatisfaction with doctors' communication behavior is at the top of the complaint lists. It is assumed that finding the specific role of different determinants of doctors' communication behavior, instructional designers can plan more effective training programs. This study aims to explore the predictive value of interns' knowledge and self-efficacy in building effective relationship with patients and determine the causal relationship between interns' knowledge and self-efficacy about effective doctor-patient relationship. In this cross-sectional study, PRECEDE model was applied and the analyzed content from semi-structured interviews with 7 interns and 14 faculty members was combined with the items from literature review. All the emerged items were categorized under eight constructs of social cognitive theory. The validity and reliability of the items of the research questionnaire were examined by 40 interns and an expert panel of 14 faculty members. The questionnaires were completed by 203 medical interns and confirmatory factor analysis [CFA] was done on the items. The data were analyzed by SPSS.21 and LISREL 8.80. CFA indicated a good fit to the data. Knowledge and self-efficacy, together, explained 23 percent of the variance in interns' communicative behavior. 53 percent of the changes in interns' self-efficacy were attributed to the changes in interns' knowledge. Improving the interns' shared vision can increase the quality of their knowledge and instructional designs based on learning facts, and gaining insights about effective doctor-patient relationship can increase the interns' self-efficacy and consequently improve the interns' communication skills

Association of TNF-alpha -857 polymorphism with inflammatory bowel disease in a group of Iranian Azeri individuals

Inflammatory bowel disease [IBD] is a chronic, relapsing, inflammatory disorder of the gastrointestinal tract that includes two entities, Crohn's disease [CD] and ulcerative colitis [UC]. As with other complex diseases, both genetic susceptibility and environmental factors play role in the pathogenesis of these diseases. The tumor necrosis factor alpha [TNF-alpha] gene is located in the IBD3 region on chromosome 6p21 which is a good functional candidate for involvement in susceptibility to IBD. In addition, the promoter region of TNF-alpha contains various polymorphisms that have shown a significant association with IBD. In this case control study we investigated the TNF-alpha -857 polymorphism in 109 patients [89 UC and 16 CD] who suffered from IBD and 100 healthy age, sex and ethnicity matched adults selected from the same population, as the control group. The polymorphism was checked by amplification refractory system [ARMS] and polymerase chain reaction [PCR]. Investigation of the association of TNF-alpha -857 gene promoter polymorphism with both types of IBD showed no significant difference in genotype and allele frequencies of this polymorphism between UC patients and controls. However, a possible association of TNF-alpha -857 polymorphism [p=0.03] was identified with CD. TNF-alpha -857 polymorphism may have a role in the development of CD in the Iranian Azeri Turkish population.

Effect of non-alcoholic fatty liver disease on carotid artery intima-media thickness as a risk factor for atherosclerosis

Aim: This study aimed to evaluate the effect of NAFLD on CIMT as a risk factor for atherosclerosis

Background: The prevalence of non-alcoholic fatty liver disease [NAFLD] is increasing worldwide due to rise of obesity and diabetes mellitus [DM] prevalence. Non-invasive assessment of carotid intima-media thickness [CIMT] by high-resolution carotid B-mode ultrasonography is widely used for determining the atherosclerosis

Patients and Methods: In this case-control setting, 151 subjects were categorized in three groups: group I including 49 patients with NAFLD and DM; group II including 50 non-diabetic NAFLD patients; and the control including 52 normal subjects as group III. The right and left CIMTs and its maximum reading [CIMT[max]] were measured by a skilled sonographist blind to the groups. The sonographic grading of the NAFLD was determined in group I and II

Results: Median CIMT[max] was significantly higher in group I comparing with group II and control group [p<0.001]. This difference between group I and group II was not significant after adjusting for age and history of hypertension and hyperlipidemia [p=0.089]. After controlling the confounders, there was statistical significant between group I and group II with the control group [p<0.05]. There was no significant difference in median maximal thickness of intima-media in the carotid of group I compare to group II in patients with and without elevated liver enzymes [in both groups, 0.6 mm, p= 0.402]

Conclusion: Based on our findings, there is a significant association between the presence of NAFLD and atherosclerosis. This association was independent to the DM presence. The grade of NAFLD and elevated liver function tests had no effect on severity of atherosclerosis

Hepatic artery and portal vein doppler indexes in non-alcoholic fatty liver disease before and after treatment to prevent unnecessary health care costs

We tested whether hepatic haemodynamics assessed by Doppler ultrasonography can be a predictor of response to therapy in patients with non-alcoholic fatty liver disease [NAFLD] to prevent further unnecessary diagnostic tests and interventions. Forty eight consecutive patients affected by NAFLD, who refered to some clinics in Tabriz, Iran between 2009 and 2011 were included in the study. Response to therapy was assessed by decrease in liver enzyme levels. Three liver Doppler parameters [hepatic artery resistance index [RI], hepatic artery pulsatility index [PI] and portal vein waveform [PVW]] were analysed in all subjects who showed a decrease in liver function tests results. Wilcoxon and paired student's /-test were used for analysis. Forty eight subjects with NAFLD were included in the study during 21 months, out of which 22 [39.1% male - mean age: 37.6 +/- 8.3] responded to the treatment and formed the basis of this study. Mean hepatic artery RI increased significantly from 0.60 +/- 0.07 to 0.83 +/- 0.27before and after treatment, however, there was no significant differences between hepatic artery PI or PVW. Increase in hepatic artery RI assessed by Doppler ultrasound may provide information on improvement of NAFLD in patients during the course of therapy

Effect of the C3435T polymorphism of the multidrug resistance 1 gene on the severity of inflammatory bowel disease in Iranian Azeri Turks

Multidrug resistance 1 [MDR1] gene encodes for P-glycoprotein [P-gp], a transmembrane efflux pump transferring both exogenous and endogenous substrate from the cells. In the human gastrointestinal tract, P-gp is found in high concentrations on the epithelial cells of the colon and small intestine. It is hypothesized that the expression level of MDR1 gene is related to susceptibility of both forms of inflammatory bowel disease [IBD]. The aim of this study was to investigate the association of C3435T Single Nucleotide Polymorphism in IBD patients with/without clinical symptoms in Iranian Azeri Turks. A total of 116 patients with IBD and 92 healthy subjects were analyzed. We investigated the distribution of MDR1 C3435T polymorphism via polymerase chain reaction - Restriction Fragment Length Polymorphism technique. All statistical analyses were calculated with the SPSS for Windows 16.0. The Fisher exact test was used to test for departure from Hardy-Weinberg equilibrium of the genotype frequencies [P> 0.05]. The data showed that IBD patient with homozygous variant carrying MDR1 3435 T/T genotype has elevated risk for development of routine IBD clinical symptoms like Abdominal pain [P= 0.005] and chronic Diarrhea [P= 0.013] compared with MDR1 3435 C/C homozygotes who has reduced risk for development of IBD symptoms. Our data showed that patients with MDR1 3435 T/T are more susceptible to the development of some routine IBD clinical symptoms [P<0.05]. This study suggests a protective role for the MDR1 3435 C/C versus MDR1 3435 T/Tgenotype and C versus T allele for the progression of IBD in this cohort

Celiac disease in patients with chronic psychiatric disorders

The aim of this study was to determine the prevalence of celiac disease in Iranian patients suffering from chronic depression or schizophrenia. Psychiatric disorders are common in untreated celiac disease. Two hundred Iranian inpatient men with in chronic phase of depressive disorders or schizophrenia, and 200 age-matched healthy male subjects were screened for celiac disease by anti-tissue transglutaminase IgA antibodies. The mean age of the study patients was 37 years. One [1%] schizophrenic and two [2%] depressive patients were positive for anti-tissue transglutaminase IgA antibodies; duodenal biopsy was not possible in these subjects. In the control group one [0.5%] individual was positive for anti-tissue transglutaminase IgA antibodies, but had normal duodenal histology. The difference between patients and controls was not statistically significant. The frequency of celiac disease serology in schizophrenic and depressive inpatients was not significantly higher than that in the general population. We would therefore not advocate systematic serologic screening in these patients, but alertness to celiac disease should be kept in mind

Ondansetron and meperidine prevent postoperative shivering after general anesthesia

Postoperative shivering is one of the common problems following general anesthesia and may lead to multiple complications. The aim of this study was to examine the preventive effects of Ondansetron and Meperidine on postoperative shivering. This randomized placebo-controlled double blind clinical trial included 90 patients scheduled for elective gynecologic operations, randomly divided to three groups. Ondansetron [4 mg], Meperidine [0. 4 mg/kg] and 2 cc normal saline [as a control group] were administered immediately before the induction of anesthesia. Anesthesia induced equivalently for all. Patients were observed in terms of vital signs, side effects and shivering. Postoperative shivering was observed in 13. 3% of patients in Ondansetron group and 20% of Meperidine group, significantly lower than the controls [50%]. The reduction of core and dermal temperature during the anesthesia and recovery, changes in systolic and diastolic blood pressure and heart rate were similar in all three groups. The incidence of nausea was similar among the three groups of study while vomiting occurred in 6. 7% of the Meperidine group and 3. 3% of the controls but none in the patients receiving Ondansetron. Ondansetron can effectively reduce post operative shivering

Grape seed extract to improve liver function in patients with nonalcoholic fatty liver change

Therapeutic intervention in nonalcoholic fatty liver disease are limited, while anti-oxidative materials have shown benefits in animal models. This study aimed to evaluate grape seed extract as an anti-oxidative material in this process. Therapeutic effects of grape seed extract were evaluated in comparison to vitamin C in a double-blind setting. Fifteen patients were enrolled in each group. Liver function tests were done; also, grade of steatosis and pattern of echogenicity of the liver were determined. Patients were followed up by the same evaluation repeated in first, second and third months. Mean age +/- standard deviation was 43.2 +/- 10.3 years. Grape seed extract [GSE] significantly improved the grade of fatty liver change; and resulted in significant decrease in alanine aminotransferase in patients receiving the concentrate compared to those receiving vitamin C independently, from the initial grade of steatosis. This study describes the beneficial effect of using grape seed extract for three months in patients with nonalcoholic fatty liver disease. These results may improve with a longer period of follow-up

Lack of association between Helicobacter pylori and laryngeal carcinoma.

OBJECTIVE: To survey the role of Helicobacter pylori at the tissue level as a cause of squamous cell carcinoma of the larynx. DESIGN: A case-control study. SETTING: In an Otolaryngology Ward at an academic university. SUBJECTS: Patients with laryngeal cancer as cases and patients with benign laryngeal lesion as controls. MAIN OUTCOME MEASURE: In all subjects, specimens of laryngeal tissue were examined by rapid urease test while histopathologic examination was achieved to detect H. Pylori. RESULTS: Totally, 44 patients (42 men and 2 women) with squamous cell carcinoma of larynx and 30 patients (24 men and 6 women) with benign laryngeal lesions (polyp, nodule, granuloma) were studied, none of which were infected with the bacterium. CONCLUSION: Our results did not show H. Pylori infection among patients with laryngeal cancer (SCC) or benign laryngeal lesions. .

cross-sectional study of metabolic and endocrine complications in beta-thalassemia major

Iron overload is a major problem in patients with beta-thalassemia major, and it has many structural and metabolic consequences. The aim of this study was evaluation of endocrine distturbances in patients with beta-thalassemia major who were older than 10 years of age. In this cross-sectional study, investigators collected demographic data and medical histories, as well as menstrual history in females, from the medical records of 56 patients with beta-thalassemia major. Patients were examined to determine their pubertal status and the standard deviation score for height for evaluation of short stature. For evaluation of glucose tolerance, a fasting blood glucose and oral glucose tolerance test were performed. Evidence for diabetes mellitus was based on American Diabetes Association and World Health Organization criteria. Serum levels of calcium, phosphorous, thyroid-stimulating hormone, free thyroxin, luteinizing hormone and follicular-stimulating hormone, and estradiol in girls and testosterone in boys were measured. The mean and standard deviation for age in the 56 patients [36 males and 20 females] was 15.62 +/- 4.44 years. Diabetes mellitus was present in 5 patients [8.9%], impaired fasting glucose was found in 16 patients [28.6%] and an impaired glucose tolerance test was found in 4 patients [7.1%]. Short stature [standard deviation score <-2] was seen in 25 [70%] boys and 14 [73%] girls. Impaired puberty was found in 40 patients [71%]. Hypocalcaemia and primary overt hypothyroidism were present in 23 [41%] and 9 patients [16%], respectively. Only eight patients [14.3%] had no endocrine abnormalities. Despite therapy with deferoxamine to treat iron overload, the risk of secondary endocrine dysfunction remained high. Hypogonadism was one of the most frequent endocrine complications. Impaired glucose tolerance, short stature, hypocalcemia, subclinical and overt hypothyroidism are also frequent