Frequency of thrombophilic gene polymorphisms in cirrhotic patients with splanchnic vein thrombosis in comparison with cirrhotic patients without thrombosis

Background and Objectives: Visceral thrombosis especially hepatic vein thrombosis deteriorates the disease in ciniiotic patients. Thrombophilic genotypes are seen in most cirrhotic patients with portal vein thrombosis. The aim of this study is the comparison of thrombophilic genes frequency in cirrhotic patients with splanchnic veins thrombosis versus cirrhotic patients without thrombosis

Materials and Methods: In a case - control study, we studied 100 patients with hepatic cirrhosis in Tabriz Imam Reza hospital after achieving inclusion criteria in the form of two groups [with and without visceral veins thrombosis]. The frequency of genetic polymorphism of thrombophilia in two groups of cirrhotic patients was assessed

Results: The mean age of the patients was 48.1 +/-18.1 years which were in the range of 15 to 85 years. 51 [51%] of patients were male and 49 [49%] were female. Thrombosis was present in portal vein in 24% of patients, in superior mesenteric vein in 7% of patients, in splenic vein in 14% and in 5% of patients in potal and splenic veins. There was no significant difference between two groups in G20210A, C677T, A1298C and PAH genes polymorphism [P=6.82, P-0.70, P-0.78 respectively]

Conclusion: With regard to the non-significant difference in frequency of thrombophilic gene polymorphism in two groups, we cannot assume prophylactic actions in cirrhotic patients for visceral vein thrombosis but we recommend more multicentric studies with more number of cases for clarifying the topic

[ effects of probiotic yogurt on metabolic factors in nonalcoholic fatty liver disease]

Background and Aim: Probiotic products may have positive effects in the non-alcoholic fatty liver disease [NAFLD]. The aim of this study was to investigate the effects of consumption of probiotic yogurt on some metabolic factors in the patients with nonalcoholic fatty liver disease [NAFLD]

Material and Methods: This double-blind, randomized, controlled clinical trial included 72 patients between 23 to 63 years of age with NAFLD [33 males and 39 females]. The intervention group [n = 36] consumed 300 g/d of pro-biotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 and the control group [n = 36] consumed 300 g/d of conventionalyogurt for 8 weeks. Using SPSS software version 16, data analysis was performed by chi-square test, independent sample t-test, analysis of covariance, and paired sample t-test

Results: Fasting blood samples, anthropometric measurements, and dietary records [24 h/day for 3 days] were collected at baseline at the end of the trial. Probiotic yogurt consumption resulted in 4.67%, 5.42%, 4.1%, and 6.92% reductions of serum levels of alanine aminotransferase, aspartate aminotransferase [P<0.02], total cholesterol [P<0.001], and low-density lipoprotein cholesterol [P<0.001], in the intervention group, compared to the control group. Both groups showed no significant changes in the levels of serum glucose, triglyceride, or high-density lipoprotein cholesterol [P>0.05]

Conclusion: Probiotic yogurt consumption improved hepatic enzymes, serum total cholesterol, and low-density lipoprotein cholesterol levels in the subjects. Therefore, it might be useful in the management of NAFLD risk factors

[Common KRAS and BRAF mutations in colorectal cancer patients]

KRAS and BRAF gene mutations are considered as key events in carcinogenesis progression of colorectal cancer. Given the importance of these gene mutations evaluations, especially in metastatic patients, in terms of determination of therapeutic strategies, we studied the prevalence of KRAS and BRAF mutations in Tabriz city. Deoxyribonucleic Acid [DNA] extracted from Fresh tumor and normal tissues of 30 primary CRC patients. Direct sequencing method, was the method for determining the mutation points of KRAS exon 2 and BRAF exon 15 genes. After mutation analysis, the clinical and pathological associations of mutant genes were assessed. The prevalence of KRAS gene mutation was 20 %[6 out of 30 cases] in this study, and none of patients had the mutant BRAF gene. The odds ratio of the KRAS gene mutation in high grade CRCs was 2.1[95% CI: 1.34 to 3.29]. The same ratio for metastasis was 1.1[95% CI: 0.93 to 1.25]. There was no significant relationship between the mutation and clinical and pathological aspects of the disease. The high occurrence of early onset of colorectal cancer in Iran demands more attention to screening and prevention programs in the younger age group in the country. However further genetic studies are needed at the molecular level and large population in different geographical areas

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.

Epidemiological and clinical characteristics of inflammatory bowel disease in patients from Northwestern Iran

There are few reports from Iran about the epidemiology and clinical features of inflammatory bowel disease [IBD]. This study aims to determine the epidemiologic profile and clinical features of IBD in Northwest Iran referral centers. In a cross-sectional setting, we evaluated 200 patients with definitive diagnoses of IBD who referred to Tabriz educational hospitals during the period of 2005 to 2007. Demographic characteristics as well as patients' clinical profiles were evaluated. Disease activity and severity were determined by the Crohn's Disease Activity Index and Truelove and Witt's classification of ulcerative colitis [UC]. The related probable demographic factors were tested. Of the 200 IBD patients, 183 [91.5%] were diagnosed with UC and 17 [8.5%] with Crohn's disease [CD]. There was a positive first degree relative of IBD in 10.9% of UC and 11.8% of CD patients. Abdominal pain was the primary presenting symptom in 25.7% of UC patients and in 58.8% of those with CD. Among UC patients, left-sided colitis was the main feature [52.5%]; while in patients with CD, colon involvement was predominant [52.9%]. There was no significant contributor for activity or severity of disease noted among demographic factors. The occurrence of UC was much higher than CD. The onset of IBD occurred in younger ages with a predominance in males. Left-sided colitis in UC and colon involvement in CD was common. Mostly, the pattern of IBD was mild to moderate with good response to pharmacotherapy. Disease activity and severity were unaffected by demographic features

Prophylactic effect of vitamin C on cyclosporine A-induced liver toxicity

Cyclosporine A [CsA] is an important immunosuppressive agent; however, its clinical use is limited by several side effects such as hepatotoxicity. Vitamin C [ascorbic acid] is a very important and powerful antioxidant and protects membranes against oxidation. The aim of this study was to study protective role of vitamin C against CSA-induced hepatotoxicity. Thirty male Wister strain rats weighting 230-260g were randomly divided into 3 groups [n = 10]: group A was the control group and received placebo [Normal Saline], group B was the CSA-treated group and received 15mg/kg/day CsA for 21 days, group C was the CsA + vitamin C group and was received 200mg/kg/day vitamin C orally 3 hours before receiving 15mg/kg/day CsA. On 22[th] day rats serum obtained for measuring biochemical factors including bilirubin, alanine aminotransferase [ALT], aspartate aminotransferase [AST], triglyceride, alkaline phosphatase [ALP] and lactate dehydrogenase [LDH], total protein, and albumin. Bilirubin, ALT, AST, triglyceride, ALP, and LDH levels were lower in CsA + ascorbic acid group than that of CsA group [P < 0.05] while plasma total protein and albumin were significantly higher in CsA + ascorbic acid group than that of CsA group [P < 0.05]. In conclusion, we have shown that vitamin C administration provides protection against CSA-induced injury in rat liver function and may have hepatoprotective role in the patients experiencing CSA treatment

Red cell distribution width levels and disease activity in ulcerative colitis

The amount of literature concerning the implication of the red cell distribution width [RDW] in the assessment of ulcerative colitis [UC] activity is rather limited. The aim of this study is to investigate the potential role of RDW in the evaluation of UC disease activity. A total of 96 patients with UC and 51 age and sex-matched healthy volunteers were included in a cross-sectional study. Clinical disease activity was defined using the numerical Disease Activity Index [DAI]. In addition to RDW, serum C-reactive protein [CRP] levels, erythrocyte sedimentation rates [ESR], and platelet counts [PLT] were measured. AThere were 47 [about 49%] patients with that had active UC. The RDW was significantly higher in patients with UC than in controls [p=0.001] and active versus patients in remission [p<0.001]. RDW was significantly correlated with DAI scores, ESR, CRP and PLT in active patients. There was a significant correlation between RDW with DAI scores and CRP levels in patients who were in remission. RDW was elevated in UC patients in comparison with healthy controls and increased markedly in active disease. It was also strongly correlated with clinical disease activity scores and inflammatory parameters such as ESR and CRP. RDW, as a cost-effective tool, may be an additional parameter to assess disease activity in UC.

[Evaluation of treatment and survival rates in patients with esophageal cancer referred to Imam Khomeini Hospital, Tabriz, Iran]

Esophageal cancer is one of the prevalent cancers in East Azerbaijan Province. The aims of this study are to estimate the survival rate of patients with esophageal cancer by treatment modalities and tumor location, as well as risk factors such as cigarette smoking, family history, age at diagnosis, and gender. In a cross-sectional study we evaluated 142 patients diagnosed with esophageal cancer [89 men, 53 women] who referred to the Educational Center in Tabriz, Iran. Demographic data, risk factors, histology, tumor location, stage and treatment modalities were collected. We followed patients for one year after diagnosis. The Kaplan-Meier method was used to estimate survival probability and Cox proportional hazards model for multivariate analysis of risk variables. Mean age of patients was 65.63 +/- 11.98 years. A past history of cigarette smoking was positive in 50.4% of all patients, of which 66% were women. The lower third of the esophagus was the most common site of involvement. One year survival rate of our patients was 43%, with a low median survival time of 10 months. Age, gender, and tumor location did not show any significant effects on patient survival. Patients treated with surgery or chemoradiotherapy alone as well as those who smoked cigarettes had shorter survival. Although the survival rate is low in esophageal cancer patients in our province, the life expectancy among those patients can be increased by proper selection of the treatment modality

Effects of low dose zinc supplementation on biochemical markers in non-alcoholic cirrhosis: a randomized clinical trial

The present study aimed to evaluate the effects of low dose zinc [Zn] supplementation on biochemical markers and underlying disease status in non-alcoholic cirrhotic patients. We enrolled 60 cirrhotic patients in a double-blind, placebo-controlled, randomized clinical trial. All patients in the interventional group [n = 30] received long-term, low dose Zn supplementation [50 mg elemental Zn sulfate daily]. The control group [n = 30] received placebo [starch]. Child-Pugh scores and biochemical markers were assessed for both interventional and control groups at the first day and the end of the 90th day of the interventional period. A per-protocol analysis was performed after excluding all participants who did not receive or complete the randomized intervention. The mean differences of quantitative variables between and within groups were evaluated by independent samples t-test and paired-samples t-test, respectively. SPSS version 13.00 was used for statistical analysis. In the initial evaluation, 16 [53.30%] patients from the interventional group had a Child-Pugh score of 5-8 and 14 [46. 70%] had a score of 9-12. In the control group 18 [60.00%] had a Child-Pugh score of 5-8 and 12 [40.00%] scored 9-12. After three months the mean Child-Pugh score in the interventional group showed a significant improvement [from 6.56 +/- 0.21 to 5.72 +/- 0.22, P = 0.001] whereas in the control group despite no significant decline, the mean Child-Pugh score increased slightly [from 6.25 +/- 0.27 to 6.67 +/- 0.31, P = 0.14]. Zn supplementation significantly decreased copper [Cu; P = 0.01] and creatinine [Cr; P < 0.0001] levels. In this study, we determined that low dose Zn supplementation could prevent deterioration of clinical status of cirrhosis and prevent excess Cu accumulation in non-alcoholic cirrhotic patients. Zn supplementation produces metabolic effects and trends towards improvements in liver function, hepatic encephalopathy, and nutritional status

Prevalence of hepatitis A in Iranian patients with chronic liver disease

Acute hepatitis A in patients with chronic liver diseases [CLD] may lead to a more severe outcome for which routine vaccination is recommended in many regions. Nevertheless, studies of HAV seroprevalence and exposure predictors in populations with CLD are scanty in our region. We studied 200 patients with CLD between September 2005 and September 2006. Patients were stratified on the basis of age, gender, size of family, place of residency and etiology of liver disease. The HAV seroprevalence in patients with CLD was compared with age- and sex-matched controls. Independent predictors of HAV exposure were identified by logistic regression analysis. Of 200 patients, HAV seroprevalence was available for 190 [96.5%]. Hepatitis B and C, alcohol, autoimmune hepatitis and Wilson's disease were the causes of CLD. Most of the seronegative patients aged 10-20 years. The overall HAV seroprevalence was 97.3% in controls. None of the risk factors were identified as independent predictors. Age stratified seroprevalence of HAV in patients with CLD is close to that of the general population. High prevalence of HAV must be considered in vulnerable travelers to our country

Seroprevalence of hepatitis E in patients with chronic liver disease from East Azerbaijan, Iran

Superinfection with HEV in patients with chronic liver disease [CLD] can cause severe hepatic decompensation leading to increased morbidity and mortality. This study aimed to determine seroprevalence of HEV infection among CLD patients compared to blood donors from Azerbaijan, north-west of Iran. CLD patients and a group of age matched blood donors with normal liver function tests were evaluated for the presence of anti-HEV IgG antibody in their sera for evidence of hepatitis E. The risk factors were estimated. The mean age of CLD patients was 48 years [range: 10-87]. 27.5% of patients were HEV IgG-positive. Among the controls 19.7% were positive for anti-HEV IgG. By multivariate analysis, there was no association between positive anti-HEV IgG and etiology of chronic liver disease, gender, literacy, accommodation, and number of family members in patients or controls. Mean age of patients infected with HEV in both groups was significantly more than the seronegative ones. We found high seroprevalence of HEV-antibody among blood donors and CLD patients in our study, so we recommend more attention to hygiene of food and water. In addition, such patients should be informed about the potential risks and simple ways to prevent the disease in their regular life and travels. This issue must be concerned in cases of "acute on chronic" hepatitis in CLD patients

Seroprevalence of anti-helicobacter pylori antibodies in hepatitis B and C patients with cirrhosis: a case-control study

Cirrhosis is terminal stage of many chronic liver diseases like hepatitis C and hepatitis B. In some studies the role of helicobacter pylori has been demonstrated in progress of cirrhosis and its complications, but none of the previous studies has investigated the role of socioeconomic conditions of patients in childhood period in this issue. In a case-control study, we examined 100 cirrhotic patients due to hepatitis [49 hepatitis B and 51 hepatitis C patients] and 101 socioeconomically matched healthy controls presenting to Taleghani Hospital for IgG antibody to helicobacter pylori. IgG antibody to helicobacter pylori was present in 73% of cirrhotic patients and 52% of control group [P < 0.003]. Odds ratio for the presence of IgG antibody to helicobacter pylori in cirrhotic men comparing with healthy men was 3.2 [95%CI: 1.4-7.4]. The relative frequency of IgG antibody to helicobacter pylori found to be higher in cirrhotic patients than in controls with regard to socioeconomic condition in childhood

Abdominal pain due to lead-contaminated opium: a new source of inorganic lead poisoning in Iran

Although the incidence of occupational and adult lead poisoning has declined, the problem still exists. We encountered three patients with lead poisoning in Iran, all of whom associated with presented with diffuse abdominal pain, which was at times colicky in nature, anemia, constipation, nausea, vomiting, and slightly abnormal liver biochemistries. A history of opium ingestion was present in each of these patients. None of the patients reported known occupational exposure to toxins. Diagnoses of lead poisoning were confirmed through the detection of elevated blood lead levels. The cause of lead poisoning was attributed to the ingestion of contaminated opium. Opium adulterated with lead had not been previously recognized as a source of lead poisoning in Iran. It is, therefore, pointed out that lead poisoning should be considered as a differential diagnosis for acute abdominal colic of unclear cause in patients with opium addiction