Effect of Selenium Supplementation on Expression of SIRT1 and PGC-1α Genes in Ulcerative Colitis Patients: a Double Blind Randomized Clinical Trial

Selenium (Se) supplementation may decrease the severity of ulcerative colitis (UC) through the activation of genes responsible for immune modulation. The present research was aimed to assess the effect of Se supplementation on the expression of silent information regulator 1 (SIRT1) and peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) in UC patients. In a double-blind randomized parallel clinical trial, 100 patients with mild-to-moderate active UC met inclusion criteria and divided into 2 groups of treatment (50 patients received selenomethionine [200 µg daily]) and placebo (50 patients received placebo [1 capsule daily]) for 10 weeks. The expression rates of SIRT1 and PGC-1α were examined in the peripheral blood mononuclear cell (PBMC) using the real-time polymerase chain reaction. There was no considerable difference in the mean of baseline demographic and clinical characteristics between groups. Also, there were no significant differences in total energy intake, macronutrients, and micronutrients between groups. The SIRT1 gene expression in the Se group was significantly increased compared to the placebo (p < 0.001). An increase in the expression of the PGC-1α gene in the Se group was not statistically significant. It seems that Se supplementation caused a significant decrease in the inflammatory response of the colon by a significant increase in the expression of the SIRT1 gene.

Effect of Selenium Supplementation on Expression of SIRT1 and PGC-1α Genes in Ulcerative Colitis Patients: a Double Blind Randomized Clinical Trial

Selenium (Se) supplementation may decrease the severity of ulcerative colitis (UC) through the activation of genes responsible for immune modulation. The present research was aimed to assess the effect of Se supplementation on the expression of silent information regulator 1 (SIRT1) and peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) in UC patients. In a double-blind randomized parallel clinical trial, 100 patients with mild-to-moderate active UC met inclusion criteria and divided into 2 groups of treatment (50 patients received selenomethionine [200 µg daily]) and placebo (50 patients received placebo [1 capsule daily]) for 10 weeks. The expression rates of SIRT1 and PGC-1α were examined in the peripheral blood mononuclear cell (PBMC) using the real-time polymerase chain reaction. There was no considerable difference in the mean of baseline demographic and clinical characteristics between groups. Also, there were no significant differences in total energy intake, macronutrients, and micronutrients between groups. The SIRT1 gene expression in the Se group was significantly increased compared to the placebo (p < 0.001). An increase in the expression of the PGC-1α gene in the Se group was not statistically significant. It seems that Se supplementation caused a significant decrease in the inflammatory response of the colon by a significant increase in the expression of the SIRT1 gene.

rare presentation of primary heptic lymphoma: a case report

Primary hepatic lymphoma [PHL] was a rare malignancy usually presenting with abdominal pain, malaise, Hepatomegaly, B-symptoms, fatigue, nausea, vomiting and jaundice. It mostly involves liver without any palpable lymphadenopathy and leukemia in peripheral blood smear. On July 22, 2014, a 64 year old man presented with abdominal pain localizing in Right upper quadrant and fullness from 2 years ago without any weight loss or constitutional symptoms. His physical examination revealed no mass or lymphadenopathy and lab data showed rise in Alkaline phosphatase [ALP] and Gamma-glutamyl transferase [gamma-GT]. Abdominal computed tomography [CT] scan with contrast showed a calcified lesion in the left lobe of liver and ill-defined hypodense area in medial segment of the left lobe of liver adjacent to gallbladder associated with mild central intra hepatic bile ducts dilation showing more enhancement in delay phase suggested peripheral cholangiocarcinoma. Finally surgical core needle biopsy of the liver confirmed malignant lymphoma of B cell type and patient was referred to oncologist for chemotherapy. His chemotherapy regimen consisted of rituximab 600 milligram [mg], endoxan 1250 mg, adriamycin 80 mg, vincristine 2 mg, prednisolone 100 mg [durgin five days] for 6 courses. After 5 months chemotherapy, on December 22, 2014 a follow up CT scan with IV and oral contrast was done. There was no evidence of previous mass lesion in the liver. In the follow up on May 9, 2015, he had no specific symptoms and all of his lab data were in normal range

Dysbiosis of fecal microbiota and high frequency of citrobacter, klebsiella spp., and actinomycetes in patients with irritable bowel syndrome and gastroenteritis

Aim: This study was aimed to characterize putative differences of fecal microbiota between irritable bowel syndrome[IBS] and gastroenteritis patients and healthy controls

Background: New evidence proposed that gut microbiota has a deep effect on the balance between health and disease

Patients and methods: The presence of Clostridium difficile, Campylobacter spp., Enterobacteriacea and Staphylococci weredetected in the samples using selective and specific culture media. Microscopic examination of the samples was done to detectActinomycetes, yeasts, Bifidobacteria, Fusobacterium spp., as well as white blood cells, red blood cells, mucus and epithelial cells

Results: Results of this study showed relatively higher frequency of Citrobacter spp., Lactobacilli, and Actinomycetes in theIBS patients. Elevated levels of WBC, RBC secretion, and increased amounts of Klebsiella, Escherichia coli and Citrobacterspp. were characterized in the patients with gastroenteritis compared with the control group

Conclusion: Depletion of gram positive cocci and gram negative bacilli also suggested dysbiosis of intestinal microbiotain these patients

Annular pancreas presenting with painless jaundice: a case report and review of literature

Annular pancreas [AP] is a rare congenital abnormality in which pancreatic tissue completely surround the duodenum. Presentation of AP in adulthood is very rare and obstructive jaundice is one of the uncommon manifestations of AP in adults. Herein; we reported a 47 years old woman who presented with icterus, mid common bile duct stricture and annular pancreas. She was diagnosed as pancreas cancer three months after surgery. Although AP presenting with jaundice is rare but is indicative of significant relationship with periampullary malignancies and requires a complete investigation of these cancers and close follow up

Dropped gallstones during laparoscopic cholecystectomy

Laparoscopic cholecystectomy [LC] is one of the most commonly performed surgeries worldwide. Stones can be spilled from the gallbladder during LC. These stones can be left in the peritoneal cavity or trapped at the trocar site. The potential late sequelae and associated morbidity are not well documented. Every effort should be made in order to avoid spillage of stones during dissection of the gallbladder through the abdominal wall. We describe one case that underwent LC and presented with dropped gallstones

review of the clinical manifestations, pathophysiology and management of opioid bowel dysfunction and narcotic bowel syndrome

Opioids are widely used for the treatment of malignant and non-malignant pains. These medications are accompanied by adverse effects, in particular gastrointestinal symptoms known as opioid bowel dysfunction [OBD]. The most common symptom of OBD is refractory constipation that is usually stable regardless of the use of laxatives. Narcotic bowel syndrome [NBS] is a subset of OBD described as ambiguous chronic pain aggravated by continual or increased opioid use for pain relief. Pathophysiology of these disorders are not definitely disentangled. Some challenging hypothesis have been posed leading to specific management in order to mitigate the adverse effects. This article is a review of the literature on the prevalence, pathophysiology and management of OBD and NBS.

[Correlation of liver enzymes and sonographic findings with pulsatile index of middle cerebral and basilar arteries in nonalcoholic fatty liver]

Nonalcoholic Fatty Liver Disease [NAFLD] is one of the most widespread human diseases that can impair liver function and sometimes progresses to cirrhosis. Recently NAFLD has been identified as an independent risk factor for cardiovascular disease. The aim of this study was to investigate the correlation of fatty liver disease and its sonographic severity on the resistance of the intracranial arteries. This study was a cross-sectional study of 55 patients referred from Gastroentrology clinic with diagnosis of NAFLD to Sonodoppler department of Iranian Center of Neurological Research. Pulsaltile index as a Hemodynamic parameter of Middle Cerebral [MCA] and basilar Arteries of NAFLD Patients was measured by Trans Cranial Doppler [TCD] sonography and the measurements were compared with normal values. Also the association of these indices with serum liver enzymes and sonographic grading of liver involvement was assessed. The analysis was done by SPSS 16. Frequency distribution, mean and standard deviation were used in descriptive analysis and statistical test c2to compare qualitative variables. Pulsatile Index [PI] were normal [MCA, P=0.166, Basilar, P=0.053] and there was no significant difference with relation to severity of fatty liver based on sonography findings [P=0.789], but serum liver enzyme levels were inversely correlated with basilar artery PI [P=0.014]. Considering the increase of cerebral arteries PI in advanced liver disease, absence of increase in vascular PI of patients in the present study could be attributed to the short duration of disease from diagnosis to perform TCD, lack of advanced liver involvement [absence of liver dysfunction] and the response effect to treatment before the TCD. Therefore, to assess vascular changes over time, repeating the TCD with assess other parameters such as Fibroscan and K18 factor that has more compatibility of liver function, could help to understand the pathophysiology of liver diseases and its effect on vascular resistance

[Comparison of the effectiveness of cognitive behavior therapy and mindfulness based therapy on the decrease in symptoms of patients who suffer from irritable bowel syndrome]

The current research is performed to compare the effectiveness of two methods of cognitive behavior therapy and mindfulness based therapy in decreasing symptoms of patients who suffer from irritable bowel syndrome. This was a quasi-experimental design study that consisted of an experimental group subdivided into two groups [pre- and final test] and a control group. Based on convenience sampling we randomly assigned 36 persons, 20 males and 16 females, n=12 per group, micro=32 years of age, to one of the three groups. Irritable bowel syndrome symptoms significantly decreased between the two treatment groups and the control group [p<0.05], which we attributed to the benefits of mindfulness based therapy. Therapists should consider modern psychotherapy techniques such as mindfulness based therapy as potential methods for decreasing the clinical symptoms of irritable bowel syndrome. Older techniques are not always perfect or effective.

[Serum IgG4 levels in patients with ulcerative colitis, a predicting factor for primary sclerosing cholangitis?]

Primary sclerosing cholangitis [PSC] is a chronic cholestatic disease that results in segmental stenosis of the bile ducts, cholestasis and fibrosis. During the previous two decades, patients with steroid responsive PSC have been presented in a few case reports and studies. This study aims to evaluate and compare IgG4 levels in patients with ulcerative colitis [UC], with and without PSC. This cross-sectional study enrolled 116 patients with UC who referred to the Gastrointestinal Clinic of Imam Khomeini Hospital, Tehran, Iran. Patients with allergic diseases such as asthma and atopic dermatitis as well as those with autoimmune disorders such as vasculitis and systemic lupus erythmatosus were excluded. After signing an informed consent form, 5cc blood sample was taken for serum IgG4 evaluation. Patients with clinical or laboratory signs of PSC underwent Magnetic resonance cholangiopancreatography [MRCP] after which patients were divided into two groups [with and without PSC] according to the results of their MRCP findings. IgG levels more than 157 mg/dl were considered elevated. SPSS software package version 16 was used for data analysis. A significance level of 0.05 was considered statistically significant. There were 57[49.1%] male participants, of which 24 [20.7%] had evidence of PSC. Among these, 7 [29.1%] had elevated IgG4 titers. Of participants, 92 did not have PSC. From this group, 9 [9.7%] had elevated IgG4 levels. This difference was statistically significant [p =0.012]. The odds ratio was 3.9 [CI: 1.28-12.1] and the area under the curve for IgG4 in predicting PSC in the ROC curve was 0.65. There was a significant relationship between IgG4 titer and colitis extension in both groups. However there was no significant relationship regarding the severity of colitis [p=0.247]. It is necessary to evaluate IgG4 titers in all patients with PSC because of its treatable nature. Determining IgG4 levels in all UC patients can be a predicting factor for PSC. Thus additional cohort studies with larger numbers of participants are recommended.

Menetrier's disease presenting with ulcerative colitis: a case report and review of the literature

Menetrier's disease or hypertrophic gastritis is a premalignant rare disease that often presents with hypertrophy in the gastric folds, hypoalbuminemia and decreased acid secretion. There are a few papers worldwide that report concomitant Menetrier's disease and ulcerative colitis [U. C], however none are from Iran. This is the first case reported in Iranian literature. The pathogenesis of this coexistence is unknown. We report the case of a 28-year-old woman with intermittent bilateral edema of the lower extremities, weight loss and epigastric pain associated with chronic intermittent diarrhea and one episode of nocturnal dysentery. Paraclinical evaluations showed hypoalbuminemia, low serum protein level, severe 25 OH vitamin D deficiency, a positive Helicobacter pylori urea breath test and negative cytomegalovirus [CMV] IgM antibody. Histologic, radiologic and endoscopic findings were consistent with Menetrier's disease associated with U. C. The patient was prescribed mesalazine, asacol suppositories and pantoprazole. During a follow up visit the patient noted improvement in her symptoms. She was referred to a surgeon to discuss additional possible therapeutic treatments

[Liver enzyme alteration]

Liver enzyme alteration may be an incidental finding in asymptomatic individuals who have undergone routine laboratory tests. lsolated alteration of liver enzymes in a healthy individual often represent a challenge even for experienced clinicians. In this article we decide to provide a guide to interpreting alterations to liver enzyme levels. Liver enzyme alterations are classified to predominantly hepatocellular or predominantly cholestatic patterns. We review abnormal enzymatic activity within the 2 subgroups, and suggested initial investigations.

unusual presentation of Vanek's tumor: a case report

We report the case of a 54-year-old Iranian man who presented with melena from three months prior to admission. Esophagogastroduodenoscopy and colonoscopy were normal. Double balloon enteroscopy showed a pedunculated tumor located in the jejunum. He underwent laparotomy and resection of a 9.5 cm tumor from the distal jejunum. Histopathologic evaluation confirmed the diagnosis of an inflammatory fibroid polyp [IFP].

Lack of association between interleukin 12 C[-1188]A polymorphism and irritable bowel syndrome

Irritable Bowel Syndrome [IBS] is a functional gastrointestinal disorder, characterized by recurrent abdominal pain and altered bowel habits. This study was performed to investigate the important role of interleukin-12 [IL-12] in intestinal inflammation. For this study seventy one patients with IBS and 140 controls were investigated. The allele and genotype frequencies of IL-12 C[-1188]A were determined using polymerase chain reaction with sequence-specific primers. The allele A was more common that the allele C in both groups of patients and controls. There was not any significant difference on IL-12 alleles and genotypes between patients and controls. The AA genotype was the most common genotypes, which was seen in 57.4% of the patients and 51.4% of the controls [p=0.53]. Although frequency of the CC genotype in the control group was lower than the patient group, this difference was not significant [5.7% vs. 11.5%, respectively, p=0.16]. Considering the lack of association between IL-12 C[-1188]A polymorphism and IBS, this cytokine gene polymorphism may not have significant role in the pathophysiology of disease

[NOD2 novel mutations in Iranian Crohn's patients]

Despite the reported role of three common mutations of the CARD15/NOD2 gene including R702W, G908R and 1007fs in Crohn's disease [CD], only about 30% of Iranian CD patients carry one of these three variants [R702W]. The aim of this study was to screen the hot points of NOD2 gene to find any novel sequence variations in Iranian patients with CD. Eighty non-related Crohn's patients from Iranian origin, referred to a tertiary center in a three-year period [2006-2009], were enrolled in this study. The hot points of NOD2 gene [including exons 4 and 8] were evaluated by direct sequencing after amplification of related sequences with polymerase chain reaction [PCR]. A total of 17 sequence variations were identified among these exons of NOD2 gene including 7 novel ones. Three of these new mutations had an allele frequency more than 5%. All new mutations were a consequence of a single nucleotide change, 4 resulted in an aminoacid change while one formed a stop coden. No deletion or insertion mutation was observed in this part of the gene. This study demonstrated the existence of uncommon NOD2 variants in Iranian patients with CD. It is possible that these mutations play a role in susceptibility to CD in Iranian population

[ overview on irritable bowel syndrome and new treatments]

Irritable bowel syndrome [IBS] is one of the most common functional gastrointestinal disorders characterized by abdominal pain/discomfort in association with altered bowel habits in the absence of any organic cause. The pathophysiology of IBS remains uncertain but hereditary and environmental factors are likely to have a role. The diagnosis of IBS is currently based on the ROME III symptom-based criteria. IBS is subtyped based on predominant bowel habit and pharmacologic treatment is according to this classification, too. In addition to pharmacologic agents, effective patient-physician relationship, diet and psychological treatment are important in management. Nowadays, with improvement in understanding the pathopysiology of IBS, many therapeutic modalities have introduced and new drugs with novel mechanism of action will hopefully be developed

frequency of non-organ-specific autoantibodies in patients with chronic hepatitis C and its relation with disease severity and response to therapy

Increased levels of non-organ-specific autoantibodies are frequently seen in patients suffering from chronic hepatitis C [CHC]; however, the etiology and its effects on the course of the disease and response to therapy are largely undetermined. Particularly, it seems of utmost importance to define whether this increase is solely an insignificant coincidence or a major finding which have an impact on the course of the disease. Materials and methods: Fifty-two patients with CHC [case group] and 52 aged- and sex-matched IBS patients [controls] were enrolled. The sera of all subjects were checked for non-organ-specific autoantibodies, including antinuclear antibody [ANA], anti-smooth muscle antibody [ASMA], anti-mitochondrial antibody [AMA], and anti-liver/kidney microsomal antibody [ALKM]. All cases underwent a liver biopsy and treated with a 12-month course of combination therapy with interferon and ribavirin. The mean age of cases and controls was 32.8 +/- 12.7 and 31.6 +/- 14.1 years, respectively. The overall frequency of non-organ-specific antibodies was significantly higher in anti-HCV positive patients in comparison with controls [36.5% vs 7.7%, p < 0.001]. Seropositivity of ANA and ASMA was significantly higher in patients with CRC than in controls [11.5% vs. 1.9%, p < 0.05 and 13.5% vs. 1.9%, p < 0.027, respectively]. There was no significant relationship between seropositivity of different autoantibodies and patients' age and sex, duration of disease and serum aminotransferases levels. Nor this seropositivity had significant relationship with grade and stage of the liver disease and response to treatment, while serum globulin level was significantly higher in ANA positive patients. Seroprevalence of ANA and ASMA seems to be higher in patients with CHC but its impact on the severity of disease and response to therapy is the subject for further investigations. Keywords: Hepatitis C, Autoantibody, Response to treatment, Aminotransferases

Comparison of sucralfate and hydrocortisone enemas in treatment of active ulcerative proctitis; a double-blind randomized clinical trial

Sucralfate enema has been proposed and investigated in treatment of ulcerative proctitis, but its efficacy is still a matter of debate. Hydrocortisone enema is still an established drug in treatment of ulcerative proctitis. This study was designed to compare the effect of sucralfate enema with hydrocortisone enema. Patients with active sigmoidoscopic and histologic features of ulcerative proctitis were included. All patients had clinical manifestations of proctitis for at least four weeks prior to the study and had negative parasitic stool culture. The total of 25 patients entered the study. They were randomly divided in two groups; group I [n =14] and group II [n = 11] who received sucralfate and hydrocortisone enemas respectively for 4 weeks. Both groups had a significant improvement in clinical features, histologic activity and sigmoidoscopic evaluation in comparison with the baseline. Furthermore there was no significant differences between the two groups concerning mean changes of clinical, sigmoidoscopic, and histologic grading, after treatment. Considering the low cost and minimal adverse effects of sucralfate, and almost equal efficacy in comparison with hydrocortisone enema, its usage can be recommended