Unfavorable survival rates in Iranian patients with gastric cancers: a single center experience from Tehran

We examined the effect of potential interfering factors that play major roles in the outcome of our patients with stomach cancer. 100 consecutive patients diagnosed with gastric cancers were prospectively observed, treated and followed from November 2009 to January. Absence of Helicobacter pylori infection [P=0.027], absence of vascularisation [P<0.001], and undetermined histopathological type of adenocarcinoma [P=0.003] were factors significantly associated with higher grade of gastric lesions. Life tables were used to define survival of gastric cancers. Survival rates of these patients at 1st week, 1st month, 2nd month, 3rd month, and 6th month were 97%, 96%, 91%, 90%, and 82%, respectively. The only determinant of 6 months of survival was age over 68 [P=0.039]. Our study confirms our previous knowledge that gastric cancers have unfavorable outcome in Iran

Predictive value of having positive family history of cardiovascular disorders, diabetes mellitus, dyslipidemia, and hypertension in non-alcoholic fatty liver disease patients

In the present study, we examined the relationship between family history of cardiovascular diseases [CVD], dyslipidemia, hypertension, and diabetes with laboratorial abnormalities and syndromes in Iranian patients with non-alcoholic fatty liver disease [NAFLD]. A total of 332 NAFLD patients from our outpatient clinic were consecutively entered into analysis. Exclusion criteria were having diabetes mellitus and fasting blood glucose over 126, active hepatitis B virus infection, having HCV positive serology, and to be under corticosteroid therapy. Family history of CVD, diabetes, dyslipidemia, and hypertension were taken from patients and related to the study variables. Family history of cardiovascular diseases [CVD] was associated with low HDL levels [P=0.05]. Patients with positive family history of diabetes mellitus were significantly more likely to have AST/ALT levels proportion of higher than one [P=0.044]. Family history of dyslipidemia was a predictor for hypertriglyceridemia [P=0.02], higher prothrombin time levels [P=0.013], lower albumin [P=0.024] and T4 [P=0.043] levels. Family history of hypertension was associated with dysglycemia/diabetes [P=0.038], high ALT [P-0.008], and low TIBC [P-0.007] and albumin levels [P=0.001]. Family history for CVD, diabetes, dyslipidemia, and hypertension were of clinical importance in the Iranian patients with NAFLD. We therefore recommend that physicians should precisely get family history of main disorders in all NAFLD patients; and to pay more attention to those having the mentioned family histories. Further studies with larger patient population and prospective approach are needed for confirming our findings

Chlamydia pneumoniae in the atherosclerotic plaques of coronary artery disease patients

An association between Chlamydia pneumoniae [C. pneumoniae] and cardiovascular disease has been demonstrated. In this study, we aimed to study this potential relationship in 105 Iranian patients. Coronary artery specimens from 105 Iranian patients undergoing CABG were analyzed by PCR method for C. pneumoniae. Serological evaluation for C. pneumoniae IgG and IgM was performed using ELISA. 53 specimens from mamillary artery were also investigated. C. pneumoniae PCR test result was positive for 23 [21.9%] of patients with coronary artery atherosclerosis, but none of the specimens from the mamillary artery was positive for C. pneumoniae when it was evaluated by the PCR [P<0.001]. Coronary artery disease patients with and without a history of unstable angina or myocardial infarction were comparable in C. pneumoniae PCR test positive rates [P=0.618]. Relevance of IgG and IgM positivity were also studied by correlating it to the study parameters, but no difference was found. CRP was significantly higher in the IgM positive group [P<0.001]. A significant proportion of coronary atherosclerotic plaques are infected with C. pneumoniae while no infection was found in the normal mamillary artery specimens. No association was found between acute coronary syndromes and serological and PCR positivity. Further prospective randomized controlled studies with large patient population are needed to confirm our findings

Elevated alanine aminotransferase activity is not associated with dyslipidemias, but related to insulin resistance and higher disease grades in non-diabetic non-alcoholic fatty liver disease

<p><b>OBJECTIVE</b>To explore demographic and metabolic factors associated with increased alanine aminotransferase (ALT) activity in non-diabetic non-alcoholic fatty liver disease (NAFLD) patients.</p><p><b>METHODS</b>Overall 372 patients who consecutively attended to Gastroenterology Clinic of Baqiyatallah University of Medical Sciences, Tehran, Iran awere diagnosed as NAFLD entered into analysis. Exclusion criteria were having diabetes mellitus and fasting blood glucose over 126 mg/dL, active hepatitis B virus infection, having hepatitis C virus positive serology, and to be under corticosteroid therapy. ALT levels were considered pathologically high when it was over 30 IU/L for men and over 19 IU/L for women.</p><p><b>RESULTS</b>Bivariate analyses using t test and chi-square test showed that patients with pathologically augmented ALT levels had significantly higher NAFLD grades in their ultrasonographic evaluations (P=0.003). Moreover, these patients represented significantly higher homeostatic model assessment levels (P=0.003), levels of serum insulin (P=0.002), fasting blood glucose (P<0.001), and uric acid (P=0.02). The prevalence of insulin resistance was also higher in patients with increased serum ALT concentrations. Multifactorial logistic regression models showed that ultrasonographic grading of NAFLD (P=0.027) and insulin resistance (P=0.013) were the only variables significantly associated with abnormal ALT levels.</p><p><b>CONCLUSIONS</b>This study shows that the associations of increased ALT serum levels in NAFLD patients are different from what are supposed before. By excluding diabetic patients from our population, we find that increased ALT levels are not associated with dyslipidemias but are independently associated with insulin resistance and NAFLD grading on ultrasonographic evaluations. Further studies are needed to confirm our results.</p>

Lymphoproliferative disorders in pediatric liver allograft recipients: a review of 212 cases

Due to the limited incidence of posttransplant lymphoproliferative disorders [PTLD] in pediatric liver graft recipients, there is a scarcity of data on the characteristics of the disease in this population. We aimed to analyze the special features and behavior of PTLD arising after pediatric liver transplantation. A comprehensive search of the literature was conducted for the available data on PTLD in pediatric liver recipients pediatric PTLD through a search of Pubmed and Google Scholar using appropriate terms. We sought data on liver recipients younger than 18 years of age at the time of transplantation. From 51 reports, 43 fulfilled the inclusion criteria. Overall 250 cases of PTLD [212 pediatric PTLD] were found from 43 reports. Data on pediatric patients was compared to adults. Pediatric PTLD lesions were more likely of the polymorphic type [P=.004] and polyclonal [when age cut-off was defined at 12 years; P=.023]. Remission rates, metastasis frequency and organ involvements were not different between the groups [P>.1 for all]. Survival analysis showed no disparity between pediatric PTLD and adult patients [P>.1]; but when data was reanalyzed for patients surviving at least 4 months post diagnosis, the log rank test showed that pediatric patients have a superior outcome compared to adults [P=.045]. Pediatric liver recipients developing PTLD have relatively better disease presentation and behavior than that in adults. Stomach involvement was also more frequently seen in patients younger than 12 years, and should be more intensively evaluated. Future studies with a prospective approach and larger population size are needed for confirming our results

Token reinforcement therapeutic approach is more effective than exercise for controlling negative symptoms of schizophrenic patients: aÿrandomized controlled trial

This study aimed to evaluate the effectiveness of exercise and token-behavior therapy on the negative symptoms of schizophrenic patients. Comparison of the effectiveness of exercise and token-behavior therapy on the negative symptoms of schizophrenic patients. This research was a randomized controlled clinical trial that was done on 45 schizophrenic patients, hospitalized in Rasht, Iran. Through systematic random allocation, the samples were placed in one control and two intervention groups, 15 patients in each. To assess the negative symptoms, the scale for the assessment of negative symptoms [SANS] was used. The effect of the interventions used [exercise and token-behavior therapy] was studied by completing the relevant checklists before and after using the interventions, and then, by comparing it with that of the studied control group. In order to analyze the collected data, one way ANOVA and Bonferroni's test and SPSS software were used. Analyses showed that the token reinforcement approach was highly and significantly more effective than exercise for reducing the negative symptoms in schizophrenic patients [-36 +/- 7 vs. -21 +/- 8, respectively; P<0.001]. Exercise was also shown to have a highly significant advantage over no therapy, in controls, to improve the negative symptoms in schizophrenic patients [-25 +/- 8 vs. 0.2 +/- 1.08, respectively; P<0.001]. Both exercise and token-behavior therapies, along with drug treatment, are very effective in reducing the negative symptoms of schizophrenia; but the impact of token therapy is significantly higher

Helicobacter pylori genotypes can predict gastric tissue histopathology: a longitudinal study of Iranian patients

Several factors have been suggested to account for differences in the virulence of Helicobacter pylori infections in various populations. Evidence suggests the existence of different strains of H. pylori with different degrees of virulence. The present study aimed to investigate the gastric histopathology in Iranian patients infected with H. pylori and to investigate the relationship between the severity of gastritis and four different bacterial virulence-associated genotypes. All of the patients with positive results from a pathological examination, a rapid urease test, and PCR analysis for H. pylori infection were consecutively included into the study. The classification and grading of gastritis were performed according to the Sydney System. Esophagitis was classified endoscopically according to the Savary-Miller grading system. The primers used in this study targeted 16S rRNa [521 bp], Urease A [411 bp], Cag A [400 bp], and 26 kDa [303 bp]. Twenty-eight patients were included in the study. The presence of Cag A showed a significant relationship with higher gastritis grades [3.0 +/- 0.7 vs. 2.3 +/- 0.9, p = 0.024] and higher scores for H. pylori infection [3.0 +/- 0.7 vs. 2.3 +/- 0.7, p = 0.027]. The patients infected with 26 kDa-positive H. pylori had significantly higher infection scores [3.5 +/- 0.6 vs. 2.5 +/- 0.6, p = 0.020]. This study showed that CagA-positive H. pylori infection is associated with more severe gastritis and with increased bacterial density and inflammation in the biopsy specimens. The 303-bp positive genotype was also significantly associated with higher grades of esophagitis. Additional in-depth trials will be helpful in extending our findings. H. pylori [Helicobacter pylori], PCR [polymerase chain reaction]

Famotidine in the treatment oft unctional dyspepsia: a randomized double-blind, placebo-controlled trial

In the present study, we aimed to investigate patients with a documented diagnosis of functional dyspepsia [FD] who had been admitted to our outpatient Gastroenterology Clinic and provided consent to participate in this randomized, double-blind, placebo-controlled trial of the therapeutic impact off amotidine on the symptoms and quality ofl ife of FD patients. A total of 160 patients attending our outpatient clinic with a diagnosis of FD according to Rome III criteria were enrolled in this double-blind study. They were randomized into case [famotidine treatment] and placebo groups; patients were asked to refill the Honk Kong dyspepsia index [a self global assessment tool] before the start of the study as well as after 3 months of treatment. Both famotidine and placebo led to significant improvements in dyspepsia symptoms, except for vomiting in both groups and loss of appetite in the placebo control group. However, the extent of these improvements was not different between the two study groups for most of the study parameters, whereas belching, feeling of acid regurgitation, heartburn, and the total score for the Hong Kong dyspepsia index were significantly more responsive to famotidine than placebo. No significant effectiveness off amotidine therapy was found regarding quality of life. This study showed a significant improvement in the total dyspepsia scores of FD, with a marked effect on belching, heartburn, and the feeling of acid regurgitation. These findings suggest that famotidine may be administered in certain FD patients who have significantly more symptoms of belching, heartburn, and acid regurgitation

Very late onset lymphoproliferative disorders occurring over 10 years post-renal transplantation: PTLD.Int. survey

Knowledge of the significance of post-transplant lymphoproliferative disorders [PTLD] that occur [very late] or more 10 years after renal transplantation is limited. Thus, we analysed and compared characteristics and prognosis of the disease in renal transplant patients with very late onset PTLD vs. early- and late-onset PTLD. Retrospective study of data obtained from comprehensive search of medical literature. We searched for available data using the Pubmed and Google scholar search engines for reports of lymphoproliferative disorders occurring in renal transplant patients by disease presentation time. We analyzed data from 27 studies that included 303 patients with lymphoproliferative disorders after renal transplantation. Renal graft recipients with very late onset PTLD were significantly less likely to be under mycophenolate mofetil [MMF]- and/or tacrolimus [FK-506] [vs. azathioprine] -based immunosuppres-sion [œ=.035] and less likely to have a history of antibody induction immunosuppression [P<.001]. Compared to [early onset] disease, [very late] onset PTLD is more likely to develop in older patients [P=.032]. Survival analysis did not show any difference in outcome [P=.5]. No organ involvement priority was found for this patient group [P>A for all]. Older renal transplant patients are at increased risk for development of very late onset PTLD, and should be strictly followed. Further multi-institutional prospective studies are needed to confirm our results

Non-alcoholic steatohepatitis: an update in pathophysiology, diagnosis and therapy

Non-alcoholic steatohepatitis [NASH], first described by Ludwig et al, in 1980, is a stage in the wide spectrum of non-alcoholic fatty liver diseases [NAFLDs] and one of the leading causes of chronic liver disease. Several scientists have tried to more distinctly discover and describe different aspects of NASH. In contrast with its counterpart in the NAFLDs-the NAFL-NASH consists of inflammation as well as necrosis in the liver tissue resulting in a poor outcome. NASH is also a known etiology for cryptogenic liver cirrhosis. Evidence suggests that cirrhosis developing due to NASH have a relatively worse outcome compared to that of hepatitis C-related cirrhosis. In this review article, we try to review and present all relevant articles about NASH

Early versus late outset of lymphoproliferative disorders post-heart and lung transplantation: the PTLD.Int Survey

The presentation time of post-transplantation lymphoproliferative disorders [PTLD] are not well described because of the limited number of cases occurring at each center and lack of a reliable and unequivocal classification together with the absence of multi-institutional prospective studies. We gathered information on the histopathological and clinical features and prognosis of the disease in a very large number of heart and lung transplant recipients, with data from 27 previous reports, with an emphasis of time of presentation. Retrospective analysis of data for individual patients from published studies entered into a database and reanalyzed. A comprehensive review of the literature by PubMed and Google Scholar was performed to find all data available reports on PTLD after heart and lung transplantation. Data from 288 PTLD patients after heart or lung transplantation from 27 reports were entered into analysis. Heart and lung recipients with early-onset PTLD compared with late-onset PTLD were significantly more likely to be of the B cell type [100% vs. 89.8%, respectively; P=.05]. PTLD in patients with early onset was less likely to involve the skin [P=.05] and spleen [P=.015], but more frequently complications of the respiratory tract [P=.002]. Morphology of PTLD lesions was significantly different between the two groups with a priority for late-onset PTLD to represent non-Hodgkin lesions [P=.009]. No difference was found between the two groups in survival [P=.237]. One and five-year survival rates for early-onset PTLD patients were 65% and 46%, respecttively; compared to 53% and 41%, respectively, for the late-onset PTLD. Due to a higher incidence of respiratory tract involvement in the early-onset PTLD patients and skin and spleen involvement in late-onset PTLD, we suggest that all heart/lung graft recipients should be evaluaated for potential multiorgan disease based early or late presentation. Further multi-institutional prospective studies are needed to confirm our results

approach to finding indications and contraindications for nephrectomy in post-transplant renal graft lymphomas: PTLD.Int survey

Allograft involvement can occur in some renal transplant recipients who develop post-transplant lymphoproliferative disorders [PTLD]. We aimed to find indications and/or contraindications for nephrectomy in renal allograft PTLD based on an outcome analysis of previous reports. A comprehensive search of Pubmed and Google scholar was performed to find reports of different treatment strategies addressing PTLD occurring within the allograft after renal transplantation. Patients who underwent nephrectomy due to kidney allograft localization by PTLD were categorized as the case group, and renal recipients with kidney PTLD for whom nonsurgical treatment modalities were used served as controls. Survival analysis demonstrated that patients with renal allograft involvement who underwent allograft nephrectomy had a significantly better outcome compared to patients for whom a non-surgical approach was used [P=.03]. In patients with disseminated PTLD, nephrectomy was not useful [P>.1]. Patients with simultaneous kidney and lung complications by PTLD benefitted from nephrectomy. We found that patients with renal graft complication with disseminated PTLD do not benefit from nephrectomy, which can be considered the only contraindication. However, some particular PTLD co-localizations were not as likely to adversely affect the benefit of nephrectomy in these patients, and these can be considered indications for the procedure. Future multicenter studies are needed to confirm our results

Hepatitis B virus-associated nephropathy: an international data analysis

Hepatitis B virus [HBV]-associated nephropathy is one of the manifestations of HBV infection. However, since it is not common, the patient populations of reports are usually limited. In order to have a more perfect understanding of the disease, we conducted this analysis of data published in articles of the English literature on HBV-associated nephropathy. We conducted a comprehensive search for the available publications on HBV-associated nephropathy through the PubMed. The patients were defined as pediatric when they were 18 years old or younger. The definition criteria for complete remission were in part different between studies, but a generalized definition was taken as a significant decrease in the proteinuria to levels around normal with no relapse episodes in 1 year after remission. Overall, 119 patients from 10 reports were included into this analysis. All of the patients using lamivudine experienced remissions compared to those receiving other treatment modalities [P=.001], of whom 72.7% [16 of 22] had complete remission [P=.08]. None of lamivudine recipients lost their kidneys [P=.04]. Pediatric patients were more frequently positive for hepatitis B envelop antigen [P=.001]. Immunoglobulin A nephropathy was more frequent among adult patients [P=.01], and membranous nephropathy in children [P=.01]. Children represented significantly higher levels for aspartate aminotransferase [P=.004] and alanine aminotransferase [P=.002]. Lamivudine therapy can effectively be used to stop progression of HBV-associated nephropathy. Pediatric patients represent different serological and laboratorial test results compared to their adult counterparts. Future studies with larger patient population are needed to confirm our findings

Outcome of kidney transplantation in type 1 and type 2 diabetic patients and recipients with posttransplant diabetes mellitus

We aimed to assess the effects of different types of diabetes mellitus [DM] on patients receiving living donor kidney allografts. A total of 111 kidney transplant patients with DM and 111 randomly selected kidney transplant recipients without DM were enrolled in the study. The characteristics of the kidney allograft recipients and the allograft and patient outcomes were assessed and compared between 4 groups of kidney recipients without DM and patients with type 1 DM, type 2 DM, and posttransplant DM. Of the 111 patients with DM, 36 [32.4%], 20 [18.0%], and 55 [49.6%] had been diagnosed with type 1 DM, type 2 DM, and posttransplant DM, respectively. Diabetic patients had significantly higher rates of rejection episodes [P = .049] and suffered more frequently from delayed graft function [P = .03] compared to the kidney recipients in the control group. Patient and allograft survival rates were significantly lower in the patients with DM [regardless of their DM type] compared to the nondiabetic patients [P = .03 and P = .04, respectively]. Prominently, type 1 DM had significantly adverse effects on patient and allograft survival. Patients with posttransplant DM had a relatively better patient survival compared to those with type 1 DM and type 2 DM. We found that kidney recipients with DM, especially preexisting DM, had worse patient and graft survival rates compared to the nondiabetics. These findings suggest that kidney transplant patients presenting with any type of DM should be more closely followed

Percutaneous nephrostomy for treatment of posttransplant ureteral obstructions

We report our experience with percutaneous management of urologic complications following kidney transplantation. Of 1402 consecutive kidney transplant recipients form living donors at our hospital, 21 required percutaneous nephrostomy [PCN] for the treatment of obstructive lymphocele [n=11], urinary calculus [n=8], and stricture of ureterovesical junction anastomosis [n=2]. We had also 11 kidney recipients with urine leakage from the ureter who were treated only by indwelling ureteral catheter. Urinary complications were diagnosed based on the clinical symptoms, elevated serum creatinine levels, ultrasonography and renal scintigraphy. Patients with ureteral obstruction or urine leakage were compared with kidney recipients without urologic complications. A mean decline of 3.1 +/- 3.0 mg/dL [range, 0.1 to 10.7 mg/dL] in serum creatinine level was detected [P<0.001] after PCN. All of the patients remained symptom free for a mean follow-up period of 34.2 +/- 20.1 months [range, 3 to 81 months]. Patients and graft survival rates were not different between the patients undergoing PCN and other kidney recipients. The only difference was the history on using antilymphocyte globulin which was significantly more frequentin the patients of the PCN group [P=0.01]. In our experience PCN is a safe and effective method for the treatment of ureteral obstructions in kidney allograft recipients. This method provided long-term success with few recurrences and low morbidity and mortality rates