[ study on the effects of supplementary L-arginine and L-ornithine on the growth indices in rainbow trout, Oncorhynchus mykiss]

Fish are useful models for physiological studies in which using nutritional, growth and hormonal indices can lead to the understanding of several biological mechanisms in vertebrates. In this study, the effects of the addition of two amino acids, L-arginine and L-ornithine, to a commercial feed on the growth indices and the blood levels of insulin-like growth factor-I [IGF-I] of rainbow trout, Oncorhynchus mykiss were examined. The fish [average initial weight 45 +/- 4 g] were fed for 8 weeks with one of the following 4 dietary treatments: Commercial trout diet supplemented with 2% L-arginine-[T1] 2% L-ornithine-[T2] 2% L-arginine + 1% L-ornithine-[T3]; 3% L-arginine + 1% L-ornithine-[T4] and the commercial feed without addition of the amino acids [controls]. According to the results, maximum weight gain [268.94 +/- 5.84%] and specific growth rate [SGR] [2.33 +/- 0.05% day-1] were observed in the fish of group T3, while maximum hepatosomatic index [HSI] [1.49 +/- 0.04%] was recorded in group T4. These amounts were significantly higher than their counterpart indices of the control group [P<0.05]. Supplementing the feed with the amino acids, overall, increased IGF-I levels throughout the study period. At the end of the eighth week, in the T3 and control groups maximum and minimum IGF levels were 1180 pg/ml and 980.35 pg/ml respectively. Results of this study showed the positive effects of providing fish diet with additional amino acids, especially a combination of arginine and ornithine, on growth promotion in rainbow trout

Identification of hepatitis B virus surface antigen [HBsAg] genotypes and variations in chronic carriers from Isfahan province, Iran

Hepatitis B virus [HBV] gene and protein variations are frequently been seen in chronic patients. The aims of study were to determine the genotypes as well as the patterns of variations distribution in chronically-infected patients from the central part of Iran. The surface gene was amplified, sequenced and subsequently aligned using international and national Iranian database. All strains belonged to genotype D, subgenotype Dl and subtype ayw2. Of all 62 mutations occurred at 39 nucleotide positions, 31 [50%] were missense [amino acid altering] and 31 [50%] were silent [no amino acid changing]. At the amino acid level, 30 substitutions occurred, however, 3 were in positions 122 and 127, corresponded to subtypic determination. 22 [73%] out of 30 amino acid mutations occurred in different immune epitopes within surface protein, of which 12 [54.54%] in B cell epitopes in 10 residues; 5 [45.45%] in T helper epitopes in positions; 5 [22.73%] in inside CTL epitopes in 4 residues. The distribution of amino acid mutations as well as the ratio between silent and missense nucleotide mutations showed a narrowly focused immune pressure had already been on the surface protein in these patients, led to the emergence of escape mutants in these patients

[Evaluation of efficacy of H. pylori eradication regimens in Iran: a systematic review]

Treatment regimens for the eradication of H. pylori as suggested in Western studies may not be applicable for Iran. Herein, we conduct a systematic review to ascertain the efficacy of eradication therapy regimens used for Iranian patients and introduce the more successful treatment regimens for Iranians. This review was a comprehensive search of English and Farsi electronic databases conducted from June to September 2011. A total of 11 trials were included in our study. In these, there were 28 different eradication regimens studied. Of the 28 regimens, 8 had an H. pylori eradication rate of over 85% and in 3 the eradication rate was greater than 90%. In Iran, the regimens that contained amoxicillin-furazolidone or amoxicillin-clarithromycin for two weeks were the most effective for H. pylori eradication, although the furazolidone-based regimen was less expensive. For first-line treatment, the amoxicillin-furazolidone-based regimen for 2 weeks is cost-effective for H. pylori eradication in Iranian patients

Epidemiology of celiac disease in Iran: a review

Celiac disease [CD] was traditionally believed to be a chronic enteropathy, almost exclusively affecting people of European origin. Celiac disease is the permanent intolerance to dietary gluten, the major protein component of wheat. The availability of new, simple, very sensitive and specific serological tests has shown that CD is as common in Middle Eastern countries as in Europe, Australia and New Zealand where the major dietary staple is wheat. A high prevalence of CD has been found in Iran, in both the general population and the at-risk groups, i.e. patients with type 1 diabetes or irritable bowel syndrome [IBS]. In developing countries, serological testing in at risk groups is necessary for early identification of celiac patients. Clinical studies show that presentation with non-specific symptoms or a lack of symptoms is as common in the Middle East as in Europe. Wheat is a major component of the Iranian diet and exposure to wheat proteins induces some degree of immune tolerance, leading to milder symptoms that may be mistaken with other GI disorders. The implementation of gluten free diet [GFD] is a major challenge for both patients and clinicians in Iran, especially since commercial gluten-free products are not available in this area

Esophagitis may not be a major precursor lesion for esophageal squamous cell carcinoma in a high incidence area in north-eastern Iran

Esophageal squamous cell carcinoma [ESCC] is usually detected in advanced stages resulting in a very poor prognosis. Early diagnosis needs identification of clinically releveant precancerous lesions which could become the target of screening and early treatment. Our aim was to check whether esophagitis could serve as a relevant histological precursor of ESCC in Northern Iran. During 2001-2005, all adult patients who were referred to Atrak clinic for upper gastrointestinal endoscopy and biopsy were enrolled. Atrak clinic is a major center for upper gastrointestinal cancer research in eastern Golestan. All subjects had been complaining of upper GI symptoms and were under further investigation to rule out cancer. Biopsies from the endoscopically normal mid-esophagus and also just above the esophago-gastric junction were obtained in all subjects whose esophagus appeared normal during endoscopy and from endoscopically normal appearing mucosa at the proximal vicinity of any detected mass. Microscopic examinations for the verification of the presence or absence of esophagitis was performed by independent histological examination of the samples by two pathologists. All the discrepant diagnoses were resolved in joint diagnostic sessions. During the study period 836 patients were enrolled including 419 non cancer patients [endoscopy clinic controls], 387 cancer patients, and 30 subjects with clinical diagnosis of malignancy referred for histological reconfirmation of diagnosis by repeated biopsy. Mild or marked mid-esophagitis was diagnosed in 39 [9.3%], 47 [12.5%] and 12 [40%] of endoscopy clinic controls, cancer patients and those who were suspicious for upper gastrointestinal malignancies. Our observation does not show evidence for esophagitis to be a predisposing factor for ESCC in Gonbad region In North Eastern Iran

[ features of esophageal cancer in Ardabil province: report of a population-based cancer registry in Northwest Iran]

Evidence shows that the mortality rate of esophageal cancer [EC] in Ardabil Province is among the highest worldwide. Studies on the epidemiological profile of EC in Ardabil are scarce. We aim to study the characteristics of EC in Ardabil using data from the recently established Ardabil Cancer Registry [ACR]. This study has been accomplished based on data collected in ACR between 2004 and 2006. Cases reported to ACR were coded based on the third edition of the International Classification of Diseases for Oncology [ICD-O III]. The age-standardized incidence rates [ASR] and the standard rate ratio [SRR] have been calculated for each district in Ardabil Province. A total of 549 new cases of EC were registered within ACR during the study period. The ASR was 19.5 for men and 19.7 for women per 100,000 person-years. The majority of cases [79.1%] were diagnosed based on pathology. The most common morphology of EC was squamous cell carcinoma [SCC, 73%] followed by adenocarcinoma [17.8%]. The ASR was significantly higher in northern districts of the province [p < 0.001]; highest in Meshkinshahr [27.2/100,000] and lowest in Nir [7.6/100,000]. The male:female ratio approximated one in the northern and above 2.5 in the southern districts. Our results demonstrate that the increased incidence of EC in Ardabil is mainly due to an increase in the incidence of esophageal adenocarcinoma [ACE] during recent years. The almost equal incidence of EC among men and women, and its geographical pattern across the province indicate the possible role of environmental risk factors, which need further investigations

[ Case-Control study on the risk factors of IBD in 258 Iranian patients]

Ulcerative colitis [UC] and Crohn's disease [CD] are chronic inflammatory bowel diseases [IBD] with uncertain etiology thought to be triggered by interactions between various environmental, genetic and immunologic factors. Role of different factors in IBD are controversial. The aim of this study is to determine the possible risk factors in a group of Iranian patients with IBD. Ninety five consecutive cases of CD and 163 cases of UC were included. Age matched controls were randomly selected. A total of 489 controls for UC and 285 controls for CD were enrolled. A standard record concerning many variables was completed. Logistic regression analysis was used to evaluate potential confounding variables. A statistically significant protective effect for smoking in UC was found [OR=0.18 95% CI=0.064-0.504, p < 0.05]. The risk of UC increases with prolonged exposure to OCP [OR=0.99, 95% CI=0.98-0.99, p< 0.05]. In patients with CD, 15 cases [15.8%] reported a previous history of appendectomy compared with 19 controls [6.7%] [OR=2.6, 95% CI= 1.2-5.4, p < 0.05]. Tonsillectomy was reported by 16 patients [16.8%] with CD compared with 25 controls [8.8%] [OR= 2.1, 95% CI= 1.07-4.1, p < 0.05]. The logistic regression analysis showed that both appendectomy and tonsillectomy are risk factors in CD. No association with other variables was found for either disease. Current smoking was a significant protective factor in UC. We observed a relationship between duration of OCP use and UC. Duration of using OCP in UC cases was significantly more than controls. Both appendectomy and tonsillectomy were risk factors in CD in this study

[Gastrointetinal and hepatic manifestations of systemic lupus erythematosus]

Gastrointestinal [GI] and hepatic manifestations are not uncommon in patients with systemic lupus erythematosus [SLE]. They include nonspecific symptoms as well as serious, life-threatening complications necessitating urgent, aggressive therapy. In addition to direct involvement of the GI system by the disease, many drug-induced side effects and opportunistic infections have GI and hepatic manifestations in these patients. Moreover, autopsy studies indicate a high prevalence of subclinical GI involvement in lupus patients. In this manuscript, the more clinically significant gastrointestinal and hepatic complications are reviewed

Time trends of gastro-esophageal reflux disease [GERD] and peptic ulcer disease [PUD] in Iran

Epidemiology of diseases changes over time with changes in socio-economic status, culture and health care systems. Gastroesophageal reflux disease [GERD] and peptic ulcer disease [PUD] are among the diseases whose epidemiology has changed over the past few decades in the west. Studies addressing the trend of GERD and PUD occurrence in Iran are lacking. We aimed to look at the time trends of GERD and PUD in a referral endoscopy clinic in Tehran, Iran. All patients with dyspeptic symptoms who underwent upper GI endoscopy from 1993 to 2005 [inclusive] in a tertiary outpatient GI referral center in Tehran were enrolled. Erosive esophagitis [EE, used as a proxy for GERD as a whole], PUD, rapid urease test [RUT] status and demographic characteristics were recorded from the endoscopy reports according to the year the endoscopy was performed. Over a period of 13 years, 8,029 endoscopic examinations were performed. The most common endoscopic diagnosis was EE that occurred in 4,808 patients [59.8%] followed by duodenal ulcer in 2,188 [27.3%] and gastric ulcer in 88 [1.1%]. Over 13 years [1995-2005], the proportion of EE increased from 14.1% in 1993 to 75.1% in 2005 among dyspeptic patients in this referral clinic. The proportion of each grade of GERD according to the Los Angeles classification was as follows: GERD-A 76.0%, GERD-B 20.9%, GERD-C 2.8% and GERD-D 0.3%. RUT positivity decreased from 71.4% to 9.5% during the study period. This study shows a remarkable increase in EE with a concomitant decrease in PUD and RUT positivity among dyspeptic patients in Tehran over a decade. This change in trend is important for future health care planning

Demographic, clinical features and treatment outcomes in 700 achalasia patients in Iran

Achalasia is the most recognized motor disorder of the esophagus. Because it is an uncommon disease, most studies have reviewed small numbers of patients. Here, we report demographic, clinical features and treatment outcomes in 700 achalasia patients. In all patients, diagnosis was established based on clinical, radiological, endoscopic and manometric criteria. A questionnaire was completed for each patient and included the patient's age, gender, initial symptoms, frequency of different symptoms, presence of positive family history for achalasia, other accompanying diseases and treatment outcomes. In our study men were affected more than women [54.3% vs. 45.7%]. Patients' mean age was about 38 years. The most frequent symptoms noted were: dysphagia to solids and liquids, active regurgitation, passive regurgitation and weight loss, respectively. Women complained of chest pain more than men [59% vs. 47.1%, p=0.04]. The vast majority of our patients were treated by pneumatic dilation [PD] of the LES and in long-term follow-up, 67% were in the responder group. Females responded better than males to PD. Dysphagia to solids is the most common symptom in patients with achalasia. Chest pain was significantly higher among women. PD is an effective treatment for achalasia with long-term efficacy in the majority of patients

effect of weight reduction on ultrasonographic findings of non alcoholic fatty liver

Non-alcoholic fatty liver [NAFL] includes a spectrum of diseases ranging from simple hepatic steatosis to nonalcoholic steatohepatitis [NASH] and cirrhosis. NAFL is typically seen in association with obesity, diabetes and hypertriglyceridaemia. In order to seek the role of diet therapy in treatment of NAFL, we compared the ultrasonographic findings of patients with fatty liver disease before and after standard diet therapy. Twenty-three overweight or obese subjects with incidental fatty liver discovered during ultrasonography were included. Subjects underwent 3 months of diet therapy, and anthropometric data including weight, height, BMI, waist circumference, and hip circumference were measured. Ultrasonographic findings were graded from 0 to 3. Changes in ultrasonographic findings and anthropometric data were studied. After three months of dieting, the ultrasonographic grade of all patients decreased by one or two grades. Fifteen patients decreased one grade while 8 others decreased by 2 grades. We observed a significant correlation between the decrease in ultrasonographic grade and the decrease in weight and BMI. Our study indicates that standard diet therapy could be used as an effective treatment for NAFL patients

Histopathological study of chronic hepatitis B: a comparative study of Ishak and METAVIR scoring systems

Ishak and METAVIR scoring systems are among the most commonly used histopathological systems to evaluate chronic hepatitis. To assess the level of agreement between these two scoring systems in patients with chronic hepatitis B. Liver biopsy samples taken from 92 patients with chronic hepatitis B were considered as the training set; 57 more biopsy specimens were used as the validation set. In the training set, grade of necroinflammation and stage of fibrosis for each liver biopsy specimen were determined by two expert liver pathologists using both Ishak and METAVIR systems. Inter-observer variability between the two pathologists was evaluated. Biopsy specimens of the validation set were seen and scored by a third expert pathologist. In the training set, criteria were developed to categorize Ishak grading and staging systems separately to best fit with the METAVIR scoring system. The criteria found in the training set, was then tested in the validation set. The level of agreement between the two scoring systems was assessed by weighted kappa statistics. For the training set, agreement between the two pathologists was excellent. Using our proposed criteria in the training set, there was excellent level of agreement in grading [Kappa = 0.89] and staging [Kappa = 0.99] between Ishak and METAVIR systems. In the validation set, the criteria led to substantial correlation [Kappa = 0.61] in grading, and excellent correlation [Kappa = 0.94] in staging between the two systems. Using our proposed criteria, excellent or at least substantial concordance between Ishak and METAVIR scoring systems can be achieved for the degree of both necro-inflammatory changes and fibrosis

[Achalasia: a review of western and iranian experiences and studies]

Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings and confirmed by radiologic, endoscopic and manometric evaluations. Several treatments for achalasia have been introduced. We searched the Pubmed Database for original articles and meta-analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures utilized for treatment. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries. Laparoscopic myotomy with fundoplication is the best surgical method for treatment of achalasia with its high success rate and therapeutic response. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. Graded pneumatic dilation with a slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to the lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for surgical treatment of achalasia. Graded pneumatic dilation is an effective alternative and can be recommended as a first therapeutic option in the majority of achalasia patients

Cell-based regenerative therapy as an alternative to liver transplantation for end-stage liver disease: experience from Iran

Several types of cells including mature hepatocytes, adult liver progenitor cells and human embryonic stem cells, fetal liver progenitor cells, bone marrow derived hematopoietic or mesenchymal stem cells, and um- bilical cord blood cells both in rodents and humans have been reported to be capable of self-replication, giving rise to daughter hepatocytes, both in vivo and in vitro. They have been shown to be able to repopulate liver in both animal models of liver injury and in patients with liver disease and to improve liver function. Human embryonic stem cell therapy seems to be a great promise for the treatment of liver cirrhosis, but there is no human clinical application due to ethical concerns or difficulties in harvesting or safely and efficiently expanding sufficient quantities. In contrast, adult bone marrow-derived hematopoietic or mesen- chymal stem cells, which can be easily and safely harvested, have been used in clinical trials to treat several chronic diseases including chronic liver disease. Cell therapy offers exciting promise for future treatment of cirrhosis and metabolic liver diseases, but significant technical hurdles remain that will only be overcome through years of intensive research. There is also serious concern about the long-term safety of stem cell therapy and the possibility of tumor development. Herein, we present our experience with cell therapy in treatment of chronic liver disease in Iran

[Pancreatobiliary cancers in Iran: a population- based study]

Our knowledge regarding the epidemiology of pancreatobiliary cancers in Iran is limited. This study presents the first population-based report on pancreatobiliary cancers performed in five provinces of Iran. Data used in this study were retrieved from population-based cancer registries in five provinces of Iran [Gilan, Mazandaran, Golestan, Ardabil and Kerman] from 1996 to 2000. Crude incidence rate, age standardized incidence rate [ASR] and age specific incidence rate were calculated for each cancer sites using the direct method. Overall ASR of pancreatic cancer in five provinces was 1.18 and 0.84 per 100, 000 person-years for men and women, respectively. These values for gallbladder and biliary tract cancers were 0.42 and 0.27 per 100, 000 person-years for men and 0.93 and 0.22 per 100, 000 person-years for women, respectively. ASR of pancreatobiliary cancer is low in Iran compared to western countries

[Inflammatory bowel disease: new comments in diagnosis and treatment]

Ulcerative colitis [UC] and Crohn's disease [CD] are chronic inflammatory bowel diseases with uncertain etiology thought to be triggered by interactions between various environmental, genetic and immunologic factors. Incidence rate of CD and UC is different in various geographic areas around the world, between 0.1-11 and 0.5-24.5 per 100, 000 people for CD and UC, respectively. Recent studies indicate a gradual increase in both CD and UC all over the world. Given the fact that the prevalence of IBD in high rate incidence areas duplicates every 10 years, it is predicted that these diseases are going to be among the most important health issues even in developing countries. Since patients are mostly young adults and because of 50% recurrence rate in IBD, quality of life will be affected greatly. Having more information about these diseases will improve health status in our country. In this study, we decided to discuss the main topics on IBD by reviewing the literature and recent papers

Cancer incidence and mortality in Ardabil: report of an ongoing population-based cancer registry in Iran, 2004-2006

Ardabil cancer registry is the first population-based cancer registry in Iran that was established in 2000. The first report from this registry revealed that Ardabil has one of the highest rate of gastric cardia cancer and the lowest rate of cervical cancer in the world. We aim to update the cancer incidence in this area by the second follow up report from this registry. Method: Data on all newly diagnosed cancer cases between 2004 and 2006 were actively collected. CanReg4 software was used for data entry and the data of cancer-related death were obtained from the comprehensive death registry system. More than 4300 new cases were registered during 3 years. Diagnosis of cancer was based on histopathology in 69%, clinical investigation 8%, clinical only 5%, and Death Certificate Only [DCO] in 18% of cases. In terms of age-standardized rate [/100,000], the five leading cancers in men [excluding skin cancer] were stomach [51.8], esophagus [19.5], bladder [13.1], lung and bronchus [10.8], and colorectal [9.6]; in women, they were stomach [24.9], esophagus [19.7], breast [11.9], colon and rectum [7.4], and brain tumors [6.9]. According to death registration data, upper gastrointestinal cancers constituted more than 43% of cancer-related death in Ardabil. The ASR for gastric cancer is among the highest rate for this cancer in male and female in the world. Most of the cancers, especially in female, have a significant increase compared to previous report from Ardabil. This is most likely due to the change in the registration practice

Digestive and liver disease statistics in Iran

Gastrointestinal and liver diseases [GILD] are among the most common causes of morbidity in Iran and constitute a substantial proportion of mortality which imposes enormous economic consequences. Our purpose is to collect information and report current statistics on physician visits, hospitalizations, and deaths due to common GILD in Iran. Data on the leading causes of death were obtained from the Iranian Ministry of Health, Office of Health Statistics. A total of 213,322 deaths were reported from March 2003 to February 2004 [excluding mortality from the Bam earthquake] which equaled 4.4 deaths per 1000 population. Of these, 36,575 were due to accidents. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases [ICD-10; 1992]. The leading causes of hospitalization were obtained from the database of the GILD ward in Shariati Hospital, one of the largest and best known gastroenterology referral hospitals in Iran. Similarly, leading causes of out-patient referrals were identified from a large multi-physician outpatient clinic in Tehran. The five leading gastrointestinal causes of death in order of frequency were: gastric cancer, hepatobiliary cancer, liver cirrhosis, esophageal cancer, and colorectal cancer. The five leading causes of hospitalization in the GILD ward of Shariati Hospital were: liver cirrhosis, hepatitis, peptic ulcer disease, cholycystitis and cholangitis, and colorectal cancer. The most common outpatient diagnosis was gastroesophageal reflux disease followed by irritable bowel syndrome [IBS], duodenal ulcer [DU], non-ulcer dyspepsia, and chronic hepatitis B [HBV]. Gastrointestinal and liver malignancy along with chronic liver disease constitute the main GILD reasons for hospitalization and deaths in Iran. Gastroesophageal reflux disease, IBS, and chronic HBV are the most common GILD outpatient diagnoses