High Prevalence Rate of Microbial Contamination in Patient-Ready Gastrointestinal Endoscopes in Tehran, Iran: an Alarming Sign for the Occurrence of Severe Outbreaks.

An alarmingly increasing number of outbreaks caused by contaminated gastrointestinal (GI) endoscopes are being reported as a particularly concerning issue. This study is the first large-scale multicenter survey to evaluate the contamination of GI endoscopes in Tehran, Iran. This multicenter study was conducted among 15 tertiary referral and specialized gastrointestinal settings. Reprocessed GI endoscopes were sampled by the sequence of the flush-brush-flush method. Bacterial and viral contamination, as well as antimicrobial resistance, were explored by culture and molecular assays. A total of 133 reprocessed and ready-to-use GI endoscopes were investigated. In phase I and phase II, 47% and 32%, respectively, of the GI endoscopes were determined to be contaminated. GI flora was the most prevalent contaminant isolated from GI endoscopes, in which the most predominant bacteria were Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae, in both phase I and II evaluations. The majority of the isolated bacteria in the current study were considered multidrug-resistant organisms (MDROs). More importantly, we recovered carbapenem-resistant nonfermentative Gram-negative bacilli (CRNFGNB), carbapenem-resistant Enterobacterales (CRE), extended-spectrum ß-lactamase (ESBL)-producing Enterobacterales (ESBL-E), multidrug-resistant Clostridioides difficile, vancomycin-resistant Enterococcus (VRE), and drug-resistant Candida spp. Disconcertingly, our molecular assays revealed contamination of some reprocessed GI endoscopes with hepatitis B virus (HBV), hepatitis C virus (HCV), and even HIV. This multicenter study indicates a higher-than-expected contamination rate among reprocessed and ready-for-patient-use GI endoscopes, which suggests a higher-than-expected endoscopy-associated infection (EAI) risk, and potentially, morbidity and mortality rate, associated with endoscopy procedures in Tehran, Iran. IMPORTANCE In the light of severe outbreaks caused by multidrug-resistant microorganisms due to contaminated GI endoscopes, understanding to what extent GI endoscopes are inadequately reprocessed is crucial. Several studies assessed contamination of GI endoscopes with various outcomes across the world; however, the prevalence and risk factors of contaminated GI endoscopes and potential subsequent nosocomial spread are still unknown in Iran. The present study is the first large-scale multicenter survey to evaluate the microbial contamination of repossessed and ready-to-use GI endoscopes in Tehran, Iran. Our study showed a higher-than-expected contamination rate among reprocessed GI endoscopes, which suggests potential seeding of deadly but preventable outbreaks associated with endoscopy procedures in Iran. These results suggest that the current reprocessing and process control guidelines do not suffice in Iran. The current study is of particular importance and could provide insights into unrecognized and unidentified endoscopy-associated outbreaks in Iran.

Scoring systems of metabolic syndrome and prediction of cardiovascular events: A population based cohort study.

BACKGROUND AND AIMS: Continuous scoring systems were developed versus traditional dichotomous approaches to define metabolic syndrome. The current study was carried out to evaluate the ability of scoring systems to predict fatal and nonfatal cardiovascular events. MATERIALS AND METHODS: The data of 5147 individuals aged 18 years or more obtained from a population-based cohort study were analyzed. The occurrence of atherosclerotic cardiovascular disease (ASCVD) in the period of 7 years follow-up was considered as the associated outcome. Joint Interim Statement (JIS) definition, as a traditional definition of metabolic syndrome (MetS), and two versions of MetS scoring systems, based on standardized regression weights from structural equation modeling (SEM) and simple method for quantifying metabolic syndrome (siMS) were considered as potential predictors. RESULTS: The scoring systems, particularly, based on SEM, were observed to have a significant association with composite cardiovascular events (HR = 1.388 [95% CI = 1.153-1.670], p = .001 in men and HR = 1.307 [0.95% CI = 1.120-1.526] in women) in multiple Cox proportional hazard regression analyses, whereas the traditional definition of MetS did not show any significant association. While both two scoring systems showed acceptable predictive abilities for cardiovascular events in women (MetS score based on SEM: area of under curve [AUC] = 0.7438 [95% CI = 0.6195-0.7903] and siMS: AUC = 0.7207 [95% CI = 0.6676-0.7738]), the two systems were not acceptable for identifying risk in men. CONCLUSION: Unlike the dichotomous definition of MetS, the scoring systems showed an independent association with cardiovascular events. Scoring systems, particularly those based on SEM, may be useful for the prediction of cardiovascular events in women.

Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars: multi-center experience in Iran.

AIM: The current study aimed to investigate the risk factors, endoscopic findings, and treatments of upper gastrointestinal bezoars. BACKGROUND: Bezoars are compact masses formed by the accumulation of dietary fiber, undigested food, hair, or medications. The majority of bezoars are asymptomatic, but they may cause serious symptoms or even life-threatening events such as bleeding, obstruction, or perforation. METHODS: This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019. Bezoars were detected in 109 of 15,830 endoscopy records (0.68%). RESULTS: A total of 103 patients (52.4% male) were enrolled in this study. Mean patient age was 60.5±11.3 years. The most frequent risk factors were history of gastric surgery (25.2%), diabetes mellitus (21.3%), hypothyroidism (15.5%), trichophagia (5.8%), and anxiety disorders (2.9%), respectively. The most common endoscopic findings were peptic ulcers (34.9%), erosive gastritis/duodenitis (12.6%), and reflux esophagitis (10.6%). While bezoars were most commonly observed in the stomach (84.4%), the majority of them were phytobezoars (92.2%). The mean number of endoscopic interventions for each patient was 1.5 (range, 1-4). Endoscopy was successful in removing bezoars in 85.4%. CONCLUSION: The synergistic effect of multiple factors for a long time, such as gastrointestinal surgery, diabetes mellitus or psychiatric disorders, may lead to bezoar formation. These risk factors should be avoided or treated in order to prevent bezoar formation and subsequent life-threatening complications.

Troponin is a useful marker in clinical decision making in hospitalized patients with COVID-19 infections.

BACKGROUND: COVID-19 was introduced by the World Health Organization (WHO) as a global pandemic. The disease manifestations ranges from a mild common cold to severe disease and death. It has a higher mortality rate in people with a history of comorbidities, including cardiovascular disease (CVD) and can also contribute to cardiac injury. This study was conducted to evaluate the relationship between troponin levels as a cardiac marker and adverse outcomes in this disease. METHODS: The study sample included 438 patients hospitalized with COVID-19; however, the troponin data of 6 patients were not available. The need to be admitted to the intensive care unit (ICU), and death were considered the adverse outcome in patients with COVID-19. Troponin levels were checked in all patients on day 1 and day 3 of hospitalization. Multiple logistic regression analysis was performed to determine whether there was an independent association between the adverse outcomes and troponin enzyme in hospitalized patients with COVID-19. RESULTS: The mean age of patients was 61.29 ± 15.84 years. Among the 432 patients tested on day 1 of hospitalization, 24 patients (5.6%) tested positive (Troponin 1), and among the 303 patients tested on day 3, 13 patients (4.3%) tested positive (Troponin 2). Based on our results, Troponin 1 showed an independent association with both death (3.008 [95%CI = 1.091-8.290]; P = 0.033) and need for ICU admission (8.499 [95%CI = 3.316-21.788]; P < 0.001) in multiple logistic regression analysis. Moreover, the status of Troponin 2 had an independent significant association with both death (4.159 [95%CI = 1.156-14.961]; P = 0.029) and ICU admission (7.796 [95%CI = 1.954-31.097]; P = 0.004). CONCLUSION: Troponin showed a significant association with adverse outcomes in people who were hospitalized with COVID-19. The periodical assessment of this enzyme from the time of hospitalization may improve the clinical decision making of clinicians.

Immunotherapeutic Effects of ß-D Mannuronic Acid on IL-4, GATA3, IL-17 and RORC Gene Expression in the PBMC of Patients with Inflammatory Bowel Diseases.

Inflammatory bowel diseases (IBD) are chronic relapsing immune-mediated disorders that result from an aberrant immunological response. IBD comprises of Crohn's disease (CD) and ulcerative colitis (UC). The precise aetiology of IBD has not been fully understood, however, recent studies support the hypothesis that patients with IBD have a dysregulated immune response to endogenous bacteria in the gastrointestinal tract (GIT). The increasing number of hospitalisation coupled with the high economic burden faced by IBD patients, calls for more concerted research efforts, to design a potent and credible treatment option for these strata of patients. This research was designed to test the efficacy and potency of ß-D Mannuronic acid (M2000) in the treatment of IBD. Ten ml of blood was aseptically collected from 24 IBD patients and 24 normal controls. PBMC was isolated and stimulated with 1 µg/mL of LPS and incubated for 4 hours. The cells were later treated with 10 µg/mL or 50 µg/mL of Mannuronic acid and incubated for 24 hours at 370C under 5% CO2 and 100% humidity. After the incubation, RNA was extracted from the cells, cDNA was synthesised, and the expression of the gene was evaluated using quantitative real-time PCR. The result indicated a significant down-regulation of RORC and IL-17 genes expression, while the expression of IL-4 and GATA3 genes were significantly up-regulated. These research findings have shown that M2000 a biocompatible agent, that has an immunotherapeutic, immunomodulatory and immunosuppressive effects on the PBMC of IBD patients.

Immunomodulatory effects of M2000 (ß-D-Mannuronic acid) on TNF-α, IL-17 and FOXP3 gene expression in patients with inflammatory bowel disease.

INTRODUCTION: Inflammatory bowel diseases (IBD) are immune-mediated disorders that result from an aberrant immunological response to the gut luminal antigen in genetically susceptible patients. IBD is categorized into two serotype, Crohn's diseases (CD) and ulcerative colitis (UC), both subtype are important cause of gastrointestinal diseases. The increasing rate of hospitalization, with the high economic burden experienced by the IBD patients, calls for more concerted research efforts to design a potent and affordable treatment option for the treatment of IBD. AIMS/OBJECTIVE: This research was designed to test the efficacy and potency of ß-D Mannuronic acid (M2000) and assess if it could serve as a better therapeutic option in the treatment of IBD. METHODOLOGY: Ten (10)ml of blood was aseptically collected into an EDTA container, from 24 IBD patients and 24 normal healthy controls. PBMC was isolated and stimulated with 1µg/ml of LPS in cell culture plate and incubated for 4h. The cells were later treated with 10µg/ml and 50µg/ml of ß-D Mannuronic acid (M2000) and incubated for 24h at 37°C under 5% CO2 and 100% humidity. The RNA extractions, cDNA synthesis, and QRT-PCR were performed. RESULTS: Our findings showed a significant down-regulation of TNF-α and IL-17 gene expression, while the expression of FOXP3 gene was significantly up-regulated. CONCLUSION: This result has indicated that ß-D Mannuronic acid (M2000) have immunoregulatory and anti-inflammatory effects on these cytokines that are pivotal in the pathogenesis of IBD.

Association between Pattern of Gastritis and Gastroesophageal Reflux Disease in Patients with Helicobacter Pylori Infection.

BACKGROUND Reflux disease is a common gastrointestinal problem. The association between reflux disease and gastritis pattern is controversial. AIM: To determine the association between reflux disease and gastritis pattern in patients with Helicobacter pylori (H. pylori) infection. METHODS 470 patients with dyspepsia and reflux disease were enrolled in this study. The inclusion criteria were willing to participate in the study, age over 40 years, and having the criteria of ROME III for at least 3 months. Patients with history of H. pylori eradication therapy during the 3 months before the study, a history of gastric surgery, and gastric cancer were excluded. All of the participants underwent upper endoscopy and two biopsy samples were taken from antrum, body, and fundal areas. RESULTS H. pylori infection rate was 367 (78.1%) with mean age of 59.8 ± 11.4 years. Of them 131 patients (35.7%) were male. Reflux disease was detected in 273 (74.4%) patients. 216 (58.9%) and 102 (27.8%) patients had non-erosive reflux disease (NERD) and gastroesophageal reflux disease (GERD), respectively. Corpus predominant and antral predominant gastritis were seen in 72 (19.6%) and 129 (35.2%) patients, respectively. Antral gastritis was significantly associated with GERD (p<0.01). In regression analysis, antral predominant gastritis had a significant association with GERD (OR=1.92; 95%CI: 1.22- 3.12). The same result was observed in mild to moderate antral and greater curvature gastritis (OR= 1.26; 95%CI: 0.25-6.40 and OR= 3.0; 95%CI: 0.63-14.17, respectively). CONCLUSION According to these finding ,we could suggest that the pattern of gastritis could be associated with reflux disease and GERD.

Fatty liver index vs waist circumference for predicting non-alcoholic fatty liver disease.

AIM: To determine the discriminatory performance of fatty liver index (FLI) for non-alcoholic fatty liver disease (NAFLD). METHODS: The data of 5052 subjects aged over 18 years were analyzed. FLI was calculated from body mass index, waist circumference (WC), triglyceride, and gamma glutamyl transferase data. Logistic regression analysis was conducted to determine the association between FLI and NAFLD. The discriminatory performance of FLI in the diagnosis of NAFLD was evaluated by receiver operating characteristic analysis. Area under the curves (AUCs) and related confidence intervals were estimated. Optimal cutoff points of FLI in the diagnosis of NAFLD were determined based on the maximum values of Youden's index. RESULTS: The mean age of men and women in the study population were 44.8 ± 16.8 and 43.78 ± 15.43, respectively (P = 0.0216). The prevalence of NAFLD was 40.1% in men and 44.2% in women (P < 0.0017). FLI was strongly associated with NAFLD, so that even a one unit increase in FLI increased the chance of developing NAFLD by 5.8% (OR = 1.058, 95%CI: 1.054-1.063, P < 0.0001). Although FLI showed good performance in the diagnosis of NAFLD (AUC = 0.8656 (95%CI: 0.8548-0.8764), there was no significant difference with regards to WC (AUC = 0.8533, 95%CI: 0.8419-0.8646). The performance of FLI was not significantly different between men (AUC = 0.8648, 95%CI: 0.8505-0.8791) and women (AUC = 0.8682, 95%CI: 0.8513-0.8851). The highest performance with regards to age was related to the 18-39 age group (AUC = 0.8930, 95%CI: 0.8766-0.9093). The optimal cutoff points of FLI were 46.9 in men (sensitivity = 0.8242, specificity = 0.7687, Youden's index = 0.5929) and 53.8 in women (sensitivity = 0.8233, specificity = 0.7655, Youden's index = 0.5888). CONCLUSION: Although FLI had acceptable discriminatory power in the diagnosis of NAFLD, WC was a simpler and more accessible index with a similar performance.

Mutation Analysis of KRAS and BRAF Genes in Metastatic Colorectal Cancer: a First Large Scale Study from Iran.

BACKGROUND: The investigation of mutation patterns in oncogenes potentially can make available a reliable mechanism for management and treatment decisions for patients with colorectal cancer (CRC). This study concerns the rate of KRAS and BRAF genes mutations in Iranian metastatic colorectal cancer (mCRC) patients, as well as associations of genotypes with clinicopathological features. MATERIALS AND METHODS: A total of 1,000 mCRC specimens collected from 2008 to 2012 that referred to the Mehr Hospital and Partolab center, Tehran, Iran enrolled in this cross sectional study. Using HRM, Dxs Therascreen and Pyrosequencing methods, we analyzed the mutational status of KRAS and BRAF genes in these. RESULTS: KRAS mutations were present in 33.6% cases (n=336). Of KRAS mutation positive cases, 85.1% were in codon 12 and 14.9% were in codon 13. The most frequent mutation at KRAS codon 12 was Gly12Asp; BRAF mutations were not found in any mCRC patients (n=242). In addition, we observed a strong correlation of KRAS mutations with some clinicopathological characteristics. CONCLUSIONS: KRAS mutations are frequent in mCRCs while presence of BRAF mutations in these patients is rare. Moreover, associations of KRAS genotypes with non-mucinous adenocarcinoma and depth of invasion (pT3) were remarkable.

Nonalcoholic Fatty Liver: The Association with Metabolic Abnormalities, Body Mass Index and Central Obesity--A Population-Based Study.

BACKGROUND: To assess the prevalence of nonalcoholic fatty liver (NAFL) in Iran and to evaluate correlates of NAFL in categories of body mass index (BMI). METHODS: Using a cluster random sampling approach, 7723 subjects over 18 years of age underwent abdominal ultrasonography, laboratory evaluations, blood pressure, and anthropometric measurements and were interviewed to obtain baseline characteristics. Prevalence of NAFL according to BMI and waist to hip ratio and its association with metabolic abnormalities in categories of BMI were assessed in multivariate analysis. RESULTS: The overall prevalence of NAFL was 35.2% [95% confidence interval (CI) 34.1-36.3]. A significant number of subjects with BMI < 30 had NAFL [22.1% (CI 21.0-23.2)]. Waist to hip ratio for 38.2% (CI 35.6-40.8) of the subjects with NAFL, and BMI < 30 was higher than normal values. The odds ratio for association of NAFL and dyslipidemias were higher in subjects with BMI < 30 versus those with BMI ≥ 30: (1) hypertriglyceridemia: 2.21 vs. 1.57, P = 0.006; (2) lower high-density lipoprotein: 1.29 versus 0.98, P = 0.046. Higher low-density lipoprotein also revealed greater association with NAFL in subjects with BMI < 25 than those with BMI ≥ 25 (odds ratio 1.84 vs. 1.1, P = 0.015). CONCLUSIONS: NAFL shows stronger association with central obesity compared to high BMI. NAFL has stronger association with dyslipidemias in subjects with low compared with high BMI.

Prevalence of gastric precancerous lesions among chronic dyspeptic patients and related common risk factors.

Gastric cancer is one of the leading causes of cancer-related deaths worldwide. Progression of gastric cancer follows several steps from gastritis to atrophy, intestinal metaplasia, dysplasia, and finally cancer. The aim of this study was to determine the prevalence of gastric precancerous lesions and related common risk factors in a group of chronic dyspeptic patients. A total of 688 chronic dyspeptic patients older than 40 years of age were consecutively enrolled. The exclusion criteria were pregnancy, and a history of gastric cancer and gastric surgery. A questionnaire including demographic and clinical data, smoking habits, alcohol use, NSAIDs, and regular aspirin use was completed for all patients. Upper endoscopy and gastric biopsy were performed for all of the participants according to the standard protocols. Upper endoscopy was performed for all of the participants and biopsies were taken according to the biopsy protocol. The specimens were examined in a blinded manner by two expert gastrointestinal pathologists. The mean age of the participants was 57.87±9.10 years; there were 361 (52.5%) women. The prevalence of intestinal metaplasia, gastric atrophy, dysplasia, and positive Helicobacter pylori infection was 19.8, 12.8, 3.2%, and 64.5%, respectively. Age and H. pylori infection showed a significant association with pathological findings (odds ratio=3.10, 95% confidence interval: 1.91-4.72 and odds ratio=3.56, 95% confidence interval: 2.30-5.53, respectively). According to the high prevalence of precancerous lesions in patients with chronic dyspepsia who were older than 40 years of age, upper endoscopy and gastric mapping sampling for the detection of these lesions is recommended in intermediate-risk to high-risk areas.

Prevalence of colorectal adenoma in an average-risk population aged 40-50 versus 50-60 years.

According to current guidelines, screening colonoscopy begins at 50 years for the average-risk population, although there are not enough data on the incidence of precancerous lesions of individuals in the preceding decades. To evaluate the prevalence of colorectal polyps including potentially premalignant lesions in asymptomatic, average-risk individuals aged 40-49 versus 50-59 years, we offered total colonoscopy screening to individuals without any lower gastrointestinal symptoms. The primary end point was the prevalence of colorectal adenoma in two age groups. Of a total of 737 studies, 333 participants were 40-49 years old and 407 participants were 50-59 years old. The overall prevalence of adenomas was 11.2 and 16.4% in the group of 40-49 and 50-59 year olds, respectively. Advanced adenoma was more common in 50-59 year olds (1.2 vs. 2.9%). Malignancy was not reported in these groups. Furthermore, 77.5 and 68.6% of adenomas were observed in the distal colon in the groups of 40-49 year olds and 50-59 year olds, whereas in the proximal colon, 22.2 and 57.1% of adenomas in the groups of 40-49 year olds and 50-59 year olds, respectively, were advanced adenomas. In our study, male sex showed an association with adenoma. However, importantly, there was no significant association between age and colorectal adenoma. Although the prevalence of colorectal adenoma was similar in the two age groups investigated, the rate of advanced adenoma was higher in the group of individuals who were 50-59 years old, suggesting that colorectal cancer screening could be recommended at an age younger than 50 years.

Prevalence of colorectal polyps in a group of subjects at average-risk of colorectal cancer undergoing colonoscopic screening in Tehran, Iran between 2008 and 2013.

BACKGROUND: Colorectal cancer (CRC) is one of the prime causes of mortality around the globe, with a significantly rising incidence in the Middle East region in recent decades. Since detection of CRC in the early stages is an important issue, and also since to date there are no comprehensive epidemiologic studies depicting the Middle East region with special attention to the average risk group, further investigation is of significant necessity in this regard. AIM: Our aim was to investigate the prevalence of preneoplastic and neoplastic lesions of the colon in an average risk population. MATERIALS AND METHODS: A total of 1,208 eligible asymptomatic, average- risk adults older than 40 years of age, referred to Firuzgar Hospotal in the years 2008-2012, were enrolled. They underwent colonoscopy screening and all polypoid lesions were removed and examined by an expert gastrointestinal pathologist. The lesions were classified by size, location, numbers and pathologic findings. Size of lesions was measured objectively by endoscopists. RESULTS: The mean age of participants was 56.5±9.59 and 51.6% were male. The overall polyp detection rate was 199/1208 (16.5 %), 26 subjects having non-neoplastic polyps, including hyperplastic lesions, and 173/1208 (14.3%) having neoplastic polyps, of which 26 (2.15%) were advanced neoplasms .The prevalence of colorectal neoplasia was more common among the 50-59 age group. Advanced adenoma was more frequent among the 60-69 age group. The majority of adenomas were detected in the distal colon, but a quarter of advanced adenomas were found in the proximal colon; advance age and male gender was associated with the presence of adenoma. CONCLUSIONS: It seems that CRC screening among average-risk population might be recommended in countries such as Iran. However, sigmioidoscopy alone would miss many colorectal adenomas. Furthermore, the 50-59 age group could be considered as an appropriate target population for this purpose in Iran.

Prevalence and risk factors of cholelithiasis in Amol city, northern Iran: a population based study.

BACKGROUND: Cholelithiasis is one of the most prevalent gastrointestinal disorders requiring hospitalization.  While different factors influence gallstone formation in patients, these factors are not the same in different societies or in different geographical locations. AIM: To evaluate the epidemiology and risk factors associated with gallstone formation in a large population group, the present survey was conducted in northern Iran. METHODS: In 6143 asymptomatic subjects, the incidence of gallstone formation as well as risk factors were evaluated through a structured questionnaire, physical examination and ultrasonography study. Sample selection was based on stratified cluster systemic randomization. RESULTS: Of these enrolled subjects 3507 (57.1%) were male and 2636 (42.9%) were female with a mean age of 42.71 ± 17.1 years.  The prevalence of gallstones was 0.80%.  On multivariate analysis, the risk of gallstone disease is correlated to rural locale, diastolic hypertension, age, and TG levels.  However, systolic hypertension, glucose serum levels and obesity were also significantly associated with the presence of gallstones. CONCLUSION: The present study proposes that the rate of gallstone disease in northern Iran is lower than previous studies have reported, and that most of the risk factors can be prevented by changes in lifestyle and diet.

A population based study on hepatitis B virus in northern iran, amol.

BACKGROUND: Viral hepatitis is a major health problem worldwide. Change in transmission patterns of hepatitis B makes it necessary to re-evaluate its prevalence and risk factors. OBJECTIVES: We aimed to determine the prevalence of HBV infection and its related risk factors in Amol city, Northern Iran. PATIENTS AND METHODS: As a population based study, a cluster sampling approach was used and 6146 individuals from the general population of urban and rural areas of Amol, Iran, from both genders and different ages were enrolled. Inclusion criteria were willingness to participate in the study, being a lifelong resident in Amol city or its surrounding areas with Iranian nationality. Ten milliliters (10 mL) of blood was taken from each study subject and checked regarding hepatitis B markers including HbsAg, HBsAb and HBcAb using a third generation ELISA. The prevalence of HBV infections and its potential risk factors were recorded. RESULTS: The prevalence of HBsAg, HBsAb and HBcAb were estimated as 0.9%, 30.7% and 10.5%, respectively. The mean age of all participants was 43.9 (95% CI: 43.4, 44.3) in females and 55.6 in (n = 3472) males. In our study, there was a significant association between family history of hepatitis, rural residency and presence of HBsAg. There was also a positive correlation between HBcAb and family history of hepatitis, history of other types of hepatic diseases, history of tattooing, traditional phlebotomy, male gender and age. In backward logistic regression, a significant association was found between history of hepatitis in first-degree family members (OR = 13.35; 95% CI: 6.26, 28.47) and place of residence (OR = 2.32; 95% CI: 1.27, 4.22) with presence of HBsAg. There was also a positive correlation between history of hepatitis among first-degree family members (OR = 2.49; 95% CI: 1.52, 4.08), history of tattooing (OR = 2.13; 95% CI: 1.33, 3.42), history of previous hepatitis (OR = 1.87; 95% CI: 1.06, 3.28), male sex (OR = 1.36; 95% CI: 1.12, 1.66) and age (OR = 1.03; 95% CI: 1.03, 1.04) with presence of HBcAb. CONCLUSIONS: The prevalence of hepatitis B in Amol City and its surrounding areas was about one percent, a lower rate than other reports from Iran.

Prevalence and risk factors of hepatitis C virus infection in amol city, north of iran: a population-based study (2008-2011).

BACKGROUND: Hepatitis C Virus (HCV) infection is one of the most important causes of chronic liver disease and related problems in the world .There are few population-based studies on the prevalence and risk factors of hepatitis C infection in Iran, which could not provide enough information. Moreover, the prevalence and risk factors of hepatitis C infection are not similar in all parts of Iran. OBJECTIVES: The aim of this survey was to determine the prevalence and risk factors of HCV infection in the general population of the city of Amol, north of Iran. PATIENTS AND METHODS: This was a population-based study. Using a cluster sampling approach, 6145 individuals of both genders and different ages were involved from general population of urban and rural areas of Amol, The inclusion criteria were Iranian nationality, willing to participate in the study, and lifelong residence in Amol city and surrounding areas. Anti-hepatitis C antibody was measured by a third generation of ELISA. The positive results were confirmed by Recombinant Immuno Blot Assay (RIBA) and quantitative HCV-RNA polymerase chain reaction (PCR) tests. Potential risk factors of HCV transmission were recorded. RESULTS: The mean age of participants was 42.70 ± 17.10 years. Of these participants, 57.2% (n = 3483) were male. Anti-HCV antibody was positive in 12 individuals from which five were RIBA positive. Three of these subjects were PCR positive. The prevalence of HCV was more predominant among males than females. The common risk factors among the study subjects included history of minor or major surgery (34.7%), unsterile punctures (21.2%), history of traditional phlebotomy (5.8%), and history of hepatitis among close relatives (5.7%). In univariate regression analysis, unsterile punctures and history of infection in family members were associated with HCV infection. CONCLUSIONS: We confirm that in Amol city and surrounding areas, the prevalence of true HCV infection is 0.05%, which is lower than that previously reported from Iran.

Long-term quality of life after ileal pouch anal restorative proctocolectomy for ulcerative colitis.

Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) has evolved as the surgical procedure of choice for ulcerative colitis (UC). The aim of our study was to evaluate the quality of life (QOL) of UC patients who underwent this procedure over 5 years ago. Thirty-nine UC patients who underwent restorative proctocolectomy with IPAA were interviewed by the validated inflammatory bowel disease questionnaire (IBDQ). Each patient was assigned a score, ranging from 32 to 224, in which the highest score indicates the best QOL. QOL for postoperative patients was good in 15 (38.5 %), regular in 23 (59 %), and bad in 1 (2.6 %) patient. QOL was not significantly influenced by age or gender of the patient. The emotional aspect received the highest score in the IBDQ and for each question that was analyzed separately; most of the patients were pleased and thankful with their lives and this question received the highest score. Long-term QOL was good in UC patients who underwent IPAA. This operation should be considered as the first choice since the patients were stable after long-term follow up.

Association between Helicobacter pylori and Serum Leptin in Iranian Dyspeptic Patients.

BACKGROUND: To investigate any possible relationship between serum leptin level and H.pylori infection in dyspeptic Iranian adults. METHODS: A total of 153 dyspeptic patients referring to Firoozgar hospital for esophagogastroduodenoscopywere enrolled in the study. Serum leptin level was measuredbefore endoscopy, after overnight fasting. Two biopsy specimens weretaken from antrum for each patient during endoscopy: one to detect H. pyloriinfection by Rapid Urease Test (RUT) and the other evaluated by an expertpathologist, blind to the RUT results and patients. Serum leptin level was comparedbetween H.pylori-positive negative groups. RESULTS: A total of 153 dyspeptic patients with the mean age of 43.2±14.3 years wereevaluated. The overall prevalence of H.pylori infection was 49.6%. H.pyloriinfection was significantly associated with serum leptin level (p<0.001). In addition,we found a significant relationship between serum leptin level and gender(p<0.02). Furthermore, serum leptin level was correlated with age (r=0.17,p=0.0031). However, the H.pylori-positive group was older in comparison tothe H.pylori negative group (45.65±13.9 vs. 40.7±14.13, p=0.035). The twogroups were not significantly different in terms of gender, height, weight orBMI. CONCLUSION: H.pylori infection may influence leptin production. Advanced age might exposethe individual to H.pylori infection and consequently influence the leptinlevel.