Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial.

OBJECTIVE: Haemorrhoids are one of the most common gastrointestinal and anal diseases. In olive oil and honey propolis, flavonoids have beneficial effects on improving vascular function and decreasing vascular resistance. In this study, we aimed to produce a combination of these two substances in the form of lotions and assess their healing and side effects in comparison with routine treatment, anti-haemorrhoid ointment (containing hydrocortisone and lidocaine). DESIGN: In this randomised clinical trial study, 86 patients with grade 2 or more haemorrhoid degrees, diagnosed by colonoscopy, were divided into two groups, the case (n=44) and control (n=42). The case group was treated with flavonoid lotion, and the control group was treated with anti-haemorrhoid ointment two times per day for 1 month. Patients were followed weekly with history and physical examination. The data of the two groups were collected before and after the intervention and statistically analysed. RESULTS: Post-treatment reduction in haemorrhoid grade was significant in the case group (p=0.02). This ratio was insignificant in the control group (p=0.139). Flavonoid lotion (p<0.05) significantly reduced the signs and symptoms of haemorrhoids more than anti-haemorrhoid ointment. CONCLUSION: According to the results, flavonoid lotion can be an excellent alternative to topical chemical drugs, such as anti-haemorrhoid ointment, in treating haemorrhoid disease. Besides its effectiveness and safety, it can be easily manufactured and widely available to patien.

Helicobacter pylori acquisition rates and the associated risk factors amongst newlywed couples; a prospective cohort study in Tehran, Iran.

BACKGROUND: The rates and routes of Helicobacter pylori transmission, in a high-prevalent country like Iran, with gastric cancer as the leading cause of male cancer mortality, are of great essence. Here, we have studied the H. pylori-associated risk factors and the likelihood of interspousal transmission. METHODS: In a cohort of 686 young prewed couples, questionnaires were self-administered and serum samples were collected, for assessment of risk factors and H. pylori serostatus, at baseline and follow-up. Of the 475 H. pylori single- or double-seronegative couples, 201 returned for follow-up. The average follow-up duration was 2.2 (SD 0.6) years, with a total of 560.1 person-years. Logistic regression and Cox regression models were used to estimate the odds ratios (ORs) and hazard ratios (HRs). RESULTS: The risk of infection was higher in men than women (OR: 1.3, 95% CI: 1.0-1.8) and among metropolitan than rural residents (OR = 1.4, 95% CI: 1.1-1.9). It was also significantly higher among those with three (OR = 1.6, 95% CI: 1.1-2.2), and four or more siblings (OR = 1.4, 95% CI: 1.0-1.9), in reference to those with one or no siblings. Adult H. pylori acquisition occurred in 10.9% (27/247) of the seronegative participants. The risk of the acquisition was significantly associated with age (P value for trend=0,000). It was also significantly lower among participants who had various degrees of education as compared to illiterate subjects (HR = 0.2, 95% CI: 0.1-0.9). Nevertheless, our analysis did not find any evidence for interspousal transmission (HR = 1.0, 95% CI: 0.4-2.2). CONCLUSION: Whilst H. pylori acquisition was detected in the young adult Iranian population, our findings did not support interspousal transmission, as a mode of acquisition.

Serum albumin level as an indicator of response to Hepatitis B vaccination in dialysis patients: A systematic review and meta-analysis.

BACKGROUND: Hepatitis B (HB) vaccination is a recommended procedure in all dialysis patients, but its efficacy has not been perfect. In the current study, we aimed to conduct a comprehensive review of the literature to find and pool data of the randomized trials evaluating the impact of serum albumin levels on the immunogenicity of HB vaccination in dialysis patients. METHODS: Literature searches were conducted by the Medline and Google Scholar. The key words used included 'Hepatitis B', 'Vaccine', 'Dialysis', 'Hemodialysis', and 'Albumin'. Data of serum albumin levels regarding seroresponse to HB vaccine in clinical trials have been achieved and analyzed. Finally, data from 17 clinical trials have been pooled and analyzed. RESULTS: One thousand six hundred eighty-two dialysis patients (1212 seroconverted) were included in the meta-analysis. Analysis of response to HB vaccination in our dialysis population showed a significant relationship to their serum albumin levels (p<0.001, z= 5.23). Regarding the dialysis mode, serum albumin level was only a significant interfering factor in hemodialysis patients versus continuous ambulatory peritoneal dialysis (CAPD) (HD group: p<0.001, I2=88.5%, χ2=95.28 (d.f. = 11); CAPD (±HD) group: χ2= 2.21; P=0.697, I2= 0%, d.f.= 4). CONCLUSION: The data showed a significant effect for the levels of serum albumin on the immunogenicity of HB vaccine in dialysis patients. Moreover, stratification of data upon dialysis mode showed that this association is only available for hemodialysis patients, and not those on peritoneal dialysis.

Female gender and Helicobacter pylori infection, the most important predisposition factors in a cohort of gastric cancer: A longitudinal study.

BACKGROUND: Gastric cancer (GC) is one of the most common Cancers in the world and Helicobacter pylori (HP) infection is considered a causative factor. The aim of this study was to determine the characteristics and the associated factors of (GC) in a small cohort. METHODS: Overall, 54 patients with diagnosed gastric cancer were followed-up at the Department of Gastroenterology & Hepatology at Baqiyatallah University of Medical Sciences. 37 (68.5%) of them were positive for H pylori infection in histopathological evaluations. Univariate and multivariate regression analyses were used to determine the associations of demographic features and HP infection status with GC characteristics and prognosis. RESULTS: Univariate analysis showed female gender (odds ratio (OR): 6.53; 95% confidence interval (95%CI): 1.59-26.8; P=0.008), and illiteracy (compared to intermediate education; OR: 5.9, 95%CI: 1.37-25.43; p=0.05) were associated significantly with higher rate of HP infection. After a mean±SD follow-up duration of 254±329 months, only female gender was significantly associated with HP infection in GC (OR:4.56; 95% CI: 1.0-21.76; P=0.05). H pylori positive patients had significantly higher grade of GC (OR: 3.97; 95% CI: 1.0-16.16; P=0.05), and a trend toward greater GC stage (OR: 4.46, 95% CI: 9.39-21.23; p=0.06). There was no association between survival rate and H pylori infection. CONCLUSION: In the current study, we found a significant association of female gender with GN and an association of higher grade of GC with female gender. These findings may indicate a sex disparity in susceptibility to HP infection regarding GC future studies of larger populations are recommended.

Iron Status and Metabolic Syndrome in Patients with Non-Alcoholic Fatty Liver Disease.

BACKGROUND A hypothesis has been presented about the role of serum iron, ferritin and transferrin saturation among patients with non-alcoholic fatty liver disease (NAFLD) and resistance to insulin (metabolic syndrome [MetS]), but there is much controversy. This study aimed at investigating the level of serum iron and demographic characteristics in patients with NAFLD with or without MetS. METHODS A case-control study was conducted on patients with elevated liver enzymes referring to Baqiyatallah clinic, Tehran, Iran during 2010-2011. After ruling out other causes of increased aminotransferases and approving the diagnosis of NAFLD, the patients were divided into two groups of with or without MetS. Then, the individuals' demographic, sonographic, and laboratory characteristics were recorded. RESULTS This research included 299 patients suffering from NAFLD who were divided into MetS (n=143; 47.8%) and non-MetS (n=156; 52.2%) groups. The age, systolic and diastolic blood pressure, body mass index, waist/hip ratio, glucose tolerance test, serum insulin, C. peptide, triglyceride, and HB A1c were different between MetS and non-MetS groups (p<0.05). There was no significant difference in serum iron and ferritin levels between the two groups, however, a significant correlation was found between serum ferritin and alanine transaminase (p=0.005) and also aspartate aminotransferase (p=0.032). CONCLUSION Our findings did not show a significant relationship between iron, in free or storage form, and the presence of MetS among patients with NAFLD, but serum ferritin can correlate with hepatocytes injuries indicated by raised aminotransferases. Nevertheless, to clarify this relationship further molecular, genomic, and histopathological studies are required.

Sex bias in response to hepatitis B vaccination in end-stage renal disease patients: Meta-analysis.

AIM: To systematically review the literature for studies investigating the potential effect of gender of dialysis patients on the immunogenicity of hepatitis B virus vaccines. METHODS: Literature searches were conducted by the MEDLINE and Google Scholar. The key words used included "hepatitis B (HB)", "vaccine", "dialysis", "hemodialysis", "sex", "male" and "female". Data of seroresponse to HB vaccine in clinical trials regarding sex of the recipients have been achieved and analyzed. Finally data from 19 clinical trials have been pooled and analyzed. RESULTS: Analysis of response to HB vaccination in our dialysis population showed males significantly respond less to hepatitis B vaccination (P = 0.002, Z = 3.08) with no significant heterogeneity detected [P = 0.766; heterogeneity χ(2) = 14.30 (df = 19); I (2) = 0%]. A reanalysis of the pooled data was conducted regarding the dialysis mode to evaluate potential differential impact of sex on HB vaccine response. Hemodialysis was the only subgroup that showed a significant difference regarding dialysis mode in response to HB vaccination regarding sex (P = 0.042, Z = 2.03). CONCLUSION: This Meta-analysis showed significant effect for the sex of chronic kidney disease and dialysis patients on the immunogenicity of HB vaccine. This sex discrimination was most prominent among hemodialysis patients.

Response of transplant recipients to influenza vaccination based on type of immunosuppression: A meta-analysis.

Influenza vaccination is widely used in transplant recipients, but there is little known about the significance and correlating factors of its effectiveness. In the current study, we reviewed the existing literature on clinical trials performed in transplant recipients on the effectiveness of influenza vaccination and to evaluate the relevance of the type of immunosuppression employed in these patients on the humoral reaction to the vaccine. A comprehensive search of the literature was performed through Pubmed and Google Scholar to find reports indicating immunogenicity of influenza vaccination in transplant patients. Finally, data from 15 published clinical trials were included in the meta-analysis. Data of 947 transplant recipients retrieved from 15 clinical trials investigating the immunogenicity of influenza vaccination were analyzed in this meta-analysis. Analysis showed significantly lower rates of sero-conversion among transplant recipients receiving mycophenolate mofetil (MMF) than other immunosuppressive agents (relative risk: 0.724; 95% confidence interval: 0.596-0.880; P = 0.001). No significant correlation was found with tacrolimus, sirolimus, cyclosporine and azathioprine. Different immunosuppressive agents seem to have different effects on the humoral response rate to influenza vaccination, with MMF having the most significant deleterious effect. The limited and controversial data available in the literature do not support any differential effect for other immunosuppressive agents.

Helicobacter pylori Infection and atherosclerosis: a systematic review.

Helicobacter pylori (H. pylori) is a spiral-shaped gram negative bacterium that naturally colonizes the human gastric epithelium. In recent years, large evidence has come to the literature strongly proposing causal link between H. pylori and extra gastric disorders. Cardiovascular system is one of the extra gastric organs that can be affected by H. pylori infection. The first evidence suggestive of such an association comes from seroepidemiological evaluations, but histopathological and eradication studies have strongly confirmed existence of a causal association between H. pylori infection and cardiovascular events.

Pancreatitis developing in the context of acute hepatitis: a literature review.

Despite strong evidence suggestive of associations between hepatic diseases and pancreas injury, a potential relationship between acute hepatitis and acute pancreatitis has not been a matter of review; which we focused on in the current paper. Some of the main findings of this review article are: fulminant hepatitis failure represents the highest incident rate of hepatitis-related acute pancreatitis; so a screening program might be indicative in these patients. Specific characteristics of HAV-related pancreatitis are that it is a benign condition with no reported mortality; and a male preponderance in the incidence, with females developing in older ages and having shown the signs of both conditions simultaneously. The incidence of acute pancreatitis in HBV infection is the lowest, but the mortality was the highest. HEV-related acute pancreatitis was most likely to represent pseudocysts and there was an apparent ethnic-priority with Indian descents, the only reported cases in the literature. Hepatitis-related pancreatitis in liver transplant recipients was most frequent in HBV infected patients; and in IFN-induced pancreatitis, cessation of the drug was most effective in treatment, with no catastrophic event reported.

A meta-analysis of potential relationship between Epstein-Barr-Encoded-RNA (EBER) and onset time of post-transplant lymphoproliferative disorders.

Epstein-Barr virus (EBV) encodes two non-polyadenylated RNAs termed EBV-encoded RNAs (EBERs). In this study, we tried to find series in which data of EBER and onset time of post-transplant lymphoproliferative disorder (PTLD) for patients have been documented to conduct a meta-analysis. A comprehensive search of the literature was performed by Pubmed and Google scholar to find reports indicating test results for EBER and PTLD onset in transplant patients. PTLD was considered "early onset" when it develops within the first post-transplant year. Finally, 265 patients from 15 studies have been included in the meta-analysis. The overall meta-analysis also showed a significant relation between EBER test positivity and early-onset PTLD development [relative risk (RR): 1.36; 95% CI: 1.16-1.59; P <0.001]. The i2 index was 49.8%. Our study suggests that PTLD lesions with positive EBER test are more likely to develop within the early post-transplant period. Since early-onset PTLD is supposed to have better prognosis, having a positive EBER test might not be a bad news. However, for having a precise conclusion, prospective studies are needed to be conducted.

Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial.

OBJECTIVE: To investigate the use of Aloe vera (A. vera) for the treatment of gastroesophageal reflux disease (GERD) symptoms and compare its effects with those of omeprazole and ranitidine. METHODS: In this pilot, randomized controlled trial, 79 subjects were allocated to A. vera syrup (standardized to 5.0 mg polysaccharide per mL of syrup) at a dose of 10 mL/d, omeprazole capsule (20 g/d) or ranitidine tablet (150 mg in a fasted state in the morning and 150 mg 30 min before sleep at night) for a period of 4 weeks. The frequencies of eight main symptoms of GERD (heartburn, food regurgitation, flatulence, belching, dysphagia, nausea, vomiting and acid regurgitation) were assessed at weeks 2 and 4 of the trial. RESULTS: A. vera was safe and well tolerated and reduced the frequencies of all the assessed GERD symptoms, with no adverse events requiring withdrawal. CONCLUSION: A. vera may provide a safe and effective treatment for reducing the symptoms of GERD.

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.

Colorectal involvement by post-transplant lymphoproliferative disorders: a review of 81 cases.

The reported number of patients representing post-transplant lymphoproliferative disorders (PTLD) within the colorectal region is quite limited. In this study, we sought to analyze and compare the characteristics, predictors and prognosis of colorectal localization of PTLDs arising in transplant recipients. A comprehensive search was performed through Pubmed and Google scholar to find case reports and series of colorectal localization of PTLD. Data of each individual patient from different studies were entered into a database and analyzed. Colorectal PTLD was significantly more prevalent in male patients (19.3% vs. 8.5%, respectively; P = 0.002) and represented a significantly shorter time to diagnosis than other localizations (P = 0.044). Multi-organ involvement (75% vs. 46%, respectively; P < 0.001) and disseminated disease (43% vs. 26%, respectively; P = 0.014) were more frequently observed in the colorectal PTLD. There was no survival difference between the two groups. Organ recipients representing colorectal involvement by PTLD are significantly at higher risk for metastasis, especially in their small intestine. Moreover, patients who underwent surgical intervention had low mortality, and, accordingly, we suggest using surgery to manage colorectal PTLD when it is applicable. Prospective studies with larger patient populations are needed to confirm these results.

Localization of post-transplant lymphoproliferative disorders to the stomach might be associated with favorable outcome: a systematic review.

Gastric localization of post-transplant lymphoproliferative disorders (PTLDs) is very rare. In this study, we aimed to accumulate existing data in the current literature to reveal the clinical, histopathological and prognostic specificities associated with gastric PTLDs and to find the best treatment strategies in this patient population. A comprehensive search was conducted for the available data in the current literature using Pubmed and Google scholar search engines for reports on gastric PTLD in renal transplant recipients. Data of different studies were standardized and entered into a database and analyzed. No statistically significant difference was found between gastric and non-gastric PTLD. Gastric PTLD was relatively more prevalent in female patients (P = 0.08) and showed a trend toward better outcome (P = 0.1) and less metastasis (P = 0.07). Surgical intervention and rituximab therapy were associated with a more favorable outcome (17% mortality). Our study showed that organ transplant recipients having gastric PTLD develop metastasis less frequently and tend to have a relatively more favorable outcome. Prospective studies with larger patient populations are needed to confirm or modify our results.

Hepatitis C virus infection in dialysis patients.

Despite the introduction of strict hygienic precautions preventing infection spread of hepatitis C virus (HCV) in dialysis settings, this infection is still prevalent among dialysis patients due to procedures making the patients vulnerable to infection through blood contamination. Treatment of HCV infection in dialysis patients is also less successful than that in the non-uremic population due to contraindication of using ribavirin, a main drug, in the infected patients. In this review article we aim to investigate the feasibility of the current antiviral therapies in dialysis patients infected with HCV infection.

Cardiovascular disorders in the context of non-alcoholic Fatty liver disease: a literature review.

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States and other industrialized countries, and the reported prevalence in the developing countries is also rather high. This disease is associated with a high rate of morbidity and mortality and damage to the other organs. The cardiovascular system is, perhaps, the most vulnerable organ to NAFLD adverse effects to the extent that most mortality associated with this disease is reportedly from the cardiovascular system rather than from the liver itself. In this article, we review the significant aspects of cardiovascular disorders associated with NAFLD, including the epidemiology of cardiovascular diseases in NAFLD patients, factors that interfere in this relationship like hypertension, severity of NAFLD, and age of the patients, and finally preventive strategies whose employment could significantly improve the outcome.

In vitro evidence for association between hepatitis C virus infection and insulin signaling pathways: a review.

Hepatitis C virus infection, besides its substantial unfavorable impact on liver health, has several other manifestations, from which we have focused on its associations with insulin resistance and diabetes mellitus in an in vitro setting in this review of the literature. Several epidemiologic studies have already proven the strong association between chronic HCV infection and development of diabetes mellitus. However, attempts to clarifying molecular mechanisms for this association have not made up until recent years. We made a comprehensive review of the literature but we only found 6 studies investigating HCV impact on insulin signaling pathway in an in vitro era. We tried to review and compare the findings of these studies to show what we already know on the issue and what we still need to know.