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Background and objective: Gastroesophageal reflux disease (GERD) is a digestive complication that is common in adults and defined by heartburn and regurgitation. Due to the increasing frequency and problems of the disease, epidemiological features of GERD have been considered in recent years. Therefore, we examined the factors related to GERD in different body mass index (BMI) categories. Materials and methods: We did a cross-sectional analysis of the primary information from a populationbased cohort study of 10520 people in Guilan Province, Iran. Demographic characteristics such as age, gender, smoking history, and alcohol consumption were collected using a self-administered questionnaire; also, anthropometric and clinical information were surveyed. Data analyzed with SPSS version 21.0. Results and conclusion: A total of 10520 participants were aged 35 to 70 years and included 5633 (53.55%) females and 4887 (46.45%) males. The frequency of GERD was 13.2% in the present study and was more prevalent in people with high BMI levels. According to analysis, GERD was significantly associated with female gender and low physical activity. Alcohol and smoke use was inversely associated with GERD. This large population-based study indicated risk factors in people with high BMI increased occurrence of GERD that altering these variables may reduce or prevent GERD indications must be elucidated in controlled trials. [ABSTRACT FROM AUTHOR]

Background and objective: The development of health indexes in recent years drag more attention to everyday life style and the impacts of socioeconomic status (SES) on individual's health state. In this regard, we aimed to investigate the socioeconomic status (SES) among the PERSIAN Guilan cohort population by considering the prevalence of gastroesophageal reflux disease (GERD) in these participants. Materials and methods: This cross-sectional study was conducted based on the PERSIAN cohort study from October 2014 to January 2017 on 10520 individuals. Data including age, gender, body mass index (BMI), educational level, habitat, and SES of patients were collected from all individuals and analyzed using SPSS.16 with a significant level <0.05. Results and conclusion: The results illustrated that out of 10520 participants, 1385 patients had GERD that its distribution was 34.9%, 33.6%, and 31.6% in low, moderate, and high levels of SES, respectively. Due to results, age, gender, educational status, and habitat significantly associated with GERD according to three levels of SES (P<0.05). GERD was more frequent in patients with low, moderate, and high levels of SES, respectively. Age, gender, educational status, and habitat, represented a significant association with different levels of SES among patients with GERD (P<0.05). This large population-based study indicated the increased risk of GERD in the low SES group compare to middle and high-SES groups, which highlighted the role of SES in the health status of individuals. [ABSTRACT FROM AUTHOR]

The incidence of microbial resistance is growing, and new rescue regimens are needed to treat Helicobacter pylori (H. pylori) infection. This study aimed to evaluate levofloxacin-based quadruple therapies' efficacy, safety, and tolerability in eradicating H. pylori. In a randomized, double-blind clinical trial, 220 patients with dyspepsia and H. pylori infection were randomly assigned to receive either bismuth subcitrate 240 mg, pantoprazole 20 mg, amoxicillin 1000 mg twice a day, and levofloxacin 500 mg daily for seven days (BPAL-7) or ten days (BPAL-10). The eradication of H. pylori was evaluated two months after the end of treatment, and adverse drug reactions (ADRs) were assessed during the intervention. According to intention-to-treat and per-protocol, the eradication rate was significantly lower in the BPAL-7 regimen at 49.1% (95% CI: 39.3–57.8) and 47.6% (95% CI: 39.7–58.4), respectively, compared to the BPAL-10 regimen at 62.7% (95% CI: 53.6–72.8) and 62.4% (95% CI: 55.1–72.8), respectively. The ADR incidence was not statistically significant between the groups of BPAL-7 (33.6%) and BPAL-10 (36.7%). Although the ADRs were negligible in both groups, these regimens could not be an ideal alternative therapy for H. pylori because of their low eradication rates compared to standard regimens. Trial Registration. The study was reviewed and approved by the Iranian Registry of Clinical Trials (IRCT201406141155N19). [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that dietary pattern is related to incidence and grades of nonalcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the relationship between major dietary patterns and hepatic histologic features of newly diagnosed patients with NAFLD. Methods: This cross-sectional study included 260 newly diagnosed NAFLD patients. Hepatic fibrosis and steatosis were diagnosed using Fibroscan. Dietary information was obtained using a validated 168-item semiquantitative food frequency questionnaire. The association between dietary patterns and odds ratio of the grade of fibrosis and steatosis was examined by multinomial logistic regression. Results: The mean ± SD age participant was 46.53 ± 11.71 years. Fifty-seven percent of the participants were women. Two major dietary patterns were recognized: "Western dietary pattern" and "Mediterranean dietary pattern." After adjustment for various confounders, adherence to the two extracted dietary patterns was not associated with odds of fibrosis and steatosis (P > 0.05). However, P was not significant. Patients in the second quartile of the Mediterranean dietary pattern had a higher risk for being in the F1 grade compared to those in the reference group in the crude and adjusted model. Conclusions: The major dietary patterns of NAFLD patients living in Gilan were not related to the severity of their disease. More precise study design such as cohort or interventional studies is suggested to reveal the strength of this study findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: In this study, efficacy and consistency of disc diffusion (DD) and agar dilution (AD) methods in determining Helicobacter pylori susceptibility to antibiotics were evaluated using Brucella blood agar (BBA) in both methods and tetrazolium egg yolk agar (TEYA) in AD. METHODS: Twenty H. pylori isolates were tested for susceptibility to nine antibiotics; metronidazole (MTZ), clarithromycin (CLR), amoxicillin (AMX), tetracycline (TET), ofloxacin (OFX), levofloxacin (LVX), ciprofloxacin (CIP), furazolidone (FRZ), and rifampin (RIF). Antibiotics solutions were impregnated into blank paper disks on BBA in the DD method or added to BBA (ADB) or TEYA (ADT) media in the AD method. Suspensions of H. pylori isolates were surface or spot inoculated on solid media. Plates were incubated in CO2 incubator at 37°C for 5-7 days. RESULTS: The highest rate of susceptibility to MTZ (65%) was determined by DD method compared with AD method (ADB: 40%, ADT: 30%). Both methods showed similar CLR (85%) and AMX (100%) susceptibility rates. Susceptibility to remaining antibiotics, determined by DD and ADB/ADT media were in respective order as 95%, 75% / 75% for TET, 100%, 95% / 85% for FRZ, 85%, 85% / 75% for OFX, 90%, 95% / 85% for LVX, 90%, 85% / 85% for CIP, and 100%, 85% / 75% for RIF. CONCLUSION: DD and AD methods showed consistency in determining 161 (89.4%) susceptibility and resistance and inconsistency in determining 19 (10.6%) susceptibility and resistance (P < 0.05). DD is recommended as a cheap and easy method with the efficacy and precision comparable to the AD method in determining H. pylori susceptibility to antibiotics. [ABSTRACT FROM AUTHOR]

Objective: Hepatitis B (HB) and C (HC) are two severe viral infectious diseases with a deleterious impact on global health. This study aimed to evaluate the prevalence of HB and HC in the Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study using immunological and molecular methods. Results: The blood samples were obtained from 10,520 enrolled participants. Complete biochemical and hematological tests, as well as urine analysis, were assessed. The presence of HBsAg, anti-HBs, anti-HBc, and anti-HCV antibodies for all participant and HBeAg and anti-HBe antibodies for HB-positive patients were evaluated. Moreover, HB genomic DNA and HC genomic RNA were extracted from serum samples of HB-positive patients. The real-time PCR assay was employed to quantify the gene copies of hepatitis B and C viruses. HC genotyping was also performed. The prevalence of HB and HC was 0.24% (95% CI 0.16–0.35) and 0.11% (95% CI 0.06–0.19), respectively. Rural participants were significantly more HB-positive than the urban people (P = 0.045), while males were significantly more HC-positive than the females (P = 0.013). The prevalence of HB and HC in this area were lower than those of other geographical locations of Iran, which may be due to different lifestyles or other unknown reasons. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. If this disease is not appropriately controlled, it can eventually cause chronic liver damage, including cirrhosis and hepatocellular carcinoma. Accordingly, the adoption of appropriate interventions to control NAFLD is important for any healthcare system. The aim of the present systematic review and meta-analysis was to clarify the effect of vitamin D supplementation on NAFLD. PubMed, Scopus, Science Direct, ISI Web of Science, and Google Scholar were systematically searched up to March 2019 to find clinical trials that examined the effects of vitamin D supplementation on liver enzyme levels in NAFLD patients. Means for liver enzymes and potential sources of heterogeneity were extracted. A subgroup analysis was performed to detect potential sources of interstudy heterogeneity. Nine trials (10 arms) comprising 467 participants were eligible for meta-analysis. The results from a pooled analysis did not reveal a significant effect of vitamin D intake on alanine aminotransferase (−2.88 U/L; 95% CI, −6.03 to 0.27; I2 = 85%), aspartate aminotransferase (−0.10 U/L; 95% CI, −1.18 to 0.97; I2 = 26%), and γ-glutamyltransferase levels (0.12 U/L; 95% CI, −5.94 to 6.18; I2 = 38%). The meta-analysis suggested a significant reduction in alkaline phosphatase (−13.79 U/L; 95% CI, −22.13 to −5.45; I2 = 72%) following vitamin D supplementation. This effect was robust in the subgroup in which > 3,000 IU/day vitamin D was administered (−19.74 U/L; 95% CI, −25.36 to −14.12; I2 = 0.0%). The present meta-analysis does not suggest the efficacy of vitamin D supplementation on NAFLD treatment. [ABSTRACT FROM AUTHOR]

Background: Data on the epidemiology of inflammatory bowel disease (IBD) in the Middle East are scarce. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the Middle East. Methods: We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) from 2017 until 2022. We collected information on demographic characteristics, past medical history, family history, disease extent and location, extra-intestinal manifestations, IBD medications, and activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions history, history of colon cancer, and IBD-related surgeries. Results: In total, 9746 patients with ulcerative colitis (UC) (n = 7793), and Crohn's disease (CD) (n = 1953) were reported. The UC to CD ratio was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. The male-to-female ratio was 1.28 in CD patients. A positive family history was observed in 17.9% of UC patients. The majority of UC patients had pancolitis (47%). Ileocolonic involvement was the most common type of involvement in CD patients (43.7%), and the prevalence of structuring behavior was 4.6%. A prevalence of 0.3% was observed for colorectal cancer among patients with UC. Moreover,15.2% of UC patients and 38.4% of CD patients had been treated with anti-tumor necrosis factor (anti-TNF). Conclusion: In this national registry-based study, there are significant differences in some clinical phenotypes such as the prevalence of extra-intestinal manifestations and treatment strategies such as biological use in different geographical locations. [ABSTRACT FROM AUTHOR]

Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with varied incidence and the onset age of disease worldwide. Overall, 161 participants who were under patronage of a local relief foundation and referred to the endoscopy ward of Razi Hospital affiliated to the Guilan University of Medical Sciences. These patients have been aged more than 50 or more than 40 years with history of colorectal cancer in their first-degree family were enrolled from March 2016-March 2017. Demographic information were collected. Colonoscopy was performed and histopathological evaluation of observed lesions and polyps was done. Most of participants were female (113 individuals, 70.2%) and aged 50-60 years (83 individuals, 51.6%). Seventy-four (46%) had certain lesions. Most of colonoscopy findings were observed in the ascending colon in which depressed polyps and diverticulum were most frequent. However, rectum showed the most histological findings. All polyps of descending and ascending colons were neoplastic, while most of rectal polyps were non-neoplastic. Male patients, who were aged more than 60 years and smokers had significant higher percentage of both lesions and polyps in their colon (p<0.05). Moreover, significant positive association was detected between exposure to harmful industries and having polyps (p=0.01). We found male gender, higher age, smoking, and exposure to harmful industries as important risk factors for having colorectal lesions, which must be confirmed in further studies. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Here, we report a case of a young man with acute motor axonal neuropathy (AMAN) subtype of GBS having hepatitis A virus (HAV) infection. A 30-year-old man with icterus was referred to emergency center of Razi Hospital. He complained of flu-like symptoms 10 days before the onset of icterus. Also, he suffered from gradual fatigue and weakness with dark urine. He experienced neurological symptoms of muscle paralysis (ascending from the legs to hands). Neurological consultant suspected GBS at the first step based on clinical examinations. He was candidate for five sessions of plasmapheresis. The ultrasonography revealed liver span 166 mm, which was greater than the normal range, with normal parenchymal echo. The gallbladder wall was thicker than normal and gallstone with lesion was not seen in different conditions. He was discharged after total improvement of neurological symptoms and muscular power. In addition, the results of International normalized ratio (INR), partial thromboplastin time (PTT), prothrombin time (PT), alkaline phosphatase (ALK), alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin total and direct (Bil T, D) tests were normal after 2-month follow-up. Although, acute viral infections such as hepatitis E virus (HEV) is common in patients with GBS; the possibility of HAV infection in patients with its risk factor should not be neglected. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to determine optimal cut-off points of plasma levels of ghrelin and serum levels of pepsinogen I, II, and their ratio for screening of gastric cancer (GC). Methods: Blood samples were taken from 41 patients with confirmed gastric cancer along with 82 patients without malignancy. Serum levels of pepsinogen I and II, plus plasma levels of acylated ghrelin were measured using commercial ELISA kits. Results: The case group had significant lower plasma levels of ghrelin, pepsinogen I, and pepsinogen I/II ratio in comparison to the control group (P<0.001). In the control group, there was significant higher serum pepsinogen I (P=0.028) and pepsinogen II (P=0.003) and lower pepsinogen I/II ratio (P=0.020) in males versus females; significantly higher serum pepsinogen II (P=0.047) and lower pepsinogen I/II ratio (P=0.030) in overweight compared to normal weight patients; and significantly lower pepsinogen I/II ratio (P=0.030) in smokers versus non-smoker. In the case group, there was only significantly lower pepsinogen I (P=0.006) in males versus females, and significantly lower plasma ghrelin (P=0.017) in overweight compared to normal weight patients. The characteristic curve analysis indicated that pepsinogen I at a cut-off of 70.95 μg/L and pepsinogen I/II ratio at cut-off of 2.99, had good sensitivity and specificity. Conclusions: Just serums levels of pepsinogen I and the ratio of pepsinogen I/II can be used as biomarker to screen GC. [ABSTRACT FROM AUTHOR]

Background and Aim: Nonalcoholic fatty liver disease (NAFLD) is a global epidemic that is often asymptomatic and silent, and progresses slowly. This study aimed to determine the biochemical markers and lipid profile among NAFLD patients and their possible relationship with degrees of fatty liver. Methods: This is analytical cross-sectional study, in which, 950 individuals referred to the PERSIAN Guilan cohort study were included through sequential sampling method. The demographic information and blood pressure of the subjects were taken and the blood sample was prepared to investigate the biochemical markers and lipid profile. Also, abdominal ultrasonography was performed to investigate NAFLD and its grades. For data analysis, independent sample t-test, one-way ANOVA, and logistic regression model were used, where P < 0.05 was considered significant. Results: The systolic blood pressure (SBP) (P < 0.001), diastolic blood pressure (DBP) (P < 0.001), hepatic enzymes (aspartate aminotransferase [AST], P < 0.001, alanine aminotransferase [ALT], P < 0.001; gamma-glutamyle transferase [GGT], P < 0.001; AST/ALT ratio, P < 0.001), lipid profile (triglyceride [TG], P < 0.001; total cholesterol [TC], P = 0.008; high density lipoprotein [HDL], P < 0.001; LDL-C/HDL-C (ratio), P = 0.003; TC/HDL-C (ratio), P < 0.001); and fasting blood sugar [FBS], P < 0.001 correlated with NAFLD. However, there was no relationship between age (P = 0.34), alkaline phosphatase [ALP] (P = 0.26) and low-density lipoprotein [LDL] (P = 0.72). Further, a significant relationship was observed between AST (P < 0.001), ALT (P < 0.001), and GGT (P = 0.004) and NAFLD degrees based on the ultrasonography. Conclusion: Biochemical markers and lipid profile are associated with NAFLD. Thus, it is recommended to investigate NAFLD in clinical settings in cases in which their changes are observed in patients through ultrasonography. [ABSTRACT FROM AUTHOR]

The optimal pharmacological regimen for eradication of Helicobacter pylori (H. pylori) has been investigated for many years. This study aimed to evaluate the efficacy and tolerability of bismuth-based quadruple therapy (B-QT) and a modified sequential therapy (ST) regimens in eradication of H. pylori. A randomized, double-blind trial was conducted on 344 patients. Patients with H. pylori infection and without a history of previous treatment were randomized to receive 14-day B-QT (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily) or 14-day ST (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and metronidazole 500 mg twice a day for seven days followed by bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and furazolidone 100 mg twice a day for additional seven days). Drug adverse effects were assessed during the study. H. pylori eradication was determined eight weeks after the end of treatment using 14C-urea breath test. Based on per-protocol and intention-to-treat, the eradication rate was significantly higher (p<0.05) in the B-QT regimen 91.9 % (95 % CI; 88.1-94.0) and 90.2 % (95 % CI; 86.3-92.9), respectively compared to the ST regimen 80.8 % (95 % CI; 76.6-84.9) and 78.1 % (95 % CI; 73.7-82.4), respectively. The severity of vomiting and loss of appetite were significantly higher in ST regimen (p<0.05). The B-QT regimen was more effective and safer than the ST regimen. Conclusively, it is suggested to assess the efficacy and safety of this regimen in longer studies, larger population, and in other communities. [ABSTRACT FROM AUTHOR]

The Guilan cohort study was conducted on 10 520 men and women between 35-70 years of age in Guilan province and Some'e Sara county, northern Iran, from October 8, 2014 to January 20, 2017 as part of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Eligible participants were contacted over the phone and were invited to refer to the cohort center. Demographic information was inquired during the phone call. Upon arrival of participants at the cohort center, consent forms were filled out and additional data on demographic characteristics, socio-economic status, employment, fuel status and location, lifestyle habits, and sleep and food habits were obtained. Blood pressure and anthropometric indices were measured. Finally, biological samples were collected. There was a participation rate of 83.2%, and a 15-year active follow-up was planned for all of the participants. The results showed that 53.5% of the participants were female and 56.1% of the participants were rural residents. A total of 1738 participants (16.5%) were illiterate. Of the total cohort participants, 4543 (43.2%) were hypertensive. Hypertension was defined as a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg, or a prior diagnosis of hypertension by a health professional, or taking antihypertensive medications. Approximately one-third of participants (n = 3435 or 32.7%) were obese, and most were females (n = 2647, 77.1%). Prevalence of diabetes (defined as fasting blood sugar equal or higher than 126 mg/dL or history of diagnosis with diabetes or taking glucose lowering medication) was 24.1% (20.2 % in males and 27.3% in females). We also obtained laboratory samples for basic and genetic scientific research. According to laboratory evaluations, 3,585 (34.1%) of the participants had hematuria, and most of them were women (n = 2151 or 60%). The preliminary results of our study demonstrate a high prevalence of metabolic risk factors for Non-Communicable Diseases and mainly cardiovascular diseases in Guilan province, which merit detailed investigation of their intricate relationships. The population-based design of the study as well as its large sample size were the main strengths of our cohort study that makes these investigations feasible. Researchers interested in using the information are invited to visit the following websites: http://www.gums. ac.ir/cohort and http://persiancohort.com/. [ABSTRACT FROM AUTHOR]

Background: Needlestick injuries (NSIs) among healthcare workers (HCWs) pose an important health challenge and several pieces of evidence show that in many cases HCWs do not report the injury. Materials and Methods: This multicenter descriptive cross-sectional study was performed in eight teaching hospitals of Rasht, Iran. Using consecutive sampling methods, 1010 nurses were enrolled from October 2014 to January 2015. A three-part self-administered questionnaire was used. It included questions on demographic features, NSI-related questions, and questions on the knowledge of hepatitis B and C viruses (HCV, HBV). Results: Among the 1010 participants, 580 (57.42%) showed a positive history of NSI; the total number of occurrences of NSI was 914. The major item causing NSI was the syringe with needle (315; 34.47%). In this way, NSIs occurred most frequently during recapping and injection [339 (37.10%) and 147 (16.10%), respectively]. Only 92 (10.07%) of all NSI positive participations had referred to the infection control units of their hospitals. The others mostly answered the question of "Why did you not report the incident?" with being too busy at work at the time of injury (140; 27.58%). The results showed that among participants with <5 years elapsed since their vaccination, the risk of NSI reduced to 60% [p < 0.02, odds ratio (OR) = 0.40, 95% confidence interval (CI) = 0.20-0.80]. Conclusions: It seems that NSI is still a major problem among nurses. Correspondingly, HCWs do not take the reporting system seriously and training them requires an ongoing activity in all hospitals. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B (HBV) and hepatitis C(HCV) are viral infections which attack the liver and can cause both acute and chronic diseases. Objectives: The aim of this study was to investigate the knowledge, risk factors, and prevalence of hepatitis B and C infections among high-risk populations of Guilan province, North of Iran. Methods: The current cross-sectional study was conducted on three high-risk groups, including nurses, municipal workers and barbers as well as the control group from the general population. Results: A total of 3391 subjects were recruited for this study. The results of the ANOVA test showed that knowledge about HBV and HCV and their components are statistically different among the groups (P value < 0.05). The overall prevalence of HBV surface antigen (HBsAg) positivity was zero in nurses, barbers, and municipal workers, and 0.5% in general population (95% CI 0.14% to 0.86%). The overall prevalence of HCV infection was zero in nurses and barbers, 0.5% in municipal workers (95% CI 0.03% to 0.97%), and 0.2% in the general population (95% CI 0.02% to 0.38%). Conclusions: Regarding the low prevalence of HBV and HCV infection in high-risk groups, it seems that mandatory vaccination has had a significant role in recruiting or obtaining work permits. However, given the low level of knowledge, it was suggested that authorities should pay more attention in general education and specialized courses for high-risk groups. [ABSTRACT FROM AUTHOR]

Introduction: Non-alcoholic fatty liver disease (NAFLD) is an obesity-associated health problem that causes other liver diseases for the patient. Four anthropometric indices: body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were analyzed as NAFLD predictors in the present study. Methods: From the total number of individuals who referred to the PERSIAN Guilan Cohort study (PGCS) located in the north of Iran during the period of study, a total of 960 people were enrolled in the present study. NAFLD was diagnosed using through an abdominal ultrasound exam. Height, weight, WC, BMI, WHR and WHtR were later calculated. Chi-square, ANOVA and logistic regression analyses were used to analyze the risk factors. Results: Out of the 960 individuals who were enrolled in the study, 597 (62.2%) were male and 363 (37.8%) were female (with an average age of 47.21 ± 7.29 years). There was a significant relationship between weight and NAFLD (P<0.001). There was also a significant relationship between BMI (OR= 8.41; 95% CI = 5.59-12.75), WC (OR= 2.67; 95% CI = 2.05-3.48), WHR (OR= 3.84; 95% CI = 2.26-6.52), WHtR (OR= 28.53; 95% CI = 6.94-117.31) and NAFLD (P<0.001). The results of the logistic regression analysis showed that WHtR, BMI and WC were effective predictors for the risk of NAFLD while WHtR played a more important role in the prediction of NAFLD. Conclusion: Anthropometric indices, especially WHtR, as a simple screening tool, seem to be an important criterion for the detection of NAFLD. [ABSTRACT FROM AUTHOR]

Background: As Methotrexate (MTX) may induce liver side effects or damage, evaluating the liver of the consumers of this drug by a noninvasive method, such as FibroScan, may be effective. Objectives: The present study aimed at evaluating the progression of liver fibrosis and steatosis using the transient elastography (FibroScan) technique in patients, who are treated with MTX. Methods: Onehundredandone patients,whowere treated withMTXbecause of different rheumatologic diagnosis and/or dermatologic disease, were included in the study. Liver stiffness was measured using FibroScan. Hepatic fibrosis was identified by converting the FibroScan results measured in kPa to the Metavir scale. Also, F0-F4 and steatosis were graded. Results: The assessment of steatosis using FibroScan showed mild, moderate, and severe stenosis in 15.8%, 13.9%, and 26.7%, respectively. With regards to grading of hepatic fibrosis, 67.0% were graded as F0 to F1, 7.0% as F2, 7.0% as F2 to F3, 2.0% as F3, 11.0% as F3 to F4, and 6.0% as F4. A significant association was found between body mass index, waist circumferences, and fibrosis. The association between the severity of hepatic fibrosis and indices of alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), and serum albumin was significant. No relationship was revealed between the severity of hepatic fibrosis and MTX dosage as well as duration of MTX use. Conclusions: The authors found significant associations between hepatic steatosis and anthropometric parameters, level of albumin, drug dosage higher than 10 mg, and cumulative dosage of MTX. The severity of hepatic fibrosis and steatosis induced by MTX was mainly affected by the patients' obesity. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis B virus (HBV) is an important occupational risk among healthcare workers (HCWs). Vaccination is the most costeffective method of preventing and controlling HBV infection. Several factors have been suggested to effect response to the vaccine. The present study aimed to evaluate vaccine response among north Iranian HCWs and to determine the factors influencing vaccine response. Methodology: Response to the standard three-dose vaccination regimen was evaluated in term of anti-hepatitis B surface antigen level among 1,010 HCWs using an enzyme-linked immunosorbent assay (ELISA) method. Logistic regression was applied to predict antibody response, with related factors including sex, age, years of working experience, marital status, history of transfusion, smoking, history of needle stick injury, rheumatic disease, steroid use, and elapsed time from vaccination measurement. Results: Of the 1,010 HCWs, 898 (88.9%) acquired protective levels of antibody (> 10 IU/mL). Compared with those < 30 years of age, HCWs older than 50 years and between 40 and 50 years of age were more likely to have non-protective anti-HBs levels (odds ratio = 4.48; p = 0.001 and odds ratio = 1.85; p = 0.03, respectively). Conclusions: HBV vaccine efficacy and immune response were satisfactory among north Iranian HCWs. Since it is predicted that anti-HBs levels decrease with aging, testing for anti-HBs titer is desirable for HCWs older than 50 years of age. [ABSTRACT FROM AUTHOR]

BACKGROUND Helicobacter pylori (H. pylori) infection is a major casual factor in any peptic diseases. Clarithromycin as one of the drugs recommended for the infection eradication regimen has shown different levels of resistance. The present study is comparing the effectiveness of clarithromycin- and gemifloxacin - based quadruple regimens in H. pylori eradication. METHODS This was a prospective double blind randomized clinical trial on patients with clear indication of H. pylori eradication. The patients were randomly divided into two groups: "BPAC group" treated with bismuth subcitrate (240 mg), pantoprazole (20 mg), amoxicillin (1 gr), and clarithromycin (500 mg), all twice daily, and the "BPAG group" treated with bismuth subcitrate, pantoprazole, and amoxicillin with same doses as "BPAC group" and gemifloxacin (320 mg daily) all for 10 days. Three months after the end of therapy, 14C-Urea breath test was performed to confirm the eradication. All the patients were assessed for compliance and drug side effects. Based on per-protocol (PP) and intention-to-treat (ITT) methods, data were analyzed and a P value<0.05 was considered as statistically significant. This project has been registered in the Iranian registry of clinical trials (IRCT). RESULTS Three patients were excluded from the survey and finally, 179 patients (89 patients in BPAC group and 90 patients in BPAG group) including 71(39.66%) men with the mean age of 46.4±12.3 years completed the treatment period. The incidence of side effects between the two study groups did not differ significantly. The success rate of BPAC regimen eradication was remarkably greater than BPAG regimen (ITT analysis; 89% vs 77%, respectively; CI 95%: 1.072-5.507, P<0.015 and PP analysis; 91% vs 77.8% respectively; CI 95%: P<0.015). There was no significant relationship between the demographic features and the eradication results. CONCLUSION The results showed that gemifloxacin is not a good alternative for clarithromycin in H. pylori eradication regimens in our region. [ABSTRACT FROM AUTHOR]

Objective: Challenging differential diagnosis Background: In patients with the diagnosis of autoimmune hepatitis (AIH), the presence of cholestatic features raise the possibility of an overlap syndrome with primary sclerosing cholangitis (PSC). Here, we present a unique case with AIH-PSC overlap syndrome and innumerable liver masses. Case Report: A 26-year-old man presented with generalized icterus. Based on the serological findings of hypergamainmunoglobulinemia and positive anti-nuclear antibody tests, together with an abnormal cholangiogram, he was diagnosed with overlap syndrome (AIH-PSC). Liver imaging revealed innumerable liver masses with a benign appearance in the pathological evaluation. To rule out the colon abnormalities that usually coexist with such liver masses, colonoscopy was performed and showed no significant changes. The liver masses were nonmalignant and were resolved after immunosuppressant therapy. Conclusions: Because AIH-PSC overlap syndrome is rare, it is suggested that radiological evaluation of the biliary tree should be performed routinely in adults diagnosed with AIH to reduce the missed diagnosis of overlap syndrome and liver masses. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Inflammatory myofibroblastic tumors (IMTs) are scarce tumors with discrete immunohistochemical and molecular attributes which are not related to a particular location. There are different reports about the intrinsic nature of these tumors as benign to possibly malignant. Case Report: Here we report the case of a 68-year-old man referred to the Internal Medicine Department of Razi Hospital in Rasht (a city in the north of Iran) due to right lower quadrant (RLQ) discomfort with no specific symptoms. Colonoscopy revealed a mass-like lesion. Polymorphonuclear cells (PMNCs) admixed by some eosinophils were demonstrated histopathologically. Immunohistochemical evaluation was positive for vimentin, CD34, smooth muscle actin, and ALK, and negative for CD117 and desmin. The tumor was successfully removed by surgery with no chemotherapy. No recurrence was reported. Conclusions: We have performed surgical excision of the mass with no chemotherapy and no recurrence. Although recurrence is reported to be low, we recommend long-term follow-up after surgery. [ABSTRACT FROM AUTHOR]

Background: Recommendations to immunize healthcare workers (HCWs) against hepatitis B are well known. However, a proportion of individuals do not respond to the primary standard three-dose HB vaccination schedule. Objectives: The current study aimed to evaluate whether a double-dose HB booster vaccine could induce better protective anti-HB titers than a single-dose booster in non-protected HCWs. Materials and Methods: This was a randomized clinical trial. A total of 91 HCWs not responding to the primary vaccine series in 2014 were enrolled. The participants were randomized into two groups that received a double dose of the HB vaccine containing 40 µg of antigen or a single dose of the HB vaccine containing 20 µg of antigen in three doses (at zero, one and six months after vaccination). Blood samples were collected before vaccinations and 28 days after the third dose to assess the seroconversion rate, according to the anti-HB antibody titer threshold of > 10 mIU/mL. Results: The seroconversion rates were 93.2% and 87.2% after the first booster doses of the double-dose and single-dose HB vaccines, respectively (P = 0.64). In the double-dose HB vaccine group, the seroconversion rate was 97.8% compared with 89.6% in the single-dose group following the second vaccine dose (P = 0.83). All of the participants in both groups were seroprotected after the third HB vaccine dose. Conclusions: Both the single- and double-dose HB vaccines were adequately immunogenic, and the double-dose HB vaccine was not significantly more immunogenic than the single-dose vaccine in terms of the seroconversion rates of HCWs who had not responded to the primary vaccine series. [ABSTRACT FROM AUTHOR]

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world. The simultaneous occurrence of NAFLD and type 2 diabetes is common, however, few studies on the prevalence of NAFLD in prediabetic patients have been performed. Therefore, the aim of this study was to determine the prevalence of NAFLD by sonography in prediabetic patients and to compare the prevalence of NAFLD between prediabetic patients and normal population. METHODS: In this cross-sectional study, 191 consecutive prediabetic patients who were referred to the internal medicine clinic in the Razi Referral Hospital of Rasht, Iran, were compared with 191 healthy controls. Diagnosis of prediabetes was based on abnormal oral glucose tolerance test or fasting plasma glucose. Both groups underwent ultrasonography for the assessment of NAFLD and data was analyzed by Student's t test and Chi-square test. RESULTS: Patient population was between 20 and 70 years old and the mean age of participants was 41.04±12.66 years. Prediabetic group had 71(37.1%) males while healthy group had 84(43.9%) males. Of the 382 subjects, 142 (37.2%) had evidence of NAFLD on ultrasound examination of which 93(65.4%) were prediaibetics (P=0.001). CONCLUSION: We show that the prevalence of NAFLD in prediabetic patients is higher than healthy individual. [ABSTRACT FROM AUTHOR]

Strongyloidiasis disease caused by the Strongyloidesstercoralis nematode .This disease mainly affects the intestines. Sometimes the symptoms were similar to inflammatory bowel disease which may lead to misdiagnosis and lack of effective treatment. A 46-year-old male patient who complained of occasional diarrhea, sometimes with blood, about two months ago consulted with an internist. He had colonoscopy and ulcerative colitis was diagnosed without biopsy. The patient was treated with Mesalamine together with Prednisolone. The patient's symptoms improved within the first two weeks, but after the third week got worse and he referred to a gastroenterologist. The patient then underwent colonoscopy and biopsy was done this time.In the biopsy, Strongyloidesstercoralis larvae were observed. Prednisone and Mesalamine were stopped and Ivermectin tablet was administered. Patient's symptoms improved within a week to ten days and one year after treatment patient did not express any complaint. For diagnosis of ulcerative colitis,In addition to the colonoscopic observations, biopsy is necessary. Especially in the northern regions of the country, before initiating treatment with immunosuppressive and steroid drugs and/or if no response to treatment, it is necessary to think about strangyloidiasis. [ABSTRACT FROM AUTHOR]

BACKGROUND The geographical incidence of IBD varies considerably. This study aimed to survey the epidemiologic features of IBD in Guilan province, North of Iran, during ten years duration. METHODS In this retrospective cross-sectional study, we assessed the documents of 868 patients with IBD referred to private and governmental clinics of Guilan province between 2002 and 2012. Variables such as demographic data, risk factors, diagnosis, extraintestinal manifestations and type of treatment were collected. RESULTS Among 868 patients with IBD, 756 patients (87.1%) diagnosed as UC and 112 patients (12.9%) as CD. The mean age of patients with UC and CD was 46.73±15.79 and 40.15±14.27 years respectively. Male/female ratio in UC and CD was 0.92:1 and 0.75:1 respectively. The most common age of disease initiation in UC was 40-59 years and in CD 20-39 years (p<0.001). Extraintestinal manifestations were seen in 25.4 percent of patients with IBD. Most of patients were treated with combination of two drugs: salicylates and azathioprine (p<0.04). The incidence of IBD gradually increased during the past 4 years in Guilan province. CONCLUSION This study showed that CD were presented significantly more common in younger patients than UC and totally the disease was slightly more common in female. [ABSTRACT FROM AUTHOR]

Background: Ulcerative colitis an inflammatory bowel disease (IBD) and chronically idiopathic immune related that associates with extraintestinal manifestations such as arthritis. Despite of the highly specificity of anti-cyclic citrullinated peptide (CCP) antibodies for rheumatoid arthritis, their role in IBD remains unclear. There are only a few studies on the prevalence of anti-CCP antibodies in patients with IBD. This study aimed to assess the prevalence of anti- CCP antibodies in ulcerative colitis and to investigate possible associations with their clinical and laboratory characteristics. Methods: In this cross-sectional study, 93 consecutive patients with ulcerative colitis referred to gastroenterology clinics in Razi referral hospital of Rasht, Iran, from September 2010 to September 2011. Rheumatologic examination, demographic data and clinical presentation of patients were recorded on specially prepared data sheets. Blood sample was collected for assessment of anti-CCP and other laboratory tests. Data were analyzed by the Chi square test, Fisher Exact test and student t test, using the SPSS 20 software for Windows, and P value less than 0.05 was considered significant. Results: Of 93 patients, anti-CCP antibodies detected in 10.8% of cases (CI 95%: 4.5-17.1%). There were a significant relation between the prevalence of anti CCP positivity and aphthous ulcers and ocular manifestations whereas other parameters were not significantly related. Conclusion: Anti CCP may have a possible role in some ulcerative colitis manifestations but there was no association between the presence of these antibodies and activity or extension of inflammatory colitis. We suggest other studies especially molecular studies to investigate other aspects of these antibodies in IBD patients [ABSTRACT FROM AUTHOR]

Background: Portal hypertension is a common consequence of hepatic cirrhosis, which causes esophageal varices. Bleeding from varices has a high mortality rate. The present gold standard for diagnosing varices is endoscopy. Considering endoscopy side effects and patients' low acceptance, there have been always efforts for finding alternative diagnostic methods including Doppler ultrasonography (US). Objectives: The aim of the present study was to evaluate changes of Doppler indices in cirrhotic patients with and without esophageal varices. Patients and Methods: Sixty six patients with known cirrhosis entered this cross-sectional study. Gastroscopy was performed for patients, and the first questionnaire was filled based on the Japanese Portal Hypertension Society guidelines. Then patients were referred for Doppler US of splenoportal system, and information was documented in the second questionnaire. Results: Forty-four patients were male and 22 female. Forty six patients had esophageal varices, and 20 did not. There were no significant associations between splenoportal indices found by Doppler US, and presence of esophageal varices in patients. However, we found a negative association between platelet ratio to spleen diameter, and to splenic vein diameter. Conclusions: Neither of studied variables was perfect to differentiate cirrhotic patients with and without EVs. Endoscopy is still the gold standard diagnostic method for diagnosing esophageal varices in patients with cirrhosis. It seems that some of the splenoportal Doppler indices are promising, but more research and evaluation is necessary. [ABSTRACT FROM AUTHOR]

Hemodialysis ( HD) patients are vulnerable to transfusion-transmitted infections such as hepatitis B virus ( HBV). HBV infection with undetectable hepatitis B surface antigens ( HBsAg) is described as occult HBV and can lead to serious complications. The aim of this study was to evaluate the prevalence of occult HBV and concomitant factors in HD patients. Using a cross-sectional design, clinical and epidemiological data were obtained from May to September 2009 in 11 different HD units in Guilan province in northern Iran. After serological testing for HBV surface antigens in 514 HD patients using a third-generation enzyme-linked immunosorbent assay kit (Diapro, Milano, Italy), HBsAg-negative patients were tested for HBV DNA using a Qiagen PCR kit (Artus Qiagen GmbH, Hilden, Germany). After omission of seven HBsAg-positive patients, 507 patients were included in the study, 280 (55.2%) of whom were male and 227 (44.8%) were female. Patients ranged in age from 16 to 66 years (mean 53.2 years). No HBV DNA was detected in HBsAg-negative patients. Some 59 patients (11.6%) were anti-hepatitis C virus positive and 32 (6.3%) were hepatitis C virus positive according to polymerase chain reaction. The study results indicate that occult HBV infection is not a significant health problem in HD patients in Guilan province. [ABSTRACT FROM AUTHOR]

Background: Celiac disease (CD) is closely associated with other autoimmune endocrine disorders, particularly autoimmune thyroid disease. The aim of this study was to find the frequency of celiac disease in patients with hypothyroidism in Guilan province, north of Iran. Methods. A total of 454 consecutive patients with hypothyroidism underwent celiac serological tests antiGliadin antibodies (AGA), antitissue transglutaminase antibodies (IgA-tTG) and antiendomysial antibodies (EMA-IgA). Small intestinal biopsy was performed when any of celiac serological tests was positive. Results. Eleven (2.4%) patients were positive for celiac serology, and two patients with documented villous atrophy were diagnosed with classic CD (0.4%; 95%). Two patients with classic CD had Hashimoto's thyroiditis (HT) (0.6%; 95%). Six (54.5%) of 11 were suffering from overt hypothyroidism and 45.5% from subclinical hypothyroidism. Six (54.5%) had HT, and 45.5% had nonautoimmune hypothyroidism. Conclusions. In this study, prevalence of CD was lower than other studies. Most of the patients with CD were suffering from HT, but there was no significant statistical relation between CD and HT. [ABSTRACT FROM AUTHOR]

Background: Celiac disease (CD) is closely associated with other autoimmune endocrine disorders, particularly autoimmune thyroid disease. The aim of this study was to find the frequency of celiac disease in patients with hypothyroidism in Guilan province, north of Iran. Methods. A total of 454 consecutive patients with hypothyroidism underwent celiac serological tests antiGliadin antibodies (AGA), antitissue transglutaminase antibodies (IgA-tTG) and antiendomysial antibodies (EMA-IgA). Small intestinal biopsy was performed when any of celiac serological tests was positive. Results. Eleven (2.4%) patients were positive for celiac serology, and two patients with documented villous atrophy were diagnosed with classic CD (0.4%; 95%). Two patients with classic CD had Hashimoto's thyroiditis (HT) (0.6%; 95%). Six (54.5%) of 11 were suffering from overt hypothyroidism and 45.5% from subclinical hypothyroidism. Six (54.5%) had HT, and 45.5% had nonautoimmune hypothyroidism. Conclusions. In this study, prevalence of CD was lower than other studies. Most of the patients with CD were suffering from HT, but there was no significant statistical relation between CD and HT. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study is to investigate the association of nonalcoholic fatty liver disease (NAFLD) with the doppler waveform pattern of hepatic veins and portal vein doppler indices. Objectives: This assay may be useful in evaluating the natural course of NAFLD and monitor treatment efficacy on follow-up. Patients and Methods: This case control study was performed in 31 patients with NAFLD and 31 normal healthy adults who served as the control group. The patients presented with elevated liver enzymes levels (ALT/AST) and hyperechogenic livers in the B-mode ultrasonography examination. Eleven patients had a liver biopsy. After an 8-hour fast, B-mode and duplex doppler ultrasonography were performed, and the waveform patterns of the right hepatic vein, portal vein diameter, grade of fatty liver, portal vein pulsatility index (VPI), and mean flow velocity (MFV) were measured. Results: VPI and MFV values were 0.42 ± 0.92 and 17.27 ± 5.34 cm/second, respectively, in the control group and 0.25 ± 0.50 and 12.82 ± 4.32 cm/second in patients with NAFLD (P < 0.01). The frequency of abnormal hepatic vein doppler waveform patterns (biphasic or monophasic) was significantly higher in patients with NAFLD (55.2%) versus control subjects (3.2%) (P < 0.001). There was no correlation between the degree of fat infiltration and VPI (P = 0.714), MFV (P = 0.911), or hepatic vein waveform pattern (P = 0.197). We found no correlation between liver enzyme levels and MFV or VPI. However, the rate of abnormal hepatic vein was higher in patients with enzyme levels that exceeded twice the normal value (P = 0.05). Conclusions: Patients with NAFLD have a high rate of abnormal hepatic vein doppler waveform patterns, and decreased VPI and MFV are suggestive of reduced vascular compliance in the liver. Elevated liver enzymes levels do not influence VPI or MFV, but patients with abnormal enzymes have higher rates of abnormal hepatic vein doppler waveform patterns. [ABSTRACT FROM AUTHOR]

We encountered repeatedly, in our clinical practice, discordant results between UBT and histopathology about H. pylori infection. Goal. To study the diagnostic accuracy of Heliprobe 14C-urea breath test (14C-UBT) for detection of H. pylori infection in an Iranian population. Study. We enrolled 125 dyspeptic patients in our study. All of them underwent gastroscopy, and four gastric biopsies (three from the antrum and one from the corpus) were obtained. One of the antral biopsies was utilized for a rapid urease test (RUT), and three others were evaluated under microscopic examination. Sera from all patients were investigated for the presence of H. pylori IgG antibodies. The 14C-UBT was performed on all subjects using Heliprobe kit, and results were analyzed against the following gold standard (GS): H. pylori infection considered positive when any two of three diagnostic methods (histopathology, RUT, serology) are positive. Results. According to data analysis, the Heliprobe 14C-UBT had 94% sensitivity, 100% specificity, 93% negative predictive value (NPV), 100% positive predictive value (PPV), and 97% accuracy, compared with GS. Conclusion. The Heliprobe 14C-UBT is an easy-to-perform, rapid-response, and accurate test for H. pylori diagnosis, suitable for office use. [ABSTRACT FROM AUTHOR]

Background and Aims: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are significant health problems, as they can lead to chronic active hepatitis, liver cirrhosis, and hepatic carcinoma. Factors associated with HBV propagation include bloo~l and derivates transfusion, duration and frequency of hemodialysis, equipment contamination and contact among patients as well as between them and health-care workers. Transmission of HCV through dialysis units has shown a progressive increase worldwide, ranging from 5% in some western countries to 70% in some developing countries. The aim of this study was to determine the prevalence of HBV and HCV infections in hemodialysis patients of Rasht (center of Guilan province, North of Iran). Methods: A cross-sectional analysis was performed on 163 chronic (>6 months) hemodialysis patients. Patients from the hemodialysis unit of Rasht were interviewed. The following data was collected: name, age, gender, occupation, duration of dialysis and cause of End Stage Renal Disease. Blood samples were collected and screened for HB5Ag and anti-HCV antibodies by a third-generation enzyme-linked immunosorbent assay (ELISA). Qualitative HCV determination in ELISA positive cases (after two tests) was performed by QIAGEN OneStep reverse transcriptase polymerase chain reaction (RT-PCR) kit (assay sensitivity 100 copies/mL). Results: Five patients were hepatitis B surface antigen (HB5Ag) positive (3.06%) and 30 were anti HCV antibody positive by ELISA (18.40%). HCV positivity was confirmed by PCR in 17(10.42%) patients. All patients had a minimum of two to a maximum of three dialysis sessions per week. Mean age in HB5Ag positive cases was 47.3 years and all of them were male. Duration of dialysis was 8-12 years in all five HBsAg positive patients. Mean age in HCV positive patients was 42.3 years. 66% of HCV positive patients were male and 33.33% of them were female. Duration of dialysis was 0-4 years in 33.33 % of HCV positive patients, 4-8 years in 26.66% of cases, 8-12 years in 20% and 12-16 years in 20% of them. Conclusions: This project suggests that hepatitis C infection has a high prevalence in dialysis patients and Anti-HCV Ab test should be performed before scheduling them. Although some references refuse to suggest isolation of dialysis settings for this group of patients, strategies such as closed control of services given to these patients such as blood transfusion and also training the personnel of hemodialysis units for infection prevention seems to be necessary. [ABSTRACT FROM AUTHOR]

Context Nonalcoholic fatty liver disease (NAFLD) is considered the leading cause of chronic liver disease worldwide. To date, no confirmed medication is available for the treatment of NAFLD. Previous studies showed the promising effects of gut microbiome–targeted therapies; however, the results were controversial and the strength of the evidence and their clinical significance remained unclear. Objectives This umbrella study summarizes the results of meta-analyses investigating the effects of probiotics, prebiotics, and synbiotics on liver enzymes in the NAFLD population. Data Source A comprehensive search of the PubMed, Scopus, Web of Science, and Cochrane Library databases was done up to December 20, 2022, to find meta-analyses on randomized control trials reporting the effects of gut microbial therapy on patients with NAFLD. Data Extraction Two independent investigators extracted data on the characteristics of meta-analyses, and any discrepancies were resolved by a third researcher. The AMSTAR2 checklist was used for evaluating the quality of studies. Data Analysis A final total of 15 studies were included in the analysis. Results showed that microbiome-targeted therapies could significantly reduce levels of alanine aminotransferase (ALT; effect size [ES], −10.21; 95% confidence interval [CI], −13.29, −7.14; P < 0.001), aspartate aminotransferase (AST; ES, −8.86; 95%CI, −11.39, −6.32; P < 0.001), and γ-glutamyltransferase (ES, −5.56; 95%CI, −7.92, −3.31; P < 0.001) in patients with NAFLD. Results of subgroup analysis based on intervention showed probiotics could significantly reduce levels of AST (ES, −8.69; 95%CI, −11.01, −6.37; P < 0.001) and ALT (ES, −9.82; 95%CI, −11.59, −8.05; P < 0.001). Synbiotics could significantly reduce levels of AST (ES, −11.40; 95%CI, −13.91, −8.88; P < 0.001) and ALT (ES, −11.87; 95%CI, −13.80, −9.95; P < 0.001). Prebiotics had no significant effects on AST and ALT levels (ES, −2.96; 95%CI, −8.12, 2.18, P = 0.259; and ES, −4.69; 95%CI, −13.53, 4.15, P = 0.299, respectively). Conclusion Gut microbiome–targeted therapies could be a promising therapeutic approach in the improvement of hepatic damage in patients with NAFLD. However, more studies are needed to better determine the best bacterial strains, duration of treatment, and optimum dosage of gut microbiome–targeted therapies in the treatment of the NAFLD population. Systematic Review Registration PROSPERO registration no. CRD42022346998. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the frequency of colorectal lesions in the first-degree relatives of patients with colorectal lesions among the Prospective Epidemiological Research Studies in Iran (PERSIAN)Guilan Cohort Study (PGCS) population. Methods: In this cross-sectional study, 162 first-degree relatives with a history of colorectal lesions were randomly selected from 52 participants in PGCS. All subjects underwent total colonoscopy by a gastroenterologist, and a pathologist evaluated colorectal biopsies. Also, individuals’ demographic information, clinical data, and dietary habits were recorded. Results: The mean age of the participants was 56.55 ± 7.04. Of 86 colon polyps, 52 neoplastic and 34 non-neoplastic polyps were observed in 56 patients (34.6%). Individuals with age > 60 years had 3.29-fold increased odds of developing colorectal polyps (OR = 3.29, 95% CI: 1.13–9.56, P = 0.029). The smokers were 2.73 times more susceptible to developing colorectal polyps than non-smokers (OR = 2.73, 95% CI: 1.24–6.02, P = 0.013). Moreover, consumption of vegetables more than three times per day was associated with decreased OR of colorectal polyp development (OR = 0.43, CI: 0.19–0.98, P = 0.045). Conclusions: Considering the high prevalence of neoplastic colorectal polyps among the first-degree relatives of patients with colorectal lesions, early screening is recommended for individuals with a family history of colorectal lesions. [ABSTRACT FROM AUTHOR]

Although hematuria is not life-threatening, some could be the result of a more severe condition. Our objectives are to report on the prevalence and risk factors of asymptomatic microscopic hematuria (AMH) in the prospective epidemiological research studies of the Iranian adults (PERSIAN) Guilan cohort study (PGCS) population. This cross-sectional study was conducted from 2014 to 2017 and consisted of 10,520 individuals aged 35–70. Data collection was conducted using a questionnaire during a face-to-face interview. The urine analyses (UA) were done up to 2 h after sample collection. Based on a urine microscopy evaluation, AMH is defined as 3 or more red blood cells per high power field (HPF). Simple and multiple logistic regression analysis was conducted to explore factors associated with AMH. The prevalence of AMH in this study was 34.1% and was more prevalent in participants of older ages and female gender as well as those with low educational level, underweight-body mass index (BMI), high physical activity, smoking, alcohol consumption, and kidney stone disease. On the other hand, obesity, opium, and diabetes decreased the likelihood of AMH. The results of the present study shed light on the prevalence and risk factors of AMH and suggested that a significant portion of the study population is affected by AMH. Considering the lack of consensus on a definite clinical guideline for AMH in our country, the results of the present study could be used to design a unit algorithm for screening and therapy of AMH. [ABSTRACT FROM AUTHOR]

• Hypermethylation of tumor suppressor genes have an impressive role in carcinogenesis. • Methylation changes in many stem cells genes are involved in a variety of tumors. • Expression of DNMTs is related with the promoter region of hypermethylation in tumor-suppressor genes. • DNMTs are most potential biomarkers in diagnosis of GC. Cancer stem cells (CSCs) show a remarkable sub class of cancer cells population which have a potential to organize and regulate stemness properties which possess a main particular responsibility for uncontrolled growth in carcinogenesis, production of different cancers in differentiated situation and also resistancy to radiotherapy and chemotherapy. Correspondingly, gastric cancer (GC) as a very serious type in cancer mortality in the world, has received a deep attention in molecular therapy recently. Besides the main characteristics of CSCs like differentiation, epithelial mesenchymal transition, self-renewal and metastasis, they are so effective in expression of stemness genes resistancy in radiotherapy and chemotherapy. In this way, the regulation of epigenetic elements including DNA methylation and the performance of DNA methyltransferase (DNMT) which is a notable epigenetic trait in GC, is of great importance. Inhibitors of DNA methylation are the first epigenetic drugs in cancer therapy. Considerably, recent studies indicate that low doses of DNMT inhibitors have a high potential in sustaining reduced DNA methylation and related with re-expression of silenced genes in tumorigenesis. Importantly, these certain doses have the ability to decrease the carcinogenesis and tumorigenesis in CSC populations within GC. Meaningly, the inhibition of DNMTs are able to reduce the accumulation of tumorigenic ability of GC CSCs. Furthermore, many epigenetic drugs have a great potential in cancer therapy, including histone methyltransferases, lysine demethylases, histone deacetylasesand, bromodomain and extra-terminal domain proteins and DNA methyltransferases inhibitors. In this review article, we try to focus on the therapeutic mechanism of DNMTs alongside with their impact on CSCs in GC. [ABSTRACT FROM AUTHOR]

Context: Non-alcoholic fatty liver disease (NAFLD) is progressing considerably worldwide. Identifying the risk factors of NAFLD is a critical step in preventing its progression. Methods: In November 2022, two independent researchers studied seven databases, including PubMed, ISI/WoS, ProQuest, Scopus, SID, Magiran, and Google Scholar, and reference list of relevant articles, searching studies that assessed NAFLD risk factors in the Iranian adult population. Heterogeneity between studies was assessed by Cochran's test and its composition using I² statistics. A random-effects model was used when heterogeneity was observed; otherwise, a fixed-effects model was applied. Egger's regression test and Trim-and-Fill analysis were used to assess publication bias. Comprehensive Meta-analysis software (version 3) was used for the analyses of the present study. Results: The results of this study showed significant associations between NAFLD with age (n = 15, odds ratio (OR) = 2.12,95% CI: 1.79 - 2.51), body mass index (n = 46, OR= 5.00,95% CI: 3.34 - 7.49), waist circumference (n = 20, OR = 6.37,95% CI: 3.25 -12.48), waist-to-hip ratio (n = 17, OR = 4.72, 95% CI: 3.93 - 5.66), total cholesterol (n = 39, OR = 1.80, 95% CI: 1.52 - 2.13), high-density lipoprotein (n = 37, OR = 0.53, 95% CI: 0.44-0.65), low-density lipoprotein (n = 31, OR = 1.68, 95% CI: 1.38 - 2.05), triglyceride (n = 31, OR = 3.21, 95% CI: 2.67-3.87), alanine aminotransferase (n = 26, OR = 4.06,95% CI: 2.94 - 5.62), aspartate aminotransferase (n = 27, OR = 2.16,95% CI: 1.50-3.12), hypertension (n =13, OR = 2.53,95% CI: 2.32 - 2.77), systolic blood pressure (n = 13, OR = 1.83,95% CI: 1.53 - 2.18), diastolic blood pressure (n = 14, OR=1.80,95% CI: 1.48-2.20), fasting blood sugar (n = 31, OR=2.91,95% CI: 2.11-4.01), homeostatic model assessment for insulin resistance (n = 5, OR = 1.92,95% CI: 1.48 - 2.59), diabetes mellitus (n =15, OR = 3.04,95% CI: 2.46-3.75), metabolic syndrome (n = 10, OR = 3.56,95% CI: 2.79 - 4.55), and physical activity (n = 11, OR= 0.32, 95% CI: 0.24-0.43) (P< 0.05). Conclusions: In conclusion, several factors are significantly associated with NAFLD. However, anthropometric indices had the strongest relationship with NAFLD in the Iranian adult population. [ABSTRACT FROM AUTHOR]

The current meta-analysis aims to investigate the existing articles that evaluated the implications of a positive family history of cancer on the risk of colorectal cancer (CRC) within the EMRO countries. We employed PubMed, Scopus, and Web of Science as search databases for this study. To assess the quality of the selected articles, we utilized the Newcastle–Ottawa (NCO) checklist. In comparing the impact of a family history of cancer between the case and control groups, we computed the odds ratio (OR) along with its corresponding 95% confidence interval (CI). Finally, 27 articles were selected for meta-analysis. The result of the meta-analysis showed a significant association between the presence of a family history of CRC or any cancers and CRC (OR 2.21; 95% CI 1.54–3.17; P < 0.001, OR 1.76; 95% CI 1.27–2.42; P = 0.001, respectively). Our findings underscore the critical importance of timely screening and early identification for individuals with a family history of cancer. By fostering close coordination among healthcare facilities and actively promoting the adoption of screening methods for early detection, we have the potential to significantly reduce both mortality rates and financial burdens of CRC on the general public, ultimately leading to enhanced patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Ultrasound is an important method to determine the volume of the gallbladder and check its structure. Considering the variation in the size and volume of the gallbladder in disease and physiological conditions, determining the volume of the gallbladder is clinically valuable. This study was carried out to evaluate the gallbladder volume and its association with patients' demographic data in the Prospective Epidemiological Research Studies of Iranian Adults (PERSIAN) Guilan cohort study (PGCS) population. Methods: In this cross-sectional study, 957 individuals aged 35–70 participated in determining the gallbladder volume by a radiologist based on the ultrasound method. The demographical data were collected using a questionnaire. After fasting for 12 h, the ultrasound was performed with an Ultrasonic device (Sonix SP series) with a 3.5 to 5 MHz probe. Results: The total frequency of gallbladder lesions was 2.2%. The results showed a significant association between marriage and gender with the presence or absence of lesions in the studied participants (P < 0.05). Also, significant differences were reported between the volume of gallbladder and gender, body mass index (BMI), social and economic status (SES), metabolic equivalent of task (MET), history of cardiovascular disease (CVD), and hypertension (P < 0.05). The results of a linear regression represented a significant association between gender, BMI, MET, and CVD and the mean volume of the gallbladder (P < 0.05). However, there was no significant association between the presence or absence of a lesion and the individuals' average gallbladder volume (P > 0.05). Conclusion: According to our results, gender, BMI, MET, and CVD were significantly associated with gallbladder volume. [ABSTRACT FROM AUTHOR]

The current meta-analysis aims to investigate the existing articles that evaluated the implications of a positive family history of cancer on the risk of colorectal cancer (CRC) within the EMRO countries. We employed PubMed, Scopus, and Web of Science as search databases for this study. To assess the quality of the selected articles, we utilized the Newcastle–Ottawa (NCO) checklist. In comparing the impact of a family history of cancer between the case and control groups, we computed the odds ratio (OR) along with its corresponding 95% confidence interval (CI). Finally, 27 articles were selected for meta-analysis. The result of the meta-analysis showed a significant association between the presence of a family history of CRC or any cancers and CRC (OR 2.21; 95% CI 1.54–3.17; P < 0.001, OR 1.76; 95% CI 1.27–2.42; P = 0.001, respectively). Our findings underscore the critical importance of timely screening and early identification for individuals with a family history of cancer. By fostering close coordination among healthcare facilities and actively promoting the adoption of screening methods for early detection, we have the potential to significantly reduce both mortality rates and financial burdens of CRC on the general public, ultimately leading to enhanced patient outcomes. [ABSTRACT FROM AUTHOR]

Background and Aim: Bowel preparation is a crucial factor affecting the diagnostic accuracy of colonoscopy, and few randomized control trials evaluated enhancement in bowel preparation. In this study, we aimed to evaluate the effectiveness of walking exercises on bowel preparation before a colonoscopy procedure. Methods: The present study is a single-blind randomized controlled trial involving 262 patients scheduled for colonoscopy procedures. These patients were randomly assigned to two groups: an intervention group (n = 131) and a control group (n = 131). In the intervention group, participants followed a predetermined plan that included the consumption of specific liquids and foods, bisacodyl pills, polyethylene glycol powder, and a regimen of walking exercises in preparation for their colonoscopy. Conversely, individuals in the control group followed the same regimen but were not instructed to engage in walking exercises. On the day of the colonoscopy, both groups were assessed for their level of physical activity using a foot counter. Additionally, an experienced gastroenterologist evaluated and compared the bowel preparation between the two groups using the Boston Bowel Preparation Scale (BBPS). Results: The number of footsteps recorded in the two groups exhibited a significant difference (P < 0.001). Although there was no statistically significant difference between the intervention and control groups in terms of mean BBPS scores (6.26 ± 1.9 vs. 6.29 ± 1.9, P = 0.416), individuals who took more than 6900 steps had significantly higher BBPS scores compared to those with fewer than 6900 footsteps (6.62 ± 1.8 vs. 5.92 ± 1.9, P = 0.003).In the univariate analysis, BBPS was found to be significantly associated with individuals under the age of 50 (OR: 2.45, 95% CI: 1.30–4.61, P = 0.006) and smoking status (OR: 0.41, 95% CI: 0.17–0.94, P = 0.043). In the multivariate analysis, the relationship between BBPS and age below 50 and smoking remained significant (OR: 2.50, 95% CI: 1.30–4.70, P = 0.005, and OR: 0.38, 95% CI: 0.16–0.93, P = 0.034, respectively). Conclusion: A higher number of footsteps taken especially more than 6900 can significantly enhance bowel preparation; however, walking exercise as an intervention before colonoscopy is not significantly associated with BBPS. Also, older people and smokers seem to have fewer benefits from walking exercises for bowel preparation. Trial registration: ISRCTN32724024 (Registration date:22/08/2018). [ABSTRACT FROM AUTHOR]

Background: Botox injections are commonly used for cosmetic and therapeutic purposes because they temporarily paralyze muscles, reduce wrinkles, and alleviate certain medical conditions. Although generally considered safe and effective, Botox injections may cause potential complications. While herpes reactivation is more commonly associated with immunosuppressive therapies, such as chemotherapy or corticosteroid use, its association with Botox injection is poorly documented. Case Presentation: A 33-year-old woman presented with progressive painful rashes and vesicles on her forehead, scalp, and right upper eyelid, accompanied by fever and malaise following a Botox injection to treat wrinkles. A positive Tzanck smear test result confirmed the diagnosis of herpes infection. The patient was treated with antiviral medication, and her symptoms gradually regressed over several days. Conclusions: Although herpes reactivation is more commonly associated with immunosuppressive therapies, few cases of herpes zoster and herpes simplex following Botox injection have been reported. The pathogenesis of herpes reactivation following Botox injection is unclear; however, it has been hypothesized that the Botox protein is a potent antigen that may activate the cellular immune system, making it easier for the virus to reactivate. Healthcare providers should be aware of this potential complication and consider it when evaluating patients who present with painful rashes following Botox injections. In addition, individuals who want to receive Botox injections should be informed of this complication. The diagnosis of herpetic infection should be made promptly, and antiviral therapy should be initiated to minimize the risk of complications. Further research is needed to better understand the pathogenesis and risk factors for herpes following Botox injection and to develop strategies for preventing and managing this complication. [ABSTRACT FROM AUTHOR]

Background: It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderlyonset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients. Methods: This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes. Results: From 10 048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn's disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients (P < 0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P = 0.001), immunomodulators (44.9% vs 25.2%, P < 0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P = 0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6-0.9, P = 0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P < 0.001), immunomodulators (58.7% vs 41.8%, P = 0.005) and anti-TNF (49.6% vs 35.4%, P = 0.006). Conclusion: Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Aberrant DNA methylation mechanism in the promoter regions of certain genes, is the most important epigenetic hallmark in human GC especially as a target for detection and diagnosis in cancer treatment. • Hyper-methylation of tumor suppressor genes can also cause cancer, and these happenings are most in parts of the CpG. • It is possible for each of the related genes in different signaling pathways to have a limited role, but their silencing or down regulation at the same time, have an increasing role in the development of malignancies and eventually all of them can provide the susceptibility for cancer progression. • Epigenetic events are mediated by several molecular mechanisms including small non-coding RNAs, poly-comb protein complexes, histone modifications, and DNA methylation which the last category is the most important epigenetic factor. • Epigenetic mechanisms transmit genomic compatibility and adaption to an environment finally helping towards given different phenotype. Abstract Gastric cancer (GC) or human gastric adenocarcinoma is one of the most commonplace type of serious cancers and also the most common cause of cancer-related mortality in the world. Relatively, many studies have acknowledged that GC is a multi-factorial pathological situation that environmental factors, particularly dietary ones and H.pylori infection are considered to have a strong key role in the etiology of GC. Inappropriate dietary habits are the first cause as they affect main molecular functions related with the onset of the GC tumorigenesis and carcinogenesis. Correspondingly, cancer investigation has impressively zoomed on the different genetic markers and also molecular mechanisms pathways responsible for the progression of the GC. Various molecular signaling pathways such as WNT, NOTCH, SHH, MYC have different functions and analyzing their role in the GC is of great importance particularly for the treatment modalities. Proportionately, fluctuations of epigenetic alterations including DNA methylation, histone modification, histone acetylation and also histone phosphorylation's are involved in all cancers specially the GC. Conspicuously, novel developments in cancer epigenetic have indicated immense reprogramming of every structure of the epigenetic mechanism in cancer, comprising microRNAs, nucleosome positioning, DNA methylation, noncoding RNAs, and histone modifications. In this account, aberrant DNA methylation mechanism in the promoter regions of certain genes, which leads to silencing of some particular genes such as tumor suppressor and other cancer-related genes in carcinogenesis, is the most important epigenetic hallmark in human GC especially as a target for detection and diagnosis in cancer treatment. Here, we review the importance of epigenetic fluctuations alongside with their molecular signaling mechanism in the GC. [ABSTRACT FROM AUTHOR]

Background: Smoking poses a significant risk for colorectal cancer (CRC), considered the third leading reason for cancer-related deaths worldwide. However, there has been limited research on the relationship between smoking and CRC in the Eastern Mediterranean Regional Office (EMRO). Therefore, a meta-analysis was conducted to combine available data and gain a comprehensive understanding of the relationship between smoking and CRC in EMRO. Methods: Two independent researchers searched PubMed, Scopus, and Web of Science until December 2022. The included studies were checked for risk of bias administering the Newcastle-Ottawa scale. Heterogeneity was evaluated using I2 statistics and the Cochrane test. Publication bias was determined through funnel plot analysis and Egger's regression test. Additionally, a meta-regression analysis explored the impact of a country's Human Development Index (HDI) on the relationship between smoking and CRC. Results: The final analysis included 26 studies, revealing a significant association between smoking and CRC (OR = 1.40; 95% CI: 1.11 - 1.78; P = 0.004). Moreover, smoking had a more pronounced adverse effect on CRC in countries with higher HDIs compared to those with lower HDIs (OR = 1.30; 95% CI: 0.99 - 1.71; P = 0.054). Conclusions: Our findings underscore the importance of implementing smoking cessation programs and policies in EMRO countries, as they demonstrate a positive relationship between smoking and the risk of CRC. Furthermore, the results suggest that a country's level of human development may influence the association between smoking and CRC. Further research is needed to investigate this potential connection and develop targeted public health interventions. [ABSTRACT FROM AUTHOR]

Background and objective: Tuberculosis is a chronic granulomatous infection and has become a global concern. This disease is caused by Mycobacterium tuberculosis, but other types of Mycobacterium can also cause the disease. Tuberculosis usually affects the respiratory system, but other organs, called extrapulmonary tuberculosis, can be involved. Lymph node tuberculosis is one of the manifestations of extrapulmonary tuberculosis, especially in regions where tuberculosis is endemic. The involvement of salivary glands with tuberculosis is an uncommon condition. Here we present three cases (two adults and one child) with tuberculosis salivary gland lymphadenitis. Subjects and methods: Three cases were studied in the current work. The first case was 27-year-old woman without any underlying diseases, was referred to our local hospital due to painful swelling of the submandibular region. The second case was 44-year-old woman without any underlying diseases, was referred to our hospital because of painful swelling in her left parotid gland region. The third case was 7-year-old boy without any underlying diseases, complaining of fever and painful swelling of the right submandibular gland. Results and conclusion: In all the cases, tuberculosis diagnosis was confirmed by biopsy. Although, the diagnosis of tuberculosis was easier in the child due to symptoms like night sweating and fever and positive purified protein derivative test, in adults, there were no abnormalities in the initial laboratory tests, and purified protein derivative tests were negative, which made the diagnosis of tuberculosis more complicated. Although, salivary gland involvement with tuberculosis is not common, it should be considered a differential diagnosis in patients with swelling of salivary glands. In addition, the diagnosis confirmation should be based on biopsy, and normal laboratory tests and negative purified protein derivative tests should not confuse us. An early diagnosis is essential, and early initiation of an anti-tuberculosis regimen can prevent the following complications. [ABSTRACT FROM AUTHOR]