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Background: Fatty liver disease is rising as the most common liver disease in recent years. One of the new approaches to manage the disease is the use of intelligent systems. The recommender system is increasingly utilized in managing chronic conditions. This study was performed to identify the common data elements and features of a recommender system for people living with fatty liver. Methods: This study was a narrative review exploring the minimum data set for a recommender system in fatty liver disease. We aimed to review the current literature evidence to comprehend the specific requirements of the related knowledge. The search was carried out in November 2020 using PubMed, Scopus, Science Direct, and Web of Science databases. We searched the keywords including fatty liver, liver disease, nonalcoholic fatty liver disease, intelligent, smart system, recommender system, minimum data set, data element, and data requirements. Results: A review of the articles showed that the most common data elements of the administrative category were sex/gender (n=22), age (n=22), and ethnic group/race (n=8). We also identified the clinical data elements and technical features of a recommender system for people living with fatty liver. Based on the findings of this study, “diabetes and glucose status” (n=18), “AST” (n=15), “BMI” (n=13), and “ALT” (n=13) were the most frequent data elements of clinical category. Furthermore, “predicting and identifying” (n=8) was the most common technical feature mentioned in the reviewed articles.‎ Conclusion: We determined the common elements and features of a recommender system in ‎three different categories: clinical data elements, demographic data elements, and technical ‎capabilities. Using these requirements, it is possible to structure data gathering, medication ‎adherence, and communication with healthcare providers in a standard manner. It is ‎suggested that appropriate policies and national grants be adopted to identify and prioritize a ‎minimum data set to support the healthcare services of people living with chronic conditions.

Immune monitoring of transplanted patients may provide a reliable basis for the individualization of immunosuppressive therapy. In addition, it might be applied for realizing the early and non-invasive diagnosis of acute allograft rejection.Percentages of TCD4 + IL-17+ (Th17) and TCD4 + CD25 + CD127Six months post-transplant, the percentage of Th17 and Treg cells in the peripheral blood of stable liver transplant recipients reduced significantly, but the Th17/Treg ratios were comparable to the pre-transplant period (1.24 vs. 1.56); however, Th17/Treg ratios in the rejection group was significantly higher than in the stable recipients (4.06 vs. 1.56, P-value = 0.001). Stable patients showed decreased amounts of serum IL-17 which was remarkably lower than in the rejection group (P-value = 0.01). Moreover, there was a significant correlation between the serum level of IL-17 and the percentage of Th17 cells (P-value0.001). Th17 frequency was negatively associated with the liver allograft function. Notably, TGF-β1 levels differed neither between pre-and post-transplant samplings nor between stable and rejection groups.Six months after liver transplantation, the mean Th17/Treg ratio in stable recipients remained comparable to the pre-transplant values; however, it was significantly elevated in patients with acute allograft rejection, suggesting the Th17/Treg ratio as a probable predictor of acute rejection.

Our aims were determining the student’s views about the effect of using the study guide on advance preparation in a flipped class setting and testing the effect of flipped class on higher cognition. Using a quasiexperimental design in Tehran University of Medical Sciences, one batch was taught using a flipped classroom and another batch by a lecture in 3 sessions. The student’s views were assessed using a questionnaire, and the effect of flipped class on levels of higher cognition based on Bloom's taxonomy was measured using two tests in two-time intervals. Seventy-two students believed that the study guide helped them to devote their time to study. Data did not support our hypothesis that flipped class could result in higher cognition one month and four months after the intervention T=-0.75, df=197, P=0.45 in knowledge Questions, T=-1.08, df=197, P=0.28 in comprehensive questions, T=-0.30, df=197, P=0.76 in an application, and T=-0.91, df=197, P=0.36 in analytical questions. Study guides could be effective tools to get students to interact with pre-assigned readings in a flipped class context. Our hypothesis that flipped class could result in higher cognition was not supported.

Background: During the pandemic of COVID-19, the overwhelm of infected patients created an exponential surge for ICU and ward beds. As a result, a major proportion of elective surgeries was postponed. However, various emergency and urgent procedures were allowed. Due to the mortality complications of hepatopancreatobiliary issues, we decided to afford urgent procedures under intensive protective arrangements. Method and results: In our ward (liver transplant), 4 ICU beds and 16 ward beds were allocated to non-COVID-19 patients. A total of 36 hepatopancreatobiliary procedures were managed for one month. All the surgeries were afforded under personal protective equipment and other intensive protective arrangements for personnel and patients. During 6 weeks following the surgery, all patients were followed up through telemedicine and no new case of COVID-19 was detected. Conclusion: In general, it appears that intensive protections could significantly reduce the number of COVID-19 incidence among patients with co-morbidities who undergo invasive procedures. (www.actabiomedica.it)

Hepatocellular carcinoma (HCC) is known as one of the common and fatal cancers in the Asian and African countries. Two significant factors could cause this type of cancer including having diets con...

Terminalia chebula (family: Combretaceae) is widely used in the traditional medicine of India and Iran to treat diseases that include dementia, constipation, and diabetes. This tree is known in Iranian traditional medicine (ITM) as halileh or halilaj and the fruit is used to develop treatments. It is described in ITM as an astringent that has a “cold” and “dry” temperament. References to the medicinal properties of Terminalia chebula were collected from important ITM sources and from modern medical databases (PubMed, Scirus, ScienceDirect, and Scopus). The medicinal properties described for this tree in ITM were compared with those reported in studies of modern phytotherapy. The results confirm that the tree referred to as halileh in traditional books is the Terminalia chebula used in present-day studies. Treatments that have not been evaluated in modern phytotherapy but have been traditionally treated with Terminalia chebula include fever, and psychological and psychiatric issues. This article confirms the medicinal uses of Terminalia chebula.

Glycogen storage disease type 3 (GSD-III) is a rare inherited metabolic disorder caused by glycogen debranching enzyme deficiency. Various pathogenic mutations of the AGL gene lead to abnormal accumulation of glycogen in liver, skeletal, and cardiac muscles. Here, we report distinct clinical and genetic data of Iranian patients with GSD-III.Clinical and laboratory data of 5 patients with GSD-III were recorded. Genetic investigation was performed to identify the causative mutations.Three patients had typical liver involvement in childhood and one was diagnosed 2 years after liver transplantation for cirrhosis of unknown etiology. Four patients had vacuolar myopathy with glycogen excess in muscle biopsy. All patients had novel homozygous mutations of the AGL gene namely c.378TA, c.3295TC, c.3777GA, c.2002-2AG, and c.1183CT.This is the first comprehensive report of patients with GSD-III in Iran with 2 uncommon clinical presentations and 5 novel mutations in the AGL gene.

ABSTRACT: Aim: Serum carnitine level and its associated factors have been evaluated in patients with chronic viral hepatitis. Methods: Patients with confirmed chronic viral hepatitis based on the serological markers and liver biopsy were included. In total, 86 volunteers and 86 patients with chronic viral hepatitis completed the study. Demographic data, type of treatment regimen and nutritional status of the patients were recorded and one blood sample was collected from each patient after an overnight fasting. A double antibody sandwich ELISA kit was used to measure carnitine serum level. Results: Mean ± standard deviation of serum carnitine level in the case and control groups were 34.3 ± 15.3 and 55.7 ± 28.4 μmol/l, respectively (p = 0.001). Regarding carnitine deficiency definition, 64 out of 86 patients (74.4%) and 21 out of 86 (24.5%) healthy individuals suffered from carnitine deficiency (p

The imaging of hepatocellular carcinoma (HCC) is challenging and plays a crucial role in the diagnosis and staging of the disease. A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC. Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable. In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated. In this paper, we aimed to review the evidence regarding imaging modalities and therapeutic interventions of HCC.

Hepatitis C remains as an important health problem worldwide. Hepatitis C treatment, especially among patients infected with HCV genotype 1 who are considered difficult to treat, is a high priority for health policy-makers. PegInterferon alfa instead of Interferon and ribavirin combination therapy has been accepted as the standard treatment regimen for hepatitis C patients; however, only 50% of patients infected with HCV genotype 1 achieve a sustained virological response. Published data from various clinical trials of protease inhibitors suggest that new therapeutic regimens may increase the chances of a successful response in patients infected with HCV genotype 1. Triple therapy that includes boceprevir has been shown to result in high rates of sustained virological response in both naive and experienced patients with HCV genotype 1 infection. In this review, we have summarized the results obtained with this new regimen and have attempted to provide a guideline for the treatment of patients in Iran, with emphasis on cost and the occurrence of adverse events. ARTICLE INFO

Objective To investigate the performance of different b values and regions of interest (ROI) for diagnosing liver fibrosis in patients with chronic viral hepatitis by using diffusion-weighted (DW) magnetic resonance imaging (MRI). Methods Eleven healthy participants and 33 patients with viral hepatitis B or C were enrolled. The stage of liver fibrosis and the grade of necroinflammation were determined by using a histologic activity index. Single-shot spin-echo echo-planar DW-MRI was performed in all participants at b values of 0-500, 0-700, and 0-1000 s/mm2 by using 2 circular small and large ROIs of 100 and 200 mm2. To evaluate the performance of different b values for determining cirrhosis, the receiver-operating characteristic curves were depicted, and the areas under the curves were compared. Results The average values of apparent diffusion coefficients significantly decreased with increasing stage or grade categories at all the 3 b values and for both small and large ROIs. The performance at b = 500 s/mm2 was significantly better than b = 1000 s/mm2 for determining cirrhosis or bridging fibrosis. The cut point of 153.4 for apparent diffusion coefficient (×10−5 mm2/s) at b = 500 s/mm2 could determine cirrhosis or bridging fibrosis with a sensitivity of 96% and specificity of 82%. No difference was found between the average apparent diffusion coefficient values of large or small ROIs. Also, there was no difference in performance of large or small ROIs in the diagnosis of liver fibrosis. Conclusions This study provided beneficial data for clinical utilisation of DW-MRI in diagnosing liver fibrosis: b = 500 s/mm2 is better in performance than b = 1000 s/mm2, and a small ROI of 100 mm2 is sufficient for determining cirrhosis or bridging fibrosis.

To compare the response of standard hepatitis B virus (HBV) vaccination between patients with chronic hepatitis C virus (HCV) infection and healthy individuals.This is a prospective case-control study. A total of 38 patients with chronic HCV infection and 40 healthy controls were included. Vaccination was performed by injection of 20 microg recombinant HBsAg into the deltoid muscle at mo 0, 1 and 6. Anti-HBs concentration was determined 3 mo after the last dose and compared between the two groups. The response pattern was characterized as (1) high-response when the anti-HBs antibody titer was100 IU/L, (2) low-response when the titer was 10-100 IU/L and (3) no-response when the titer was10 IU/L.In the patient group, there were 10/38 (26.3%) non-responders, 8/38 (21.1%) low-responders and 20/38 (52.6%) high-responders. The corresponding values in the control group were 2/40 (5.0%), 7/40 (17.5%) and 31/40 (77.5%), respectively. The response pattern was statistically different between the two groups. In multivariate analysis, smoking was a significant confounder, while HCV infection lost its significant correlation with lower antibody response.Patients with chronic HCV infection tend to respond weakly to HBV vaccination compared to healthy individuals, though this correlation is not independent according to multivariate analysis.

Hepatitis C virus (HCV) infection is highly prevalent in thalassemic patients. This may decrease serum antibody response to hepatitis B virus (HBV) vaccine. There is also some alteration in the immune system of multi-transfused thalassemic patients as a consequence of iron overload. We deduced that HCV infection may reduce the effectiveness of HBV vaccine in multi-transfused thalassemic patients.Subjects were cited and studied prospectively in three groups. Group 1:125 multi-transfused thalassemic patients with negative serum HCV antibody, Group 2:96 multi-transfused thalassemic patients with positive serum HCV antibody on at least 2 different occasions, and Group3:100 healthy subjects. Subjects in all groups had negative serum HBsAg, anti-HBc, and anti-HBs, and they received three 20-microg doses of recombinant HBV vaccine in months 0,1, and 6. The anti-HBs titer was obtained one month after the last dose of vaccine and was considered seroprotective ifor =10 IU/l.The seroprotection rate was 83.2% in Group 1 and 80.2% in Group 2 (P = 0.74). It was 86% in healthy subjects, which didn't significantly differ from HCV-positive and -negative thalassemics (P = 0.56). Moreover, the mean values of ALT among the responder and non-responder thalassemic patients were 55.5 +/- 41.9 and 57.4 +/- 48.5 U/l, respectively (p = 0.802). During the vaccination periods, patients in all 3 groups did not show any significant adverse reactions.Our study shows that three standard doses of HBV vaccine are immunogenic and safe in multi-transfused thalassemic patients with or without HCV infection.

Background Increased hepatic iron is assumed to potentiate progression towards liver fibrosis in chronic hepatitis C virus (HCV) infection. In this study we have evaluated the potentiating effect of marked hepatic iron overload and chronic HCV infection on hepatic fibrosis in thalassemic patients. Methods Liver biopsies of one group of patients with beta thalassemia major and chronic HCV infection (group 1) was compared with two groups of patients (groups 2&3) with either chronic HCV infection or thalassemia major, respectively (20 patients in each group). Necroinflammation, fibrosis, and iron overload were graded and compared. Results Stage of fibrosis in group 1 patients was significantly higher than the other two groups (p < 0.05). Necroinflammatory grade was significantly lower, but iron score was significantly higher in thalassemic patients (group 3) in comparison to groups 1 and 2 (p < 0.05). Conclusion Our results indicate that marked liver iron overload and HCV infection in thalassemic patients have potentiating effect on hepatic fibrogenesis.