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Background: Evolving evidence indicates the role of vitamin D deficiency in the progression of IBD and its impact on the severity of the disease, but it remains unclear whether vitamin D deficiency causes IBD or vice versa. Methods: This cross-sectional study was conducted to determine the serum levels of vitamin D and its effects on the severity of disease in patients with inflammatory bowel disease in the Imam Khomeini Hospital complex. A questionnaire containing demographic information, records on the use of supplements and medications, disease complications, and criteria for determining the severity of the disease based on the Mayo score and Crohn’s Disease Activity Index (CDAI) and 25 hydroxy vitamin D levels was completed and evaluated. Results: Of the 101 participants, 21 were with Crohn’s disease and 80 had ulcerative colitis. The mean age of Crohn’s patients was 33.80±9.5 years and ulcerative colitis was 38.43±10.2 years. Among patients with ulcerative colitis, 37 (46.8%) had a mayo score less than 3 and 42 (53.2%) were 3 and more. Mean vitamin D in the mayo score less than 3 was 32.14 and the mayo score 3 and more was 23.99. Of the Crohn’s patients, 12 (57.1%) were in the recovery phase and 9 (52.9%) were in a non-recovery phase. The mean of vitamin D in the recovery phase was 29.10 and in the others was 27.04 Conclusion: There is a significant relationship between the level of vitamin D supplementation, the final value of CDAI, and the identification of the patients with the Mayo score.

Introduction Colorectal cancer (CRC) is one of the most frequent neoplasms in the world. Based on the emerging role of noncoding RNAs, particularly circular RNAs in pathogenesis of cancers, we designed this study to inspect the expression levels of a circ0009910-mediated regulatory pathway in colorectal cancer. Methods After bioinformatics analyses and construction of putative circ0009910/ miR-145-5p/PEAK1 pathway, the expression levels of these components were evaluated in 50 CRC tissues and adjacent specimens by quantitative real-time PCR. Moreover, we appraised the correlation coefficients between these transcripts and calculated the correlation between circ0009910 expression levels with clinicopathological features of patients. Results Circ0009910 and PEAK1 were significantly upregulated, while miR-145-5p was decreased in CRC samples compared with adjacent tissues (p < 0.05). Moreover, statistically significant correlations were observed between expression levels of circ0009910, miR-145-5p, and PEAK1. We also reported considerable correlations between circ0009910 expression and clinicopathological parameters including sex and perineural invasion. Finally, ROC curve analysis showed circ0009910 level as a discriminative biomarker for CRC. Conclusion For the first time, we could introduce circ0009910 as an important biomarker in CRC. Collectively, this investigation helped us to identify a newly diagnosed pathway in CRC that can be a potential axis for designing effective drugs for treatment of CRC patients.

Colorectal cancer (CRC) has become one of the most common cancers in recent years. Given the importance that non-coding RNAs have recently acquired in various diseases including cancers, we decided to design this study to evaluate the expression levels of circ0001955/miR-145-5p/ONECUT2 axis in CRC.After bioinformatics analysis of GEO datasets related to CRC, a putative circ0001955/ miR-145-5p/ ONECUT2 pathway was assumed. Then, the expression levels of these genes were measured in 50 CRC samples and adjacent tissues by qRT- PCR. Also, correlation coefficients, receiver operating characteristic (ROC) curves, and correlation between circ0001955 levels with clinicopathological parameters of patients were analyzed.Circ0001955 and ONECUT2 were considerably up-regulated, while the expression level of miR-145-5p was decreased in CRC samples compared with adjacent tissues (p 0.05). Moreover, statistically significant correlations were observed between expression levels of circ0001955, miR-145-5p, and ONECUT2. We did not find any significant correlation between circ0001955 expression and clinicopathological parameters.Our study showed that circ0001955 is dysregulated in CRC. This finding can open a new window for researchers for a better understanding of the potential pathways involved in CRC pathogenesis and, consequently, to find new treatment pathways.

Jejunogastric intussusception (JGI) is a rare complication of gastrojejunostomy surgery (

Genetic variations in miRNAs binding site might participate in cancer risk. This study aimed to systematically review the association between miRNA‐binding site polymorphisms and colorectal cancer (CRC). Electronic literature search was carried out on PubMed, Web of Science (WOS), Scopus, and Embase. All types of observational studies till 30 November 2018 were included. Overall 85 studies (21 SNPs) from two systematic searches were included analysis. The results showed that in the Middle East population, the minor allele of rs731236 was associated with decreased risk of CRC (heterozygote model: 0.76 [0.61‐0.95]). The minor allele of rs3025039 was related to increased risk of CRC in East Asian population (allelic model: 1.25 [1.01‐1.54]). Results for rs3212986 were significant in overall and subgroup analysis (P, MicroRNA‐binding site polymorphisms in 3'UTR of target genes could play critical roles on cancer genes regulation by affecting miRNA:mRNA interactions, but no comprehensive study has been considered on association between cancers and the mentioned polymorphisms. In this study, the authors carried out two comprehensive systematic searches and a meta‐analysis on 21 included polymorphisms on colorectal cancer (CRC). The results have shown that these polymorphisms can serve as genetic biomarkers of CRC, and their roles were exclusively related to population stratifications. It is strongly recommended that further studies should be performed to display the effect of population stratifications.

Pancreatic neuroendocrine tumors are rare neoplasms that comprise 1-2% of all pancreatic tumors. However, they are the second most common solid pancreatic neoplasms. They have a wide range of imaging appearances and they can show common to very rare imaging presentations. Most of the time they are solitary well-marginated enhancing solid mass arising in a certain aspect of the pancreas. We present a case report of a 41-year-old female who underwent clinical work-up for abdominal pain, loss of appetite and weight loss for the past year. Ultrasound, computed tomography, and magnetic resonance imaging show diffuse homogenous pancreatic enlargement without contour deformity or a focal mass. Lymphoma and autoimmune pancreatitis were suggested based on imaging findings but IGg4 level and other lab data were normal. Endoscopic ultrasonography confirmed the diffuse enlargement of the pancreas without peripheral structures involvement. The pathological results of multiple fine-needle aspiration biopsy from all parts of the enlarged pancreas revealed a low-grade neuroendocrine tumor.

BACKGROUND Infiltration of IgG4 positive plasma cells has been detected in the colonic mucosa of patients with ulcerative colitis (UC). The aim of the study was to investigate the association between colonic mucosal infiltration of IgG4 plasma cells and the presence, activity, extension, and duration of UC. METHODS In this case-control study (2009-2014), 102 subjects (84 with UC/18 controls) were enrolled. Clinical records and rectosigmoid biopsies of UC patients were selected, and biopsies were stained with IgG4 monoclonal antibodies. IgG4 positive plasma cells were counted by a single pathologist. RESULTS Amongst 84 patients with UC, 73.8% had UC without primary sclerosing cholangitis (PSC), and 26.2% had UC with PSC. IgG4 plasma cells were seen in 35 (41.7%) patients with UC and 0% of controls (p = 0.001). The mean amount of IgG4 containing plasma cells was significantly different between active and inactive patients with UC, although it was not significantly different between UC patients with and without PSC. The presence of IgG4 infiltration was significantly associated with the extension and duration of the disease. Furthermore, IgG4 count had a sensitivity/specificity of 78.6%/83.3% for the diagnosis of UC. CONCLUSION Our study revealed the diagnostic role of IgG4 plasma cells in the colonic mucosa of patients with UC and its association with activity, extension, and duration of disease.

Histiocytic sarcoma (HS) is a very rare neoplasm of hematopoietic origin characterized by the proliferation of malignant cells that have the morphological and immunohistochemical features of mature tissue histiocytes, with only a few cases reported. Most patients with symptoms of the unilateral or multichannel disease are more involved with the intestines, skin, and soft tissues, palpable mass lesions, and compressions of adjacent organs, such as intestinal obstruction, or constitutional symptoms (e.g., fever and weight loss). In this study, we reported a 56-year-old man with a six-month history of a cutaneous plaque lesion on the left arm’s posterior surface. He underwent skin lesion biopsy, histopathologic examination, and immunohistochemistry that was compatible with histiocytic sarcoma. Since surgical resection not deemed appropriate, our patient underwent aggressive multiagent chemotherapy with six cycles of ICE (ifosfamide, mesna, carboplatin, and etoposide) regimen and radiotherapy. After the completion of chemoradiotherapy, the skin lesion was completely disappeared. The patient is currently coming to us for the follow-up without any recurrence of the disease.

Background: Multiple Endocrine Neoplasia type 2B (MEN2B) is an autosomal dominant disorder characterized by Medullary Thyroid Carcinoma (MTC) and pheochromocytoma. MTC occurs in almost all MEN2B patients. The tumor develops at an earlier age and is aggressive. Surgery is often not curative for this condition. Death from MTC occurred in 50% of patients with MEN2B. Thus, early diagnosis and prevention are crucial in this regard. Thyroidectomy, as early as the neonatal period, may be indicated in patients with MEN2B identified by genetic screening. Case Presentation: We reported a 24-year-old male presented to the emergency department with dyspnea for the past 3 months. There was a nodule 3*3 cm in the Right Lower Lobe (RLL) of the thyroid gland. Non-contrast Computer Tomography (CT) scan of the lung revealed multiple nodular lesions compatible with metastasis. The Fine Needle Aspiration (FNA)cytology of the thyroid nodule indicated that the features of medullary thyroid carcinoma were positive stains in Immunohistochemistry (IHC) for calcitonin. A diagnosis of pulmonarymetastatic medullary thyroid carcinoma, as a presenting feature of MEN2B, was made. The patient was treated with Vandetanib. Conclusion: In the reported MEN2B patient, MTC occurred in the early stages of life and was multifocal. Thus, it is crucial to diagnose medullary thyroid cancer at the early stages of the disease.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus, and its infection, coronavirus disease 2019 (COVID-19), have quickly become a worldwide threat. It is essential for clinicians to learn about this pandemic to manage patients. Among different aspects of the condition, is the treatment of this disease. Unfortunately, currently there is no effective treatment option that can be supported by evidence-based medicine. This review analyzes information from literature on treatments.

BACKGROUND A dramatic rise in the rate of clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has been reported in recent years. METHODS In this observational case control study, 65 patients ulcerative colitis (UC) with flare up were included and were divided into two groups of UC + CDI as case group and UC without CDI as control group. RESULTS 35 patients who had positive test for clostridium difficile were assigned to the case group. The control group consisted of 30 patients with negative test for clostridium difficile. Pancolitis was seen in the cases more statistically significant than the controls and proctitis was seen more among the controls than the cases (p = 0.001). The cases were on immunosuppressive (p = 0.001) and antibiotic (p = 0.02) therapy more than the controls. Colonoscopic findings revealed more severe and extensive inflammation among the cases versus milder inflammation among the controls, but these differences were not statistically significant (p = 0.2). Colectomy was seen in 10% of controls and none of the cases and this difference was statistically significant (p value = 0.05). More fecal calprotectin were seen among the cases than the controls and this difference was statistically significant (p < 0.05). CONCLUSION This study showed more clostridium difficile infection among the patients on antibiotic or immunosuppressive therapy. Pathological investigation revealed more severe and extensive inflammation among the cases than the controls. Cases had clinically more severe signs and symptoms with higher mayo scores than the controls. ESR (Erythrocyte sedimentation rate) and fecal calprotectin were higher in patients with positive clostridium difficile infection and serum albumin was lower in such patients.

The growing trend in addition to their burden, prevalence, and death has made obesity and cancer two of the most concerning diseases worldwide. Obesity is an important risk factor for common types of cancers where the risk of some cancers is directly related to the obesity. Various inflammatory mechanisms and increased level of pro-inflammatory cytokines have been investigated in many previous studies, which play key roles in the pathophysiology and development of both of these conditions. On the other hand, in the recent years, many studies have individually focused on the biomarker's role and therapeutic targeting of microRNAs (miRNAs) in different types of cancers and obesity including newly discovered small noncoding RNAs (sncRNAs) which regulate gene expression and RNA silencing. This study is a comprehensive review of the main inflammation related miRNAs in obesity/obesity related traits. For the first time, the main roles of miRNAs in obesity related cancers have been discussed in response to the question raised in the following hypothesis; do the main inflammatory miRNAs link obesity with obesity-related cancers regarding their role as biomarkers? Graphical abstractConceptual design of inflammatory miRNAs which provide link between obesity and cancers.

Introduction: Renal colic is caused by colicky spasms of ureters. As has been shown in previous experiments, glycerol trinitrate (TNG) can inhibit these muscular spasms. Objective: This study was performed to assess the pain relieving effect of TNG among patients referred due to renal colic pain to the emergency department (ED). Methods: This study is a randomized, placebo-controlled study on 60 patients with renal colic who were referred to the ED, who were diagnosed clinically to have renal colic, and their pain was more than 5 based on a visual analogue scale (VAS). The patient's pain was recorded at the moment of clinical diagnosis, and each one received one capsule, either 0.4 mg TNG or placebo, plus a 100 mg indomethacin suppository. The pain score was re-assessed after 5 and 30 min. The values were recorded and compared using SPSS-16 software. Results: Sixty patients with a mean age of 35.75 ± 11.99 years were enrolled (73.3% male). Patients in the two groups were matched for age (p = 0.290), sex (p = 0.559), and the presence of microscopic hematuria (p = 0.292). Pain relief from the start point until the end of the intervention was statistical different in all studied patients (p < 0.05); but the comparison between the two groups showed no significant difference in this regard (p = 0.440). Conclusion: It is likely that adding TNG to an indomethacin suppository had no significant effects on better pain management of patients referred with renal colic to the ED.

The idea of using the colon to replace a resected esophagus has a long history. The colon has become a favored organ for esophageal reconstruction in adults with esophageal cancer when the stomach is not suitable or is unavailable. In this article, we introduce an 84-year-old woman that she had surgery 40 years ago and presented with an invasive well differentiated squamous cell carcinoma of colonic origin in reconstructed esophagus.

Background: Distinguishing low-grade from high-grade gliomas can aid in optimal treatment planning and prognostication. Diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) have been applied in several studies for non-invasive glioma grading. However, these studies focused on limited aspects of these imaging techniques and used different study setups, resulting in occasionally inconsistent and incomparable conclusions in the literature. Objectives: This study was designed to introduce the optimal imaging setup and the most reliable and applicable imaging parameters in glioma grading, using DWI and MRS. Patients and Methods: During this prospective study, using a 3T-MR scanner, 55 glioma patients underwent brain MRS with short, intermediate, and long echo times (TEs), as well as DWI using low, intermediate, and high b-values. Postoperatively, all of the specimens were graded pathologically using light microscopy. Results: We found that Max (Chol/Cr)/ Min (NAA/Cr) ((maximum choline to creatine ratio)/(minimum N-acetyl aspartate to creatine ratio)), followed by Max (Chol/ Cr), both in long-TE, were the most reliable metabolite ratios on MRS for accurate glioma grading. These had values for area under the curve (AUC) of 0.92 (P < 0.05) and 0.89 (P = 0.001), respectively, compared to conventional MR imaging (cMRI), which had an AUC of 0.83 (P < 0.05). DWI at maximal accuracy showed an AUC of 0.80 (P < 0.05). Conclusion: Max (Chol/Cr)/Min (NAA/Cr) in long-TE was the most reliable of all of the MRS parameters studied, while DWI showed no superiority over cMRI in glioma grading. No significant differences existed among the various b-values applied, or between the minimum and mean tumor apparent diffusion coefficient values used in DWI-based glioma grading.

Heterotaxy syndrome with polysplenia is a congenital abnormality with malposition of the visceral organs and multiple associated abnormalities. The majority of affected individuals die during childhood due to severe cardiovascular anomalies. However, affected individuals who reach adulthood are usually asymptomatic. Anomalies of the abdominal venous system, including interruption of the inferior vena cava with azygos or hemiazygos continuation, congenital absence of the portal vein with a portosystemic shunt, preduodenal portal vein, and abnormalities of renal veins are frequent findings. Heterotaxy syndrome usually has no clinical significance except in the setting of planned vascular intervention or surgery. We are reporting an extremely rare case of heterotaxy syndrome (polysplenia) that presented with massive variceal hemorrhage due to associated venous malformation and systemic to portal venous system collaterals.

Background: Constant monitoring of Helicobacter pylori resistance is necessary for selection of the best treatment regimen for eradication of the resistant strains. Objectives: The aim of this study was to investigate diversity of resistance and minimum inhibitory concentration (MIC) of H. pylori strains against metronidazole in Tehran, Iran. Patients and Methods: This cross-sectional study was performed among 96 patients, who had undergone gastric endoscopy at Imam Khomeini hospital in Tehran, during years 2013 to 2014. Helicobacter pylori isolates were obtained from gastric biopsy sam- ples on selective culture media after characterization by conventional biochemical tests and polymerase chain reaction. Minimum inhibitory concentration of metronidazole was determined by the agar dilution method. Results: Helicobacter pylori infection was detected in 22 patients (22.92%). Identity of the isolates was confirmed by PCR using glmM primers. Chronic gastritis, duodenitis, intestinal metaplasia, dysplasia and cancer were detected among 70.1%, 6.25%, 1.04%, 1.4% and 10.41% of the patients, respectively. Smoking showed a negative relationship with H. pylori infection. The rate of antibiotic resistance was 81.8% (18/22) and MIC ranges of 8 to 512 g/mL were detected. Furthermore, MIC50 and MIC90 were determined as 256 and 512 g/mL, respectively. Conclusions: In conclusion, these results suggested a need for a switch to second line therapy regimens for treatment of infected patients in the Iranian population.

Background. Helicobacter pyloriis highly adapted to the gastric environment where it lives within or beneath the gastric mucous layer. The aim of this study was to evaluate whether the addition of N-acetyl cysteine to the treatment regimen ofH. pyloriinfection would affect eradication rates of the disease.Methods.A total of 79H. pyloripositive patients were randomized to two therapeutic groups. Both groups received a 14-day course of three-drug regimen including amoxicillin/clarithromycin/omeprazole. Experimental group (38 subjects) received NAC, and control group (41 subjects) received placebo, besides three-drug regimen.H. pylorieradication was evaluated by urea breath test at least 4 weeks after the cessation of therapy.Results.The rate ofH. pylorieradication was 72.9% and 60.9% in experimental and control groups, respectively (P=0.005). By logistic regression modeling, female gender (OR 3.68, 95% CI: 1.06–5.79;P=0.040) and treatment including NAC (OR 1.88, 95% CI: 0.68–3.15;P=0.021) were independent factors associated withH. pylorieradication.Conclusion.The results of the present study show that NAC has an additive effect on the eradication rates ofH. pyloriobtained with three-drug regimen and appears to be a promising means of eradicatingH. pyloriinfection.

A rare adult case of absent azygos vein associated with polysplenia syndrome who was admitted due to pulmonary emboli is presented, image findings are described and embryological bases of venous abnormalities and its association with coagulopathy is discussed via reviewing literatures.

Fibrodysplasia ossificans progressiva (FOP) is a rare catastrophic genetic condition of extraskeletal (heterotopic) ossification. One in every two million people is affected worldwide, with no ethnic, racial, gender, or geographic predisposition. Most cases of FOP arise from a spontaneous missense mutation in the gene encoding bone morphogenic protein (BMP) type II receptor (ACVR1/ALK2). Affected individuals are normal at birth apart from malformed great toes. Onset of clinical symptoms is usually in the first decade of life, presenting with episodic emergence of painful rapidly appearing tumor-like soft tissue swellings (flare-ups). Heterotopic bone replaces the skeletal muscles, tendons, ligaments, and connective tissue at the site of the damage through a process of endochondral ossification, causing fixation of joints and permanent limitation of motion. Most affected individuals are confined to wheelchair in the third decade of life. Worldwide rate of misdiagnosis of FOP is very high; clinicians often fail to associate the two classic clinical features of FOP: rapidly developing soft tissue swellings and the abnormal great toes. The current case presents a previously undiagnosed 39-year-old FOP patient, sadly a victim of lack of clinical awareness of this rare condition. As a result of repetitive iatrogenic harm, he has tragically "turned into stone."

Background: Approach to the small intestine has been difficult even with newer methods. Double-balloon enteroscopy (DBE) has been created for diagnostic and therapeutic interventions in diseases of the small intestine. Small intestinal diseases have different etiologies in each country. The DBE has been introduced in recent years in Iran. Our aim was to study the indications and results of DBE in some academic centers in Iran. Methods: Fifty-five patients with symptoms and signs related to small intestine without definitive diagnosis but with previous workup were enrolled in the study. The DBE was performed in three different medical universities in Iran. Results: The mean age of the patients that underwent the DBE was 47.2 ± 17.3 years. Abdominal pain (54.5%) and occult gastrointestinal bleeding (23.6%) were the most common presentations. Small bowel lesions were detected in 26 patients (47.3%); the most common lesions were ulcer (46.2%) and polyps (19.2%). Crohn’s disease (12.7%) was the commonest diagnosis found in DBE procedure. Patients presenting with abdominal pain orl ower hemoglobin level were more likely to be diagnosed (both p≤ 0.05). Small intestinal diseases were ultimately diagnosed in 47.3% of the patients. Twenty percent of the patients had another disease outside the small bowel. Conclusions: DBE is an effective and relatively safe diagnostic and therapeutic option for small bowel evaluations. Accurate selection of patients and more experience technicians and physicians will improve the efficacy of this procedure in Iran.

A lost guidewire is a hazardous, yet completely preventable, and rare complication associated with central venous catheter insertion. Here, we report a case of a lost guidewire in a patient presented with persistent abdominal pain. The guidewire was retrieved completely during a surgical operation after the diagnosis had been confirmed by radiologic studies. Following some tips during insertion of a central venous catheter will help to prevent this mortal complication or at least, in rapid diagnosis of its loss. Interventional radiologic techniques are now readily used to retrieve a lost guidewire.

A 2-year-old child presented to the emergency department after a car accident while crossing the street. He had normal primary trauma survey on arrival. On secondary survey besides scattered abrasions especially on his back and small laceration on pinna, there were several petechial haemorrhages of the face and the subconjunctival tissue with …