Assemblage characterization of Giardia duodenalis in South Khorasan province, eastern Iran, using HRM real-time PCR method.

BACKGROUND: Giardia duodenalis is a common parasitic protozoan causing gastrointestinal illness in humans worldwide. The genetic diversity of G. duodenalis is reflected through the identification of different assemblages. In this study, we aimed to determine the assemblages of G. duodenalis in eastern Iran using nested-PCR and high-resolution melting (HRM) real-time PCR methods. METHODS: A total of 58 positive G. duodenalis, which were isolated from 1800 subjects, referred to medical center laboratories in South Khorasan province, eastern Iran, from April 2020 to March 2022, were included in this study. DNA was extracted and HRM real-time PCR was performed for assemblage characterization. RESULTS: HRM real-time PCR successfully characterized all samples. Accordingly, out of 58 positive samples, 53 (91.36%) and 5 (8.62%) were identified as assemblage A and B, respectively. CONCLUSIONS: Our findings showed that HRM real-time PCR was able to characterize the assemblages of G. duodenalis. In addition, our results suggest high prevalence of assemblage A in eastern region of Iran.

Classification and Diagnostic Prediction of Colorectal Cancer Mortality Based on Machine Learning Algorithms: A Multicenter National Study.

INTRODUCTION: Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths. This study aimed to predict survival outcomes of CRC patients using machine learning (ML) methods. MATERIAL AND METHODS: A retrospective analysis included 1853 CRC patients admitted to three prominent tertiary hospitals in Iran from October 2006 to July 2019. Six ML methods, namely logistic regression (LR), Naïve Bayes (NB), Support Vector Machine (SVM), Neural Network (NN), Decision Tree (DT), and Light Gradient Boosting Machine (LGBM), were developed with 10-fold cross-validation. Feature selection employed the Random Forest method based on mean decrease GINI criteria. Model performance was assessed using Area Under the Curve (AUC). RESULTS: Time from diagnosis, age, tumor size, metastatic status, lymph node involvement, and treatment type emerged as crucial predictors of survival based on mean decrease GINI. The NB (AUC = 0.70, 95% Confidence Interval [CI] 0.65-0.75) and LGBM (AUC = 0.70, 95% CI 0.65-0.75) models achieved the highest predictive AUC values for CRC patient survival. CONCLUSIONS: This study highlights the significance of variables including time from diagnosis, age, tumor size, metastatic status, lymph node involvement, and treatment type in predicting CRC survival. The NB model exhibited optimal efficacy in mortality prediction, maintaining a balanced sensitivity and specificity. Policy recommendations encompass early diagnosis and treatment initiation for CRC patients, improved data collection through digital health records and standardized protocols, support for predictive analytics integration in clinical decisions, and the inclusion of identified prognostic variables in treatment guidelines to enhance patient outcomes.

The triglyceride-glucose index as a clinical useful marker for metabolic associated fatty liver disease (MAFLD): a population-based study among Iranian adults.

Background and aims: There is a bi-directional association between non-alcoholic fatty liver disease (NAFLD) and insulin resistance in type 2 diabetes mellitus (T2DM) and metabolic syndrome. The triglyceride-glucose (TyG) index is a novel surrogate marker of insulin resistance. In this population-based study, we aimed firstly to investigate the association of the TyG-index with metabolic-associated fatty liver disease (MAFLD) risk. Methods: This case-control study used the data from the first phase of the Persian Cohort Study in Sabzevar. Of 4,241 participants aged 35 to 70 years, we identified and recruited 968 MAFLD cases and 964 age- and sex-adjusted controls. Demographic, lifestyle, anthropometric, and biochemical information were collected. We calculated TyG and a new index combined of TyG and alanine aminotransferase (TyG-ALT). We used the multivariable unconditional logistic regression model to calculate the odds ratios (ORs) of the TyG and TyG-ALT for having MAFLD. Results: Among those in the highest relative to the lowest TyG and TyG-ALT tertiles, the multivariable-adjusted ORs were 12.01 (95% CI [confidence interval] 9.03 - 15.98; P trend < 0.001) and 10.89 (95% CI 7.66 - 15.48; P trend = 0.001), respectively. The area under the curves (AUC) for the TyG-index to predict MAFLD was 8.62, resulting in a cut-off value of 8.62 with a sensitivity of 81.66% and specificity of 75.36%. Conclusions: The higher TyG and TyG-ALT scores were significantly positively associated with higher MAFLD risk in the Iranian population.

Dietary and Lifestyle Inflammation Scores Are Inversely Associated with Metabolic-Associated Fatty Liver Disease among Iranian Adults: A Nested Case-Control Study.

BACKGROUND: Diet and lifestyle may affect risk for metabolic-associated fatty liver disease (MAFLD) by chronically elevating systemic inflammation. OBJECTIVES: In this study we investigated the separate and joint associations of dietary and lifestyle inflammation scores (DIS and LIS, respectively) with MAFLD risk. METHODS: For this nested case-control study we identified and recruited 968 patients with MAFLD (defined as having a fatty liver index ≥60 plus ≥1 of the following conditions: overweight or obese, type II diabetes mellitus, evidence of metabolic dysregulation) and 964 controls from among 35-70-y-old men and women in the baseline phase of the Sabzevar Persian Cohort Study. We collected demographic, lifestyle, anthropometric, biochemical, and dietary intake information (via a validated FFQ) from which we calculated a circulating inflammation biomarker-weighted, predominantly whole foods and beverages-based, 19-component DIS and a 3-component LIS. We estimated DIS- and LIS-MAFLD associations using multivariable unconditional logistic regression. We also calculated equal-weight DIS and LIS to capture all potential mechanisms (inflammation plus other mechanisms) for associations of diet and lifestyle with MAFLD risk. RESULTS: Among those in the highest relative to the lowest DIS and LIS tertiles, the multivariable-adjusted ORs and their 95% CIs were OR: 1.84; 95% CI: 1.61, 2.07; Ptrend < 0.001, and OR: 1.96; 95% CI: 1.69, 2.21; Ptrend < 0.001, respectively. For those in the highest relative to the lowest joint DIS and LIS tertile, the values were OR: 2.56; 95% CI: 2.19, 2.93; Pinteraction < 0.001. The findings were similar by sex. The third tertile values for the equal-weight DIS- and LIS-MAFLD associations were OR: 1.87; 95% CI: 1.41, 2.34; and OR: 2.16; 95% CI: 1.85, 2.46, respectively. CONCLUSIONS: Our results suggest that higher balances of pro- relative to anti-inflammatory dietary and lifestyle exposures, separately and especially jointly, may be associated with higher MAFLD risk among adults. Also, inflammation may be the primary mechanism through which diet affects MAFLD risk.

Prevalence of celiac disease in patients with atypical presentations.

BACKGROUND AND STUDY AIMS: Unawareness about atypical forms of celiac disease (CD) leads to the underdiagnoses of CD. This study has investigated the prevalence of CD in patients with atypical presentations, such as idiopathic low bone mineral density (ILBMD) and dyspepsia, in the Iranian population. PATIENTS AND METHODS: Two separate groups of patients who have been diagnosed with dyspepsia and ILBMD (including either osteopenia or osteoporosis of unknown cause) were screened for CD during 2016-2019. Patients were serologically screened by means of IgA anti-tissue transglutaminase (IgA anti-tTG); in case of positive results, the patients underwent endoscopic intestinal biopsy to confirm the diagnosis of CD. RESULTS: Of 200 patients with ILBMD, six (3%) had a positive result for IgA anti-tTG; in five cases (2.5%), duodenal histology confirmed the CD diagnosis. Of 290 patients with dyspepsia, 25 (8.6%) had a positive result for anti-tTG IgA; nine cases (3.7%) were histologically compatible with CD. No significant differences were found between the two groups of patients. CONCLUSIONS: The prevalence of CD in patients with atypical presentations, such as ILBMD and dyspepsia, is consistent (pvalue = 0.788) and higher than that in the general population (p value = 0.001); therefore, screening program for CD in these patients is highly recommended.

Predictors of metabolic-associated fatty liver disease (MAFLD) in adults: a population-based study in Northeastern Iran.

AIM: This study aimed to identify the risk factors of metabolic (dysfunction)-associated fatty liver disease (MAFLD) among adults in northeastern Iran. BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and hepatic manifestation of metabolic syndrome that threatens global public health. Recently, MAFLD has been proposed as a new terminology updated from NAFLD and diagnosed based on modified criteria. METHODS: A nested case-control study was performed on the participants of the first phase of the Persian Sabzevar Cohort Study (PSCS), a survey that was conducted in northeastern Iran and enrolled 4,242 participants aged 35-70 years. In total, 968 MAFLD cases and 964 controls adjusted for age and sex were recruited. Data including demographic, lifestyle, anthropometric, biochemical, sleep pattern, and dietary intake information was collected. RESULTS: The mean (SD [standard deviation]) age of participants was 49.2 (8.8) years, and 39.9% of the participants were males. The prevalence of MAFLD was 22.8% (95% CI [confidence interval] 19.2 - 26.3%). Increased body mass index (BMI) (OR [odds ratios] 5.51, 95% CI 2.73 - 11.10), waist circumference (WC) (OR 1.85, 95% CI 1.44 - 2.38), blood concentrations of triglycerides (TG) (OR 1.10, 95% CI 1.06 - 1.15), total cholesterol (TC) (OR 1.02, 95% CI 1.003 - 1.04), and alanine aminotransferase (AST) (OR 1.10, 95% CI 1.05 - 1.16) were significantly associated with an increased risk of the MAFLD (p-value <0.05). Furthermore, the odds of MAFLD risk was 43% higher in subjects who slept ≤ 5 hrs/day than those with ≥ 7 hrs per day of sleep (OR 1.43; 95% CI 1.07 - 1.92, p-value = 0.01). CONCLUSION: In this study, it was found that MAFLD was best predicted by BMI, WC, and serum levels of TG, total cholesterol, and AST. Sleeping ≤ 5hrs/day compared to ≥ 7hrs/day was associated with an increased risk of MAFLD.

The effect of an educational intervention based on the theory of planned behavior on childbearing intentions in women: A quasi-experimental study.

BACKGROUND: Childbearing is an important biological and social event in the life of most women. It is a voluntary behavior that can be affected by many factors. Behavioral theories are a potential path way to study and influence childbearing behavior. The present study was conducted to determine the effect of an educational intervention based on the theory of planned behavior (TPB) on childbearing intentions in women presenting to premarital counseling centers in Tehran. MATERIALS AND METHODS: This randomized controlled quasi-experimental study was conducted on 150 women aged 20-35 years presenting to premarital counseling centers. The participating women were randomly divided into an intervention (n = 75) and a control (n = 75) group using randomized sampling in Excel. The intervention group received two 90-min sessions of training. The effect of training was assessed 6 weeks after the intervention using the researcher-made questionnaire based on the components of the TPB. The questionnaires included subjects' demographic details, knowledge (11 items), attitude (13 items), subjective norms (10 items), perceived behavioral control (8 items), and behavioral intention (4 items). Data were analyzed by SPSS software (version 22) and independent t-test, Chi-square, Mann-Whitney U-test, and Wilcoxon test. P <0.05 was considered statistically significant. RESULTS: There were significant differences between the intervention and control group after the intervention in the Mean ± SD scores of knowledge (6.73 ± 2.63 vs. 4.73 ± 2.85, P = 0.001), attitude (48.23 ± 7.19 vs. 40.13 ± 5.80, P = 0.001), perceived behavioral control (33.19 ± 5.28 vs. 23.59 ± 3.47, P = 0.001), and behavioral intention (13.84 ± 2.95 vs. 11.77 ± 2.12, P = 0.027). CONCLUSION: The findings showed that an education based on the TPB increased women's childbearing intentions by affecting their knowledge, attitude, perceived behavioral control, and intention. It is therefore essential to implement better public policies, create a more conducive educational setting for women of different age groups, and build a social support system.

Patterns of clustering of the metabolic syndrome components and its association with coronary heart disease in the Multi-Ethnic Study of Atherosclerosis (MESA): A latent class analysis.

BACKGROUND: The Metabolic syndrome (MetS), refers to one of the most challenging public health issues across the world. The aim of this study was to explore the clusters of participants on the basis of MetS components and determine its effect on coronary heart disease (CHD). METHODS: This study used the information from Multi-Ethnic Study of Atherosclerosis (MESA). MESA was performed at 6 US sites and was a population-based cohort study of 6776 adults (3576 females; 3200 males), aged 45 to 84 years. The participants were free of clinical cardiovascular disease at baseline. Latent class analysis (LCA) was conducted to achieve the study's objectives. The outcome variable was CHD during the study period (2000-2012). RESULTS: The prevalence of all Mets components (except triglyceride (TG) and fasting blood glucose (FBS)) is more common in females than in males. Three latent classes were recognized: (1) Non-MetS, (2) low risk, and (3) MetS. Notably, MetS latent class included 29.88% and 35.38% in females and males, respectively. After adjustment for covariates (e.g. demographic, biomarker etc.), MetS latent class showed a positive association with CHD events in both genders. CONCLUSIONS: Results showed that clustering pattern of the MetS components, as well as the association between latent classes and risk of incident CHD events, are different in females and males. Notable percentages of individuals are in the MetS class, which emphasizes the necessity of implementing preventive interventions for this sub-group of the population.

Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study.

BACKGROUND: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The incidence of post-ERCP pancreatitis (PEP) ranges between 15 and 20% among patients at high risk of developing PEP. The efficacy of indomethacin administration in the prevention of PEP is rather debatable. In the present randomized trial study, we evaluated whether or not the combination of indomethacin and epinephrine in comparison to the single administration of indomethacin differs in the pathogenesis and prevention of post-ERCP pancreatitis. PATIENTS AND METHODS: One hundred and ninety-two patients were randomized in a double-blinded manner into 3 groups: the epinephrine group (group A), the indomethacin group (group B), and the combined epinephrine and indomethacin group (group C). After the procedure, patients were evaluated for the PEP development. RESULTS: During the procedure, 66 patients were randomized to the epinephrine group (group A), 68 cases to the indomethacin group (group B), and 58 individuals to the indomethacin-epinephrine group (group C). The mean age of patients in the epinephrine group was 59.59 ± 15.680 years, in the indomethacin group it was 58.06 ± 17.125 years, and in the combination group it was 59.62 ± 15.369 years. In the present study, we did not observe a significant difference between the 3 groups in sex, age, pre-ERCP amylase, lipase, and patient and procedure risk factors including pancreatic duct (PD) dilation (p = 0.404), PD cannulation (p = 0.329), and difficult cannulation (p = 0.076) among others. PEP developed in 7 of the 192 individuals (3.6%), 6 PEP cases occurred in the indomethacin group and 1 in the epinephrine group (p = 0.016). Univariate analysis of risk factors for PEP in patients with and without pancreatitis revealed no significant difference between the pancreatitis group and the non-pancreatitis group. CONCLUSION: In comparison to the administration of indomethacin alone, a single application of epinephrine and the combination of epinephrine and indomethacin seem to be effective in reducing the cases of PEP. A further randomized clinical trial with a larger sample size is required to confirm the efficacy of our medication in the prevention of pancreatitis after ERCP.

Genetic diversity analysis of Blastocystis subtypes from both symptomatic and asymptomatic subjects using a barcoding region from the 18S rRNA gene.

Blastocystis is the most prevalent protozoa found in human stool samples. This study aimed to evaluate genetic diversity among Blastocystis subtypes isolated from both symptomatic and asymptomatic subjects as well as the potential correlation between subtypes and symptoms. A total of 55 Blastocystis-positive isolates were included in this study. A barcoding region of the small subunit rDNA was amplified and genetically assessed using MEGA6 and DnaSP regarding the presence of symptoms. BLAST analyses revealed the presence of 5 different subtypes (ST1, ST2, ST3, ST6 and ST7) among the samples. ST3 was the most prevalent subtype (25/55, 45%) while only one ST7 isolate was detected. Moreover, alleles 4 and 86 for ST1; alleles 9, 11 and 12 for ST2; alleles 31, 34, 36, 37 and 52 for ST3; allele 122 for ST6 and allele 137 for ST7 were detected. No statistically significant association was found between gender and symptoms with certain subtypes. Analysis of the intra-subtype variability in both symptomatic and asymptomatic subjects revealed highest similarity among ST1 isolates while lowest similarity was seen among ST3 isolates. Neutrality indices, Tajima's D and Fu's Fs, were negative but only statistically significant for ST3. Furthermore, highest values of Hd, π and S were observed among ST1, ST2 and ST3 isolated from symptomatic patients indicating high level of diversity among isolates obtained from these subjects. In addition, inter-subtype analysis showed the highest similarity between ST1 and ST2 isolates and the lowest similarity between ST2 and ST7 isolates. This is the first study revealing the presence of both ST6 and ST7 isolates in human from Iran. Phylogenetic analysis did not suggest any significant correlation between clinical manifestations and certain subtypes although genetic analysis showed highest value of diversity and significant neutrality indices among ST3 isolates obtained from symptomatic patients.

Metabolic syndrome prevalence in the Iranian adult's general population and its trend: A systematic review and meta-analysis of observational studies.

AIMS: Metabolic syndrome (MetS) is one of the most important predictors of CVD. Determining the trend of MetS, represents the trend of its components and consequently could forecast the incidence of related diseases particularly CVD. The main object of this study is describing the trend of MetS prevalence in both male and female. MATERIALS AND METHODS: Original research studies from March 21, 2005 to March 20, 2015 that were published in English database and Persian databases were included in the systematic review. The random effect model was used to estimate the pooled prevalence of MetS. Subgroup analyses, to portray the trend of MetS, conducted based on implementation year. RESULTS: The total sample sizes for males using the criteria of ATP III and IDF were 30012 and 35064, and for female were 14572 and 16292. The pooled estimation of MetS prevalence in total, male, and female population according to ATP III was 28%, 23%, and 33%; for IDF definitions was 28%, 22%, and 33%. Moreover, according to meta-regression for ATP III the most important source of heterogeneity was mean age. CONCLUSION: The findings revealed the trend of MetS prevalence is declining although steady in the last 10 years.

The effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women.

BACKGROUND: Nipple fissure is a common problem in breastfeeding women, and the main reason for the early discontinuation of breastfeeding. OBJECTIVE: To determine the effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women. METHODS: This randomized clinical trial was conducted on 100 subjects admitted to the health centers in Tehran, Iran from mid-July to mid-November 2015. The subjects were randomly divided into two equal groups of 50 for the Saqez ointment group and the control group. The subjects were divided into the two groups through random allocation in Excel. The subjects were monitored on day 1, 3 and 7. Data were analyzed in SAS using the Cumulative Logit model and in SPSS-21 using Mann-Whitney, independent-samples t-test, the Chi square and Fisher's exact test. RESULTS: No significant differences were observed between the two groups in terms of their demographic and fertility characteristics. The Cumulative Logit model showed that high levels of nipple fissure and pain were significantly less frequent in the Saqez group compared to the control group (p<0.001). There was about 83% reduction in the severity of fissure and 85 %in the severity of pain in the Saqez group compared to the control group (p<0.001). CONCLUSION: Saqez ointment is more effective in the treatment of nipple fissures and pain than breast milk. As this study was done for the first time, judgment about the conclusive efficacy of Saqez ointment on the nipple fissure, needs further similar studies. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015080723535N1. FUNDING: The authors received no financial support for the research, authorship, and/or publication of this article.

Association Between Socioeconomic Status and Participation in Colonoscopy Screening Program in First Degree Relatives of Colorectal Cancer Patients.

BACKGROUND: Approximately 15% to 25% of colorectal cancer (CRC) cases have positive family history for disease. Colonoscopy screening test is the best way for prevention and early diagnosis. Studies have found that first degree relatives (FDRs) with low socioeconomic status are less likely to participate in colonoscopy screening program. OBJECTIVES: The aim of this study is to determine the association between socioeconomic status and participation in colonoscopy screening program in FDRs. PATIENTS AND METHODS: This descriptive cross-sectional, study has been conducted on 200 FDRs who were consulted for undergoing colonoscopy screening program between 2007 and 2013 in research institute for gastroenterology and liver disease of Shahid Beheshti University of Medical Sciences, Tehran, Iran. They were interviewed via phone by a valid questionnaire about socioeconomic status. For data analysis, chi-square, exact fisher and multiple logistic regression were executed by SPSS 19. RESULTS: The results indicated 58.5% participants underwent colonoscopy screening test at least once to the time of the interview. There was not an association between participation in colonoscopy screening program and socioeconomic status to the time of the interview in binomial analysis. But statistical significance between intention to participate and educational and income level were found. We found, in logistic regression analysis, that high educational level (Diploma and University degree in this survey) was a predictor to participate in colonoscopy screening program in FDRs. CONCLUSIONS: According to this survey low socioeconomic status is an important factor to hinder participation of FDRs in colonoscopy screening program. Therefore, planned interventions for elevation knowledge and attitude in FDRs with low educational level are necessary. Also, reducing colonoscopy test costs should be a major priority for policy makers.

Low Level of Microsatellite Instability Correlates with Poor Clinical Prognosis in Stage II Colorectal Cancer Patients.

The influence of microsatellite instability (MSI) on the prognosis of colorectal cancer (CRC) requires more investigation. We assessed the role of MSI status in survival of individuals diagnosed with primary colorectal cancer. In this retrospective cross-sectional study the MSI status was determined in 158 formalin-fixed paraffin-embedded tumors and their matched normal tissues from patients who underwent curative surgery. Cox proportional hazard modeling was performed to assess the clinical prognostic significance. In this study we found that MSI-H tumors were predominantly located in the colon versus rectum (p = 0.03), associated with poorer differentiation (p = 0.003) and TNM stage II/III of tumors (p = 0.02). In CRC patients with stage II, MSI-L cases showed significantly poorer survival compared with patients who had MSI-H or MSS tumors (p = 0.04). This study indicates that MSI-L tumors correlate with poorer clinical outcome in patients with stage II tumors (p = 0.04) or in tumors located in the colon (p = 0.02). MSI-L characterizes a distinct subgroup of CRC patients who have a poorer outcome. This study suggests that MSI status in CRC, as a clinical prognostic marker, is dependent on other factors, such as tumor stage and location.

Association of Sick Building Syndrome with Indoor Air Parameters.

BACKGROUND: Energy crisis in 1973 led to smaller residential and office buildings with lower air changes. This resulted in development of Sick Building Syndrome (SBS). The objective of this study was to assess the association of SBS with individual factors and indoor air pollutants among employees in two office buildings of Petroleum Industry Health Organization in Tehran city. MATERIALS AND METHODS: The association between personal and environmental factors and SBS symptoms was examined by a reliable and valid combined questionnaire. Environmental parameters were measured using calibrated instruments. RESULTS: The results suggested that SBS symptoms were more common in women than men. Malaise and headache were the most common symptoms in women and men. Throat dryness, cough, sputum, and wheezing were less prevalent among employees in both offices. Light-intensity was significantly associated with some symptoms such as skin dryness (P = 0.049), eye pain (P = 0.026), and malaise (P = 0.043). There were no significant differences in prevalence of SBS symptoms between female workers of the two offices (P>0.05). CONCLUSION: The main causes of SBS among the employees were recycling of air in rooms using fan coils, traffic noise, poor lighting, and buildings located in a polluted metropolitan area.

Effect of vitamin D3 supplementation on TNF-α serum level and disease activity index in Iranian IBD patients.

AIM: The aim of the study was to assess the effectiveness of vitamin D3 [1, 25(OH)2D3] treatment in IBD with regard to tumor necrosis factor-alpha (TNF-α) serum level and clinical disease activity index (CDAI). BACKGROUND: Vitamin D has immune-regulatory functions in experimental inflammatory bowel disease (IBD) and vitamin D deficiency is common in IBD patients. PATIENTS AND METHODS: This was a randomized clinical trial on 108 IBD patients with serum 25-OHD levels less than 30ng/ml, which divided into vitamin D and control groups. Vitamin D group received 50000 IU vitamin D3 for 12 weeks. Before and after the study, TNF-α and 25-OHD serum levels were measured by ELISA method. Data were analyzed using paired t-test, chi-square test and Spearman correlation coefficient. P-values ​​less than 0.05 were considered statistically significant. RESULTS: Before the intervention no significant difference was found between baseline characteristics and TNF-α serum level of two groups. After intervention TNF-α serum level reduced but this reduction was not statistically significant (p= 0.07, 95% CI: -0.45 to 8.14). The mean serum 25-OHD level of vitamin D increased from 15.54 to 67.89, which was statistically significant (p= 0.00, 95% CI: -61.40 to -43.30). TNF-α level was also associated significantly with CDAI before (Spearman's rho: 0.3, p<0.0001) and after (Spearman's rho: 0.27, P=0.01) intervention. CONCLUSION: Oral supplementation vitamin D3 significantly increased serum vitamin D levels and insignificantly reduced serum TNF-α level. More studies with larger samples would be beneficial to assess vitamin D3 supplementation efficient effect in IBD.

Effect of a Combination of Omeprazole Plus Sustained Release Baclofen Versus Omeprazole Alone on Symptoms of Patients with Gastroesophageal Reflux Disease (GERD).

Previous studies have reported the efficacy of baclofen in the treatment of Gastroesophageal Reflux Diseases (GERD). The objective of present study is to evaluate the effect of co-administration of omeprazole 20 mg/d plus sustained Release baclofen (SR baclofen) vs. omeprazole 20 mg/d plus placebo on alleviation of symptoms in patients with a diagnosis of GERD. A prospective, double blind, placebo controlled trial included 60 patients with diagnosis of GERD have been done. Patients were randomly selected to receive either SR baclofen or a placebo in addition to omeprazole 20 mg/d for a period of 2 weeks. Patients were questioned regarding heartburn, regurgitation, chest pain and hoarseness at the base line and after 2 weeks. All patients tolerated the medications and no patients failed to complete the study due to adverse drug reactions. A total of 53 patients completed the study, 25 in SR baclofen and 28 in placebo group. After 2 weeks, 1 patient (4%) in SR baclofen group reported heartburn and regurgitation. However 13(46.4%) and 15 (53.6%) of patients in the placebo group had heartburn and regurgitation respectively. The analysis of the data shows that there is a significant difference between the two groups in heartburn and regurgitation (p < 0.0001, p < 0.0001 respectively). Statistical analysis revealed a significant difference in two groups regarding total GERD score (p <0.0001). The results of the present study suggest that a combination of SR baclofen and omeprazole may be a more effective treatment for heartburn and regurgitation than omeprazole alone.

Estimation of diagnosis and treatment costs of non-alcoholic Fatty liver disease: a two-year observation.

BACKGROUND: There are insufficient data available on utilization and health care costs of non-alcoholic fatty liver disease. The cost data for different health conditions and services is a major gap in Iranian health system. So this study is the primary or first step towards filling this gap. OBJECTIVES: This study aims to estimate the diagnosis and treatment costs of Non-alcoholic Fatty Liver. PATIENTS AND METHODS: This cross-sectional study was conducted on 528 subjects. The subjects had been diagnosed with non-alcoholic fatty liver. All the subjects had been referred to the Tehran Fatty Liver Clinic, a clinic of the Baqiyatallah Research Center for Gastroenterology and Liver Diseases, in 2009 and they had been observed for 2 years to determine the frequency of health care utilization (physician visit, laboratory tests, medication and cost of sonography). The costs of diagnosis and treatment for each person were estimated in Purchasing Power Parity dollars (PPP$). RESULTS: The average total cost was 5,043 PPP$ per person in the 2 years of observation. Majority of these 528 patients (87.9%) had a BMI ≥ 25 (kg/m2). Also, 33.9% were diagnosed with comorbid diseases such as Diabetes Mellitus (DM), Coronary Artery Disease (CAD), hypertension (HTN) and hypothyroidism (HYPO). CONCLUSIONS: The results confirmed that the total costs for non-alcoholic fatty liver among the Iranian adult urban population alone exceeded 1 billion PPP$ per year. These costs can be saved or reduced by effective disease management and early prevention.

Direct medical care costs associated with patients diagnosed with chronic HCV.

BACKGROUND: HCV virus (HCV) is a significant global problem with wide-ranging socio-economic impacts. Because of the high morbidity and mortality associated with end-stage liver disease, cirrhosis, and hepatocellular carcinoma (HCC), the economic burden of HCV infection is substantial. OBJECTIVES: This study aimed to estimate the direct medical care costs of chronic HCV infection. PATIENTS AND METHODS: For this cross-sectional study, 365 courses of HCV treatment were extracted from medical records of 284 patients being referred to Tehran HCV clinic, a clinical clinic of Baqiyatallah Research Center for Gastroenterology and Liver diseases, from 2005 to 2010. All the patients had been diagnosed with HCV. Direct medical care costs for each course of HCV treatment have been calculated based on Purchasing Power Parity Dollar (PPP$). RESULTS: Average direct medical costs for the courses treated with conventional interferon plus ribavirin (INF-RBV) were 4,403 PPP$, and 20,010 PPP$ for peg-interferon plus ribavirin (PEG-RBV) courses. There was an increase of the direct costs in both courses of treatment to achieve Sustain Viral Response (SVR). The costs amounted to 10,072 PPP$ in (INF-RBV) treatment and 34,035 PPP$ in (PEG-RBV). The significant difference between the costs of these two courses of treatment is attributable to high cost of Peg-interferon. This indicates that the medication costs are the dominant costs. CONCLUSIONS: According to the results, total direct medical costs for HCV patients in Iran exceeded 12 billion PPP$ in (INF-RBV) treatment and 55 billion PPP$ in (PEG-RBV).

Seroepidemiology of hepatitis A and E virus infections in Tehran, Iran: a population based study.

Hepatitis A virus (HAV) and hepatitis E virus (HEV) are enteric hepatotropic viruses and their prevalence is related to the sanitary conditions of the region under investigation. There are only a few studies on the seroepidemiology of these two viruses in the general Iranian population. The purpose of this investigation was to measure the prevalence of hepatitis A and E infections in the general population. Between 2006 and 2007, a cross sectional study was performed in Tehran, Iran. Blood specimens were collected and questionnaires were filled in for 551 persons. Patient sera were tested by ELISA for anti-HEV and anti-HAV IgGs. The χ(2) test and independent t-test were used for statistical analysis and p<0.05 was considered significant. The overall seroprevalence rates of anti-HEV IgG and anti-HAV IgG were 9.3% and 90%, respectively. The prevalence of antibodies to HAV and HEV was greater among men than women and increased with age. However, there was no significant relationship between age and gender with the existence of anti- HAV and HEV IgG antibodies. Our results show the seroprevalence of HAV and HEV antibodies are high and both viruses are endemic in this region. These findings are in accordance with results obtained from previous studies. We recommend that foreign travelers to Iran are vaccinated against HAV.