International survey on complications of religious fasting after metabolic and bariatric surgery.

Religious fasting in Ramadan the 9th month of the lunar year is one of five pillars in Islam and is practiced for a full month every year. There may be risks with fasting in patients with a history of metabolic/bariatric surgery (MBS). There is little published evidence on the possible complications during fasting and needs stronger recommendations and guidance to minimize them. An international survey was sent to surgeons to study the types of complications occurring during religious fasting in patients with history of MBS to evaluate the risk factors to manage and prepare more evidence-based recommendations. In total, 21 centers from 11 countries participated in this survey and reported a total of 132 patients with complications occurring during religious fasting after MBS. The mean age of patients with complications was 36.65 ± 3.48 years and mean BMI was 43.12 ± 6.86 kg/m2. Mean timing of complication occurring during fasting after MBS was 14.18 months. The most common complications were upper GI (gastrointestinal) symptoms including [gastroesophageal reflux disease (GERD), abdominal pain, and dyspepsia], marginal ulcers and dumping syndrome in 24% (32/132), 8.3% (11/132) and 23% (31/132) patients respectively. Surgical management was necessary in 4.5% of patients presenting with complications (6/132) patients due to perforated marginal or peptic ulcer in Single Anastomosis Duodenoileostomy with Sleeve gastrectomy (SADI-S), one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG), obstruction at Jejunojenostomy after Roux-en-Y gastric bypass (RYGB) (1/6) and acute cholecystitis (1/6). Patients after MBS should be advised about the risks while fasting including abdominal pain, dehydration, and peptic ulcer disease exacerbation, and a thorough review of their medications is warranted to minimize complications.

Genetic relationship between Hashimoto`s thyroiditis and papillary thyroid carcinoma with coexisting Hashimoto`s thyroiditis.

Hashimoto's thyroiditis (HT) is present in the background of around 30% of papillary thyroid carcinomas (PTCs). The genetic predisposition effect of this autoimmune condition is not thoroughly understood. We analyzed the microarray expression profiles of 13 HT, eight PTCs with (w/) coexisting HT, six PTCs without (w/o) coexisting HT, six micro PTCs (mPTCs), and three normal thyroid (TN) samples. Based on a false discovery rate (FDR)-adjusted p-value ≤ 0.05 and a fold change (FC) > 2, four comparison groups were defined, which were HT vs. TN; PTC w/ HT vs. TN; PTC w/o HT vs. TN; and mPTC vs. TN. A Venn diagram displayed 15 different intersecting and non-intersecting differentially expressed gene (DEG) sets, of which a set of 71 DEGs, shared between the two comparison groups HT vs. TN ∩ PTC w/ HT vs. TN, harbored the relatively largest number of genes related to immune and inflammatory functions; oxidative stress and reactive oxygen species (ROS); DNA damage and DNA repair; cell cycle; and apoptosis. The majority of the 71 DEGs were upregulated and the most upregulated DEGs included a number of immunoglobulin kappa variable genes, and other immune-related genes, e.g., CD86 molecule (CD86), interleukin 2 receptor gamma (IL2RG), and interferon, alpha-inducible protein 6 (IFI6). Upregulated genes preferentially associated with other gene ontologies (GO) were, e.g., STAT1, MMP9, TOP2A, and BRCA2. Biofunctional analysis revealed pathways related to immunogenic functions. Further data analysis focused on the set of non-intersecting 358 DEGs derived from the comparison group of HT vs. TN, and on the set of 950 DEGs from the intersection of all four comparison groups. In conclusion, this study indicates that, besides immune/inflammation-related genes, also genes associated with oxidative stress, ROS, DNA damage, DNA repair, cell cycle, and apoptosis are comparably more deregulated in a data set shared between HT and PTC w/ HT. These findings are compatible with the conception of a genetic sequence where chronic inflammatory response is accompanied by deregulation of genes and biofunctions associated with oncogenic transformation. The generated data set may serve as a source for identifying candidate genes and biomarkers that are practical for clinical application.

Inverse correlation of soluble programmed cell death-1 ligand-1 (sPD-L1) with eosinophil count and clinical severity in allergic rhinitis patients.

BACKGROUND: T-cell response outcome is determined by co-stimulatory/inhibitory signals. Programmed cell death-1 ligand-1 (PD-L1) is a member of these co-signaling molecules with known soluble form in human serum. Soluble PD-L1 (sPD-L1) is also recognized in patients with some types of malignancy or autoimmune disorders, though there are few studies on sPD-L1 roles in allergic diseases. The purpose of this survey was to evaluate the association between sPD-L1 levels with eosinophil count as well as disease severity in allergic rhinitis (AR) patients. METHODS: 90 patients with AR were selected. Disease severity was determined by a modified Allergic Rhinitis and its Impact on Asthma (ARIA) classification as mild, moderate and severe. Whole blood samples were collected. Then eosinophil count and serum sPD-L1 were detected by a hematologic analyzer and a commercial ELISA kit. RESULTS: 13 (14.44%), 31 (34.44%), and 46 (51.12%) of patients had mild, moderate and severe disease, respectively. The mean levels of sPD-L1 and eosinophil count were ascertained 18.38 ± 14.42 ng/ml and 422.43 ± 262.26 cell/µl. A significant inverse correlation was determined between sPD-L1 levels and eosinophil count (r = -0.364, P < 0.001). Moreover, we detected a significant negative association between sPD-L1 levels and disease severity (r = -0.384, P < 0.001). CONCLUSIONS: It is deduced that sPD-L1 can be used as a helpful marker to determine the severity of AR. Furthermore, this study indicated that sPD-L1 may have an inhibitory role in AR development, and its modulation may be considered as a useful accessory therapeutic approach for reduction of AR progression.

Helminth Parasites of Wild Boars, Sus scrofa, in Bushehr Province, Southwestern Iran.

BACKGROUND: Wild boars, Sus scrofa, of wide distribution considered as a potential source of zoonotic parasites. The current study aimed to assess the prevalence of helminth infections in wild boars in the Persian Gulf coastal area (Bushehr Province), Southwestern Iran. METHODS: Twenty-five wild boars, including 11 males and 14 females, were collected during a course of vertebrate pest control in the Bushehr Province, southwestern Iran in 2013. The specimen were immediately dissected and carefully searched for the parasites. During necropsy, each organ was examined macroscopically for presence of any helminthic agents. Tissue samples were taken from each organ. Moreover, samples were taken from the content of digestive system. Blood samples were also collected from each boar. All the samples were evaluated for helminth infections by parasitological methods. RESULTS: Twenty-two (88%) of the wild boars were infected with at least one helminth. Out of 25 wild boars, 1 (4%) were infected with Cysticercus tenuicollis, the larval stage of Taenia hydatigena, 13 (52%) with Macracanthorhynchus hirudinaceus, 17 (68%) with Metastrongylus spp, and 20 (80%) with Ascarops spp. Hydatid cyst was detected in the lung of one of the wild boars. No Trichinella spp. larvae were detected in any of the tissues of the animals when evaluated by artificial digestion method. In addition, no contamination with microfilaria was detected in any of animals when the blood samples were tested with Knott's method. CONCLUSION: Wild boars are contaminated by some helminthes including zoonotic ones. These animals could be involved in the epidemiology of zoonotic helminth by acting as reservoir hosts. This in turn may bring potential risk for locals and residents of the Bushehr Province, Southwestern Iran.

Molecular characterization and seroprevalence of Echinococcus granulosus in wild boars (Sus scrofa) in south-western Iran.

This study presents the first molecular and serological evaluation of Echinococcus granulosus infections in wild boars in Iran. Twenty five wild boars were collected in south-western Iran, during authorized hunting program, from March to October 2013, necropsied and examined for E. granulosus infection. Furthermore, seroprevalence of cystic echinococcosis in hunted boars was evaluated by an ELISA system. A fertile hydatid cyst due to E. granulosus was detected in the lung of one of the animals. Genotype analysis of the isolate was determined by analyzing a mitochondrial gene, cytochrome C oxidase subunit 1 (co1). DNA was extracted from the cyst sample and polymerase chain reaction amplification and DNA sequencing of the specific region of the co1 gene was performed. Molecular evaluation confirmed the presence of a sheep strain, the G1 genotype, in the wild boar in south-western Iran. This is the first report of the presence of G1 genotype of E. granulosus in wild boar in Iran. Serological evaluation of hydatid cyst by antigen-B ELISA revealed E. granulosus antibodies in 5 (20%) of 25 wild boars. A statistically significant difference was observed between the prevalence of E. granulosus antibodies and gender while the difference between the seroprevalence of E. granulosus and age was insignificant. Findings of this study might have important implications for the prevention and control of cystic echinococcosis.