Can modulation of gut microbiota affect anthropometric indices in patients with non-alcoholic fatty liver disease? An umbrella meta-analysis of randomized controlled trials.

Background and aim: Modulating the gut microbiota population by administration of probiotics, prebiotics, and synbiotics has shown to have a variety of health benefits in different populations, particularly those with metabolic disorders. Although the promising effects of these compounds have been observed in the management of patients with non-alcoholic fatty liver disease (NAFLD), the exact effects and the mechanisms of action are yet to be understood. In the present study, we aimed to evaluate how gut microbiota modulation affects anthropometric indices of NAFLD patients to achieve a comprehensive summary of current evidence-based knowledge. Methods: Two researchers independently searched international databases, including PubMed, Scopus, and Web of Science, from inception to June 2023. Meta-analysis studies that evaluated the effects of probiotics, prebiotics, and synbiotics on patients with NAFLD were entered into our umbrella review. The data regarding anthropometric indices, including body mass index, weight, waist circumference (WC), and waist-to-hip ratio (WHR), were extracted by the investigators. The authors used random effect model for conducting the meta-analysis. Subgroup analysis and sensitivity analysis were also performed. Results: A total number of 13 studies were finally included in our study. Based on the final results, BMI was significantly decreased in NAFLD patients by modulation of gut microbiota [effect size (ES): -0.18, 05% CI: -0.25, -0.11, P<0.001]; however, no significant alteration was observed in weight and WC (ES: -1.72, 05% CI: -3.48, 0.03, P=0.055, and ES: -0.24, 05% CI: -0.75, 0.26, P=0.353, respectively). The results of subgroup analysis showed probiotics had the most substantial effect on decreasing BMI (ES: -0.77, 95% CI: -1.16, -0.38, P<0.001) followed by prebiotics (ES: -0.51, 95% CI: -0.76, -0.27, P<0.001) and synbiotics (ES: -0.12, 95% CI: -0.20, -0.04, P=0.001). Conclusion: In conclusion, the present umbrella meta-analysis showed that although modulation of gut microbiota by administration of probiotics, prebiotics, and synbiotics had promising effects on BMI, no significant change was observed in the WC and weight of the patients. No sufficient data were available for other anthropometric indices including waist-to-hip ratio and waist-to-height ratio and future meta-analyses should be done in this regard.

Prevalence and patterns of cerebral venous sinus thrombosis following vestibular schwannoma surgery: a systematic review and meta-analysis.

PURPOSE: Cerebral venous sinus thrombosis (CVST) is a potentially serious complication following surgical treatment of vestibular schwannoma, a benign tumor originating from Schwann cells of the vestibulocochlear nerve. This study aimed to determine the prevalence of CVST following surgical treatment of vestibular schwannoma and the factors contributing to its occurrence. METHOD: Two independent researchers searched the global databases of PubMed, Web of Science, Scopus, and the Cochrane Library up to September 01, 2023. We employed a random-effects model for data analysis. Heterogeneity was evaluated using the I2 test. To assess the quality of the studies meeting our inclusion criteria, we employed the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS: We included 23 articles in this meta-analysis. The pooled prevalence of CVST after vestibular schwannoma surgery was 6.4% (95%CI 3.4-11.5%). The pooled prevalence of CVST following the retrosigmoid (RS), translabyrinthine (TL), and middle cranial fossa (MCF) approaches was 4.8% (95%CI 2.0-11.0%), 9.6% (95%CI 4.3-20.3%) and 9.9% (95%CI 1.6-42.2%), respectively, revealing a significant difference between the TL and the RS approaches (Odds ratio = 2.10, 95%CI 1.45-3.04, P < 0.001). The sigmoid sinus exhibited the highest post-operative thrombosis rate (7.9%), surpassing the transverse sinus (3.7%) and involvement of both sigmoid and transverse sinuses (1.6%), respectively. No significant associations were found with demographic or surgical factors. CONCLUSION: In the current meta-analysis, we identified a 6.4% CVST prevalence following vestibular schwannoma surgery, with varying rates depending on the surgical approach. No significant associations with patient or surgical factors were found, emphasizing the need for heightened clinical vigilance and further research in this context. TRAIL REGISTRATION: PROSPERO ID: CRD42023453513.

The frequency of colorectal lesions in the first-degree relatives of patients with colorectal lesions among PERSIAN Guilan Cohort Study population (PGCS).

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.

Prevalence and associated factors for asymptomatic microscopic hematuria in adults in the PERSIAN Guilan cohort study (PGCS).

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.

Family history of cancer as a potential risk factor for colorectal cancer in EMRO countries: a systematic review and meta-analysis.

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.

The effectiveness of walking exercise on the bowel preparation before colonoscopy: a single blind randomized clinical trial study.

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).

Association between smoking and colorectal cancer in Eastern Mediterranean Regional Office (EMRO): A systematic review and meta-analysis.

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.

Prevalence of Tinnitus and Its Associated Factors in the PERSIAN Guilan Cohort Study.

Introduction: Tinnitus can be associated with many auditory and non-auditory factors, and its prevalence varies widely in the literature. There is no large sample of published data on tinnitus prevalence and its associated factors in Iran. Here, we analyzed the PERSIAN Guilan Cohort Study (PGCS) data and reported the prevalence of tinnitus and some of the risk factors related to tinnitus in the Iranian population. Materials and Methods: This cross-sectional study was conducted on 10520 men and women between 35 and 70 years old. The prevalence of tinnitus and associations between tinnitus and age, sex, habitat, marital status, employment status, socioeconomic status, educational level, lifestyle habits, and comorbid diseases were examined using simple and multiple logistic regression analyses. Results: The prevalence of tinnitus was 6.4% in this study. Based on the adjusted analysis, only older age (odds ratio: 2.60, 95% confidence interval: 1.88 - 3.60), residency in a rural area (odds ratio: 1.22, 95% confidence interval: 1.03 - 1.44), cigarette smoking (odds ratio:1.33, 95% confidence interval: 1.04 - 1.72), and having other comorbidities (odds ratio: 2.75, 95% confidence interval: 2.19 - 3.44) were related to tinnitus. In addition, the results of subgroup analyses by sex were mostly consistent with the overall analysis. Conclusions: Our results revealed that the prevalence of tinnitus in the north of Iran is comparable with other communities. Age and other comorbidities were among the most related factors to tinnitus.

Epidemiologic Profile of Microscopic Hematuria in Iran: A Systematic Review and Meta-Analysis.

Background: Hematuria is one of the most common symptoms in nephrology and urology. Due to the lack of extensive meta-analysis studies on the epidemiology of hematuria in Iran, this study was conducted to determine the epidemiological status of hematuria in Iran. Methods: In Sep 2020, researchers studied six international databases such as PubMed, ISI/WOS, ProQuest, Embase, Scopus, and Google Scholar for English papers and Iranian databases (SID and MagIran) for Persian papers. Joanna Briggs Institute (JBI) checklist was used to review and control the quality of articles. Heterogeneity between studies was assessed by Cochran's test and its composition using I2 statistics. Results: After several screening phase, the number of 25 article included to the final analysis. The prevalence of hematuria in the general population and children, in Iran were estimated at 16.4% (95% CI, - 0.05-37.9) and 1.6% (95% CI, 0.9-2.3) respectively. The odds ratio (OR) of women to men in the prevalence of hematuria in the general population 1.74, 95% CI: 1.20-2.52, P=0.003, patients with beta-thalassemia major 2.02, 95% CI: 1.11-3.65, P=0.020, children 2.61, 95% CI: 1.19-5.71, P=0.016, the elderly 1.50, 95% CI: 1.15-1.94, P=0.002, and taxi drivers 3.73, 95% CI: 2.58-5.38, P<0.001 was obtained. Conclusion: The prevalence of hematuria in the general population is relatively high. Hematuria is a good predictor for detecting of bladder cancer and Idiopathic hypercalciuria and the physician should attention to microscopic hematuria.

The seroprevalence of celiac disease in patients with symptoms of irritable bowel syndrome: A cross-sectional study in the north of Iran.

BACKGROUND: Celiac disease (CD) is a common cause of malabsorption that is definitively diagnosed by abnormal bowel biopsy, symptoms and histologic changes to gluten free diet. The symptoms of irritable bowel syndrome (IBS) are common in our community as the majority of people in Guilan, in the north of Iran, consume rice daily. Also, a number of celiac patients are unknown, and IBS are mistakenly diagnosed. OBJECTIVE: This study aimed to evaluate the prevalence of CD among IBS patients. METHODS: A total of 475 consecutive patients with IBS, confirmed by Rome IV, underwent celiac serological tests antitissue transglutaminase antibodies (IgA-tTG, IgG-tTG) after obtaining a written consent form. In case of positive serological tests, biopsy was performed from small intestine after endoscopyRESULTS: Thirty-one (6.53%, 95% CI: 4.55-9.22) patients were positive for celiac serology. Based on Marsh-Oberhuber criteria, out of 9 patients with positive pathology 77.78% (95% CI: 40.19-96.05) had marsh IIIc. In IBS patients cramp (0.009) and stomach fullness (0.021) were two statistically significant IBS symptoms. CONCLUSIONS: We suggest physicians to consider celiac examinations for all patients with IBS symptoms, even for patients with no obvious celiac symptoms.

OLGA- and OLGIM-Based Staging in the Patients with Gastritis and Endoscopy Indications.

BACKGROUND: Gastric cancer is one of the most common cancers with high mortality. In Iran, the high-risk regions include Northern and Northwestern parts. The aim of this study was to assess the operative link on gastritis assessment- and operative link on gastric intestinal metaplasia-based staging in patients with upper gastrointestinal symptoms. METHODS: Totally, 345 patients underwent upper gastrointestinal endoscopy. Also, the status of Helicobacter pylori infection was evaluated using rapid urease test and histological method. Moreover, histological changes were assessed using the Update Sydney System. The operative link on gastritis assessment- and operative link on gastric intestinal metaplasia-based stages of 0-II were considered as low-risk stages and stages III and IV were considered as high-risk stages. RESULTS: Most of the patients were lower than 60 years (245 patients, 71%), and 71.9% of our patients had H. pylori infection. The frequency of atrophic gastritis and intestinal metaplasia was 44.9% and 25.2%, respectively (P < .001). Eleven patients (73.7%) with gastric adenocarcinoma had a low risk and 2 patients with low-grade dysplasia had a high risk of operative link on gastritis assessment and operative link on gastric intestinal metaplasia. Almost, 62.5% of gastric cancer patients with an intestinal type of gastric adenocarcinoma were at low-risk stages. CONCLUSIONS: Although high stages of operative link on gastritis assessment and operative link on gastric intestinal metaplasia need further follow-up, lower stages of atrophy or intestinal metaplasia also require follow-up. Furthermore, operative link on gastritis assessment method in detecting a greater number of patients who need follow-up is more successful and profitable.

Dietary supplements consumption and its association with socioeconomic factors, obesity and main non-communicable chronic diseases in the north of Iran: the PERSIAN Guilan Cohort Study (PGCS).

BACKGROUND: Dietary supplements (DSs) use have become a growing trend worldwide, and it may be affected by demographic and sociocultural factors. Some people use supplements with the thought that they can improve their health, reduce symptoms and prevent disease. The aim of the present study was to define the frequency of DS use and its association with socioeconomic factors among participants with selected main non-communicable chronic diseases (NCDs) (diabetes, cardiovascular disease (CVD), hypertension (HTN), cancers, and obesity in the north of Iran. METHODS: This large cross-sectional study was conducted as a part of the PERSIAN Guilan cohort study. Supplement use during last year and its type, demographic factors, socioeconomic status, lifestyle habits were asked by face-to-face interview. The history of chronic disease was defined by a trained team. Data were analyzed using SPSS. The chance of supplement use according to demographic, socioeconomic, and lifestyle variables and history of chronic disease was analyzed by logistic regression. RESULTS: 10,520 men and women aged 35-70 years in Some'e Sara County (including urban regions and 39 villages) were studied. About 25% of participants consumed DSs. The highest consumption of DS was calcium/vitamin D (11.1%), ferrous sulfate (8.8%), and vitamin D pearl or ampoule (7.7%). The highest percent of the history of chronic disease was central obesity (62.7%), HTN (43.2%), and general obesity (32.7), respectively. After adjustment for confounders, those with female gender, the highest age ranges (55-65 and > 65 years), high academic education, living in urban regions, and good economic status were more likely to be DSs consumers; however, married and smoker subjects were more likely to consume DS. Participants who had a history of diabetes, HTN, CVD, Obesity, and Central Obesity were more likely to intake DS in comparison with healthy subjects. CONCLUSION: This study showed that a quarter of the participants were DS users. Female sex, older age groups, and higher educated participants, and among chronic disease, patients with HTN, CVD, and diabetes were more likely to be users of any DS.

Helicobacter pylori infection in Iran: demographic, endoscopic and pathological factors.

BACKGROUND: Helicobacter pylori (H. pylori) infection is the most important risk factor for gastritis and peptic ulcer. However, factors other than H. pylori are involved in its pathogenesis. In the current study, we aimed to compare the clinical manifestations and endoscopic and histopathological findings of patients with and without H. pylori infection. METHODS: In this cross-sectional study, 233 patients with dyspepsia, referred for endoscopy, were examined regarding the presence of H. pylori infection. During an endoscopic exam, 5 biopsy specimens were taken from the stomach. The criteria for the presence of H. pylori infection was the presence and identification of bacteria in pathology. Two groups of H. pylori-positive and H. pylori-negative patients were compared regarding their demographic, endoscopic, and pathological findings. RESULTS: Of 233 patients, 154 (66.1%) were non-smokers, 201 (86.3%) were not alcohol users, and 153 (65.7%) used tap water. The most common symptom, reported in 157 (67.4%) patients, was epigastric pain. There was a significant difference between patients with and without H. pylori infection in terms of the educational status, occupational status, family history of gastrointestinal cancer, and some gastrointestinal symptoms. Also, there was a significant relationship between the endoscopic and pathological findings of patients with H. pylori. CONCLUSIONS: The results of the present study revealed that H. pylori infection was not associated with sex, alcohol consumption, or non-steroidal anti-inflammatory drug use. The role of H. pylori in the pathophysiology of peptic ulcer was clarified. Also, there was a significant difference in the endoscopic and pathological findings of patients with H. pylori.

Knowledge About Gastrointestinal Cancers in People Referred for Endoscopy and Colonoscopy During a Screening Program: a Cross-sectional Study in Guilan, North of Iran.

PURPOSE: The most northern and northwestern regions of Iran are at a high risk for gastrointestinal cancers. In this study, we evaluated knowledge of gastrointestinal (GI) cancers in people referred for endoscopy and colonoscopy screening. METHODS: This cross-sectional study was carried out among 461 people who were under the patronage of a local relief foundation and referred for endoscopy and colonoscopy to the Gastrointestinal and Liver Disease Research Center (GLDRC), Rasht, north of Iran, from March 2016 to March 2017. A well-defined two-sectioned questionnaire was carried out for each group. RESULTS: Overall, 300 and 161 individuals were in the gastric and colon cancer knowledge group, respectively. The level of knowledge in various areas of gastric and colon cancer was desirable. In general, the average of different domains in gastric and colon cancer knowledge questions were 20.2 ± 6.6 and 19.2 ± 4.9, with the knowledge level higher than the mean in gastric cancer (58%) and colon cancer (67.1%). The mean score of knowledge of GI cancers in terms of risk factor indicated a significant relationship between BMI and alcohol consumption. Meanwhile, a meaningful relationship between symptoms and BMI with knowledge was declared. About domains of colon cancer, there was a significant relationship between younger age and knowledge in the risk factor. CONCLUSIONS: The results of this study can provide an opportunity to formulate strategies to achieve goals, especially in the field of education, prevention, and control of the disease by raising knowledge for the general public and educating people who are responsible for providing and delivering health services to this community.

Imaging Accuracy in Diagnosis of Different Focal Liver Lesions: A Retrospective Study in North of Iran.

INTRODUCTION: Focal liver lesions (FLLs) are incidentally detected masses found in daily abdominal imaging which are necessary to be characterized, because of the potential of being malignant. There are several imaging methods, such as ultrasonography (US), computed tomography (CT scan), and contrast enhanced magnetic resonance imaging (MRI). Here, we evaluate and compare the diagnostic accuracy (i.e., sensitivity and specificity) of these imaging methods for the diagnosis of FLLs. MATERIAL AND METHODS: In this retrospective study, patients with focal liver lesions included and based on the gastroenterologist decision, in 79 patients different imaging methods were used to determine the nature of FLLs: the US, CT scan, and MRI. At the next step, fine-needle aspiration biopsy (FNA) was performed in all cases, and the results about the true nature of FLLs compared with different imaging results. The chi-square test and McNemar test were used. RESULTS: Ultrasound diagnosis of benign and malignant was obtained with 82% diagnosis accuracy, 100% sensitivity, 71.4% specificity, 100% negative predictive value, and 69.2% positive predictive value (PPV) compared with the biopsy. Also, the results of benign and malignant masses in CT scan were obtained with diagnostic accuracy of 95%, 100% sensitivity, 80% specificity, 93.9% positive predictive value, and 100% negative predictive value. MRI performed only in 2 cases with similar results to pathology. CONCLUSION: It seems that CT scan is more appropriate and useful in the diagnosis of hepatic masses due to its higher diagnostic accuracy than the ultrasound.

Lifetime prevalence of recurrent aphthous stomatitis and its related factors in Northern Iranian population: The PERSIAN Guilan Cohort Study.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions. The aim of this large population base study was estimated lifetime prevalence of RAS and its related factors among the Northern Iranian population. MATERIALS AND METHODS: This study was conducted on 10,520 participants aged 35-70 years based on the PERSIAN Guilan Cohort Study (PGCS). Prevalence proportions and multivariate logistic regression models were constructed for lifetime RAS prevalence using the SPSS software. Data on potential correlates of RAS including demographic profiles, lifestyle habits, and self-reported past medical histories were obtained. RESULTS: The lifetime prevalence of RAS was 8.3%. Multivariate logistic models showed that urbanization (adjusted odds ratio (AOR) = 1.2) and having a history of systemic disease, including rheumatic disease (AOR = 2.1), genital aphthous disease (AOR = 11.7), depression (AOR = 1.3), chronic headaches (AOR = 1.8), diabetes mellitus (AOR = 1.6), and epilepsy (AOR = 2), were independent predictors of RAS. In addition, smokers (AOR = 0.5) and individuals older than 50 years of age (AOR = 0.8) were less likely to have a history of RAS. The lifetime prevalence of RAS among the Northern Iranian population was relatively low. CONCLUSIONS: It seems that predisposing factors, such as younger age, urbanization, and systemic disease, including rheumatic disease, genital aphthous disease, depression, chronic headaches, diabetes mellitus, epilepsy, and not smoking, could contribute to RAS prevalence.

Naproxen, isosorbide dinitrate and co-administration cannot prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial.

BACKGROUNDS/AIMS: Acute pancreatitis is the most widespread complication of endoscopic retrograde cholangiopancreatography. Here, we investigated the efficacy of rectal suppository naproxen, sublingual isosorbide dinitrate and their co-administration in the prevention of post-ERCP pancreatitis. METHODS: This double-blind randomized clinical trial carried out from June 2015 to February 2016 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 585 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients divided into three groups. Group A received 500 mg naproxen, group B took 5 mg isosorbide dinitrate, and group C was co-administrated both agents before ERCP. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and increase of serum amylase activity more than 3 times over the upper normal limit (60-100 IU/L) within first the 24 h post-ERCP. RESULTS: Totally, 80 patients developed PEP included 29 (4.9%), 24 (4.1%), and 27 (4.6%) patients in groups A, B, and C, respectively (p=0.845). Longer ERCP time (p=0.041), using diazepam (p=0.033), a higher number of pancreatic ducts cannulation (p＜0.001), pancreatic duct injection (p=0.013), and using pancreatic stent (p=0.004) were the predisposing factors for PEP. CONCLUSIONS: Our findings indicated that prophylactic naproxen suppository or isosorbide dinitrate sublingually or co-administration had no significant difference in the prevention and severity of PEP, however, enhancing the endoscopist's skills can be effective. Departments and educational hospitals should develop their assessment and quality assurance measures for the training of fellows' not only technical training but also an understanding of the diagnostic and therapeutic roles of the procedure.

Association of Serum Levels of Vitamin D with Blood Pressure Status in Northern Iranian Population: The PERSIAN Guilan Cohort Study (PGCS).

BACKGROUND: Evidence in the last decades has indicated an association between vitamin D and cardiovascular risk factors including blood pressure. The present study aimed to determine whether serum 25-hydroxyvitamin D is independently associated with blood pressure in a large population-based study. METHODS: The study was based on subjects from PERSIAN Guilan Cohort Study (PGCS), a prospective, population-based cohort study in Guilan, Iran. In 9520 men and women, aged 35-70 years, serum 25-hydroxyvitamin D, systolic and diastolic blood pressure were measured. Multiple logistic and linear regression analyses were conducted with adjustments for demographic factors (age and gender), anthropometric characteristics (waist circumference and body mass index), lifestyle variables (physical activity, alcohol, and smoking consumption), and renal function (serum creatinine). RESULTS: Fully adjusted linear regression analyses revealed a weak but statistically significant negative association between serum 25-hydroxyvitamin D levels and systolic blood pressure (ß = -0.02, 95% CI= -0.052 to -0.0001, P-value=0.04), whereas vitamin D status was not significantly associated with diastolic blood pressure (ß = -0.01, 95% CI= -0.026 to 0.009, P-value=0.3). Serum 25-hydroxyvitamin D status showed no significant association with the presence of hypertension (OR 1.09, 95% CI=0.94 to 1.25 for the lowest (25OHD <12 ng/mL) versus the highest (25OHD ≥20 ng/mL) category). CONCLUSION: Lower serum vitamin 25 (OH) D levels were associated with higher systolic blood pressure; however, it was not associated with diastolic blood pressure and presence of hypertension.

Soy Metabolism by Gut Microbiota from Patients with Precancerous Intestinal Lesions.

BACKGROUND: Colorectal cancer (CRC) requires the presence of a variety of factors predisposing a tumorigenic milieu. Excluding familial clustering and hereditary CRC syndromes, the development of sporadic CRC from precancerous lesions is influenced by tissue inflammation, modulation of intestinal immunity, hormones, dietary habits and gut microbiota composition. As concerning the last two aspects, the intestinal presence of equol, the most biologically active metabolite of the soy isoflavone daidzein and the presence of a genetic determinant of gut microbiota able to metabolize daidzein, seem to lower the CRC risk. It has been hypothesized that the anaerobic microorganisms of the Bacteroides genus play a role in equol production. AIM: To evaluate the presence of (i) anaerobic gut microbiota and (ii) the urinary levels of soy isoflavones (daidzein, genistein and equol) in patients with and without precancerous lesions, challenged with a daidzein-rich soy extract. METHODS: Consecutive subjects undergoing colonoscopy participated to the study. Feces were collected from all patients one week before colonoscopy for gut microbiota studies. After the endoscopy examination and the histological evaluation, 40 subjects, 20 with sporadic colorectal adenomas (SCA/P group) and 20 without proliferative lesions (control group) were enrolled for the study. Urine levels of soy isoflavones daidzein, genistein and their metabolite equol, were determined by high performance liquid chromatographic (HPLC) analysis and gut microbiota analysis was performed by Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) procedure. RESULTS: Seventeen different bacterial species were identified in the fecal samples of the forty subjects participating to the study. Ten bacterial species resulted anaerobic Gram-negative bacteria, all belonging to the Bacteroides genus. A significant difference of bacteria species was evidenced in the fecal samples of the two groups of subjects. Particularly important was the evidence of Parabacteroides distasonis, Clostridium clostridioforme and Pediococcus pentasaceus only in control fecal samples, such as the presence of Bacteroides fragilis and Prevotella melaningenica only in SCA/P fecal samples. Concerning the soy isoflavones levels, no statistically significant differences were revealed in the genistein and daidzein urinary levels between the two groups of subjects. On the contrary, urinary equol levels were undetectable in ten SCA/P subjects and in two controls; moreover, when present, the levels of urinary equol were significantly lower in SCA/P subjects compared to controls (0.24 ± 0.27 mg/24 hrs vs. 21.25 ± 4.3 mg/24 hrs, respectively, p = 1.12 × 10-6). CONCLUSIONS: Our results suggest that the presence of anaerobic Bacteroides in the colon, and the production of equol from soy, could determine a milieu able to contrast the development of colonic mucosa proliferative lesions.