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.

Spatial Analysis of COVID-19 Vaccination: A Scoping Review.

Spatial analysis of COVID-19 vaccination research is increasing in recent literature due to the availability of COVID-19 vaccination data that usually contain location components. However, to our knowledge, no previous study has provided a comprehensive review of this research area. Therefore, in this scoping review, we examined the breadth of spatial and spatiotemporal vaccination studies to summarize previous findings, highlight research gaps, and provide guidelines for future research. We performed this review according to the five-stage methodological framework developed by Arksey and O'Malley. We screened all articles published in PubMed/MEDLINE, Scopus, and Web of Science databases, as of 21 September 2021, that had employed at least one form of spatial analysis of COVID-19 vaccination. In total, 36 articles met the inclusion criteria and were organized into four main themes: disease surveillance (n = 35); risk analysis (n = 14); health access (n = 16); and community health profiling (n = 2). Our findings suggested that most studies utilized preliminary spatial analysis techniques, such as disease mapping, which might not lead to robust inferences. Moreover, few studies addressed data quality, modifiable areal unit problems, and spatial dependence, highlighting the need for more sophisticated spatial and spatiotemporal analysis techniques.

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.

Gut Microbiota as a Positive Potential Therapeutic Factor in Carcinogenesis: an Overview of Microbiota-Targeted Therapy.

Cancer therapeutic methods comprising chemotherapy, radiotherapy, and surgery are so routine in cancer treatment. Remarkably, there are several personal features which affect the effectiveness of such treatments including nutrition, microbiome diversity, and physical activity which has distinct significant roles during and after therapies along with their bilateral connections. In this way, the ability of gut microbiota36 in modulating the efficacy of chemotherapeutic medications in cancer and other types of disorders is of great importance. In addition, the role of dietary, probiotic, and synthetically engineered bacteria in manipulating and optimizing the gut microbiota is of interest. Conspicuously, the correlation between the commensal microbiota and also host can regulate the physiological activities comprising the immunity system and inflammatory agents and it is scanned in the category of cancers. Bacterial species have been employed in cancer therapy; commensal microbes posse a key beneficial role in this field. Practically, the microbiota has this potential to accelerate and modulates a certain response by priming in order to release the pro-inflammatory agents. We would like to discuss these vital factors in this review as gut microbiota has the potential to be the main option for personalized cancer treatment strategies in the future. Meaning, this novel data present clinical promising feasibilities of modulating cancer therapy with using microbiota.

Prevalence of pre-cancerous colon lesions in referred patients under patronage of a local relief foundation in Guilan province.

Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with varied incidence and the onset age of disease worldwide. Overall, 161 participants who were under patronage of a local relief foundation and referred to the endoscopy ward of Razi Hospital affiliated to the Guilan University of Medical Sciences. These patients have been aged more than 50 or more than 40 years with history of colorectal cancer in their first-degree family were enrolled from March 2016-March 2017. Demographic information were collected. Colonoscopy was performed and histopathological evaluation of observed lesions and polyps was done. Most of participants were female (113 individuals, 70.2%) and aged 50-60 years (83 individuals, 51.6%). Seventy-four (46%) had certain lesions. Most of colonoscopy findings were observed in the ascending colon in which depressed polyps and diverticulum were most frequent. However, rectum showed the most histological findings. All polyps of descending and ascending colons were neoplastic, while most of rectal polyps were non-neoplastic. Male patients, who were aged more than 60 years and smokers had significant higher percentage of both lesions and polyps in their colon (p<0.05). Moreover, significant positive association was detected between exposure to harmful industries and having polyps (p=0.01). We found male gender, higher age, smoking, and exposure to harmful industries as important risk factors for having colorectal lesions, which must be confirmed in further studies.

A 30-Year-Old Man with Acute Motor Axonal Neuropathy Subtype of Guillain-Barré Syndrome Having Hepatitis A Virus Infection.

Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Here, we report a case of a young man with acute motor axonal neuropathy (AMAN) subtype of GBS having hepatitis A virus (HAV) infection. A 30-year-old man with icterus was referred to emergency center of Razi Hospital. He complained of flu-like symptoms 10 days before the onset of icterus. Also, he suffered from gradual fatigue and weakness with dark urine. He experienced neurological symptoms of muscle paralysis (ascending from the legs to hands). Neurological consultant suspected GBS at the first step based on clinical examinations. He was candidate for five sessions of plasmapheresis. The ultrasonography revealed liver span 166 mm, which was greater than the normal range, with normal parenchymal echo. The gallbladder wall was thicker than normal and gallstone with lesion was not seen in different conditions. He was discharged after total improvement of neurological symptoms and muscular power. In addition, the results of International normalized ratio (INR), partial thromboplastin time (PTT), prothrombin time (PT), alkaline phosphatase (ALK), alanine aminotransferase (ALT) , aspartate aminotransferase (AST), bilirubin total and direct (Bil T, D) tests were normal after 2-month follow-up. Although, acute viral infections such as hepatitis E virus (HEV) is common in patients with GBS; the possibility of HAV infection in patients with its risk factor should not be neglected.

Prevalence of non-alcoholic fatty liver disease in patients with diabetes mellitus, hyperlipidemia, obesity and polycystic ovary syndrome: A cross-sectional study in north of Iran.

BACKGROUND AND AIM: The aim of this study was to describe the frequency of non-alcoholic fatty liver disease (NAFLD) in patients with diabetes mellitus (DM), hyperlipidemia, obesity and polycystic ovaries syndrome (PCOS). METHODS: In a cross-sectional study, 333 patients who had one of the certain diagnosis of DM, hyperlipidemia, obesity or PCOS were enrolled. Information about demographics, anthropometric, nutritional habitude, smoking history, medical history and physical activity were recorded. Liver ultrasound examination and routine biochemistry analysis were performed. RESULTS: Among 333 patients with one of the four above-mentioned diseases. 199 patients (59.8%) had NAFLD. Male were more likely to have NAFLD than female (72.8% vs. 50.8% respectively, P < 0.001). About, 80.7% of patients through 41-50 years age had NAFLD. The frequency of abnormal fasting blood glucose, alanine aminotransferase (ALT), triglyceride, and total cholesterol were significantly higher in patients with NAFLD (P < 0.05). Subjects with NAFLD had a higher body mass index than non-NAFLD (33.6 ±â€¯7.9 kg/m2 vs. 31.1 ±â€¯5.0 kg/m2 respectively, P = 0.002). Patients with DM, hyperlipidemia, hypertension, and hypothyroidism were more likely to have NAFLD (P < 0.05). Patients with consumption of supper, high-fat diet, enjoy of eating and smoking were more likely to have NAFLD and patients with fruit and vegetable uptake and physical activity were less likely to have NAFLD (P < 0.05). CONCLUSIONS: As most patients with NAFLD are asymptomatic, employed individuals with higher education levels, with a history of smoking and unhealthy diet along with DM, hyperlipidemia, PCOS and obesity seriously have to be followed and educated for lifestyle modification.

Fecal calprotectin role in diagnosis of ulcerative colitis and treatment follow-up / Papel da calprotectina fecal no diagnóstico de colite ulcerativa e no acompanhamento do tratamento

ABSTRACT Objective: Ulcerative colitis usually affects the rectum and potentially can involve the whole colon. Noninvasive methods such as fecal calprotectin measurement may be considered as a reliable and inexpensive approach in assessing disease severity or treatment change strategy. Methods: In this retrospective cross-sectional study, records of 56 ulcerative colitis patients who hospitalized with exacerbation between May 2016 and April 2017 were assessed based on IBD Data Bank Software in Gastrointestinal and Liver Diseases and Research Center (GLDRC), Guilan province, Iran between. A questionnaire of demographic characteristics, clinical findings and fecal calprotectin level was completed. Montreal classification severity of ulcerative colitis and Mayo disease activity index were scored. Data were analyzed for descriptive and analytical analysis. Results: Fecal calprotectin was significantly different in terms of disease severity based on both Mayo score (p = 0.007) and Montreal classification (p = 0.001). In patients with mild symptoms, no increase in fecal calprotectin was observed, but in patients with moderate and severe elevations in fecal calprotectin levels was significant. Also, C-Reactive Protein surge was related to disease severity (p = 0.02). Furthermore, regression comparison among high-chance patients based on fecal calprotectin was significantly related to higher Erythrocyte Sedimentation Rate levels and smoking, p = 0.01 and p = 0.05, respectively. Conclusion: It seems fecal calprotectin levels are related to the disease severity. Non-invasive methods, such as fecal calprotectin assay, may seem to be an alternative to aggressive, costly and time-consuming methods, such as colonoscopy and biopsy, to reduce the suffering of patients and ultimately help improve the patients' life quality.

RESUMO Objetivo: A colite ulcerativa geralmente afeta o reto, podendo acometer todo o cólon. Métodos não invasivos, como a dosagem de calprotectina fecal, podem ser uma abordagem confiável e barata para a avaliação da gravidade da doença ou da estratégia de mudança de tratamento. Métodos: Neste estudo transversal retrospectivo, os registros de 56 pacientes com colite ulcerativa que foram hospitalizados devido a exacerbação entre maio de 2016 e abril de 2017 foram avaliados usando o software IBD Data Bank no Centro de Pesquisa e Doenças Gastrointestinais e Hepáticas (GLDRC), na província de Guilan, Irã. Foi aplicado um questionário de características demográficas, achados clínicos e nível de calprotectina fecal. Foram usados o escore de Mayo de atividade da doença e a classificação de Montreal da gravidade da colite ulcerativa. Os dados foram analisados de forma descritiva e analítica. Resultados: A calprotectina fecal apresentou diferença significativa em termos de gravidade da doença com base no escore de Mayo (p = 0,007) e na classificação de Montreal (p = 0,001). Em pacientes com sintomas leves, nenhum aumento na calprotectina fecal foi observado. Entretanto, em pacientes com sintomas moderados e severos, o aumento nos níveis de calprotectina fecal foi significativo. Além disso, o aumento nos níveis de proteína C reativa foi associado à gravidade da doença (p = 0,02). A análise da regressão entre pacientes considerados de alto risco com base na calprotectina fecal indicou uma associação significativa com níveis elevados da taxa de sedimentação de eritrócitos e tabagismo (p = 0,01 e p = 0,05, respectivamente). Conclusão: Os níveis de calprotectina fecal parecem estar relacionados com a gravidade da doença. Métodos não invasivos, como o estudo de calprotectina fecal, podem ser uma alternativa a métodos agressivos, caros e demorados, tais como colonoscopia e biópsia, reduzindo o sofrimento e ajudando a melhorar a qualidade de vida dos pacientes.

Exacerbation causes among inflammatory bowel disease patients in Guilan Province north of Iran / Causas de exacerbação entre pacientes com doença inflamatória intestinal na província de Guilan, norte do Irã

ABSTRACT Objective: Numerous factors may contribute as triggers to the exacerbation of the condition of patients with inflammatory bowel disease. Methods: The medical files of 109 patients with the positive history of inflammatory bowel disease exacerbation between March 2016 and March 2017 were assessed retrospectively. Data were obtained using the inflammatory bowel disease data bank software. The parameters were obtained from the inflammatory bowel disease data bank software. The mentioned parameters were assessed in terms of type and severity of disease using chi-square test in SPSS software. Moreover, binary logistic regression test was used to assess the associations between season of disease onset and inflammatory bowel disease exacerbation as odds ratios with 95% confidence intervals (95% CI). Results: Overall, (88.1%) of cases with inflammatory bowel disease exacerbation, had ulcerative colitis. The mean age of patients was 38.14 ± 14.66 years. The disease duration in all patients (ulcerative colitis and Crohn's disease) was 35.43 and 38.85 months, respectively. About 50% of patients with infection were strongyloides stercoralis positive. The occurrence of mild inflammatory bowel disease exacerbation was significantly higher in spring in comparison to other seasons (OR = 3.58; 95% CI 0.1-1.04). Most patients with ulcerative colitis were prescribed salicylates alone (53.12%). Most patients with Crohn's disease with mild and severe activity were non-smokers (p = 0.058). This difference was marginally significant. Conclusion: It is suggested that in future studies, the evidences of distribution of SS infections among patients with inflammatory bowel disease and the history of exacerbation along with other environmental factors such as enhancing nutritional quality and surface water be taken into consideration.

RESUMO Objetivo: Em pacientes com doença inflamatória intestinal, vários fatores podem servir como gatilhos para a exacerbação do quadro. Métodos: Os prontuários de 109 pacientes com história de exacerbação da doença inflamatória intestinal entre março de 2016 e março de 2017 foram avaliados retrospectivamente. Os dados foram obtidos usando o software do banco de dados sobre doença inflamatória intestinal, que também foi usado para a definição dos parâmetros do estudo. Esses parâmetros foram avaliados quanto ao tipo e severidade da doença usando o teste do qui-quadrado no software SPSS. Além disso, o teste de regressão logística binária foi utilizado para avaliar as associações entre a estação do início da doença e a exacerbação da doença inflamatória intestinal, expressados em razão de probabilidade (odds ratio) com intervalos de confiança de 95% (95% CI). Resultados: No geral, 88,1% dos casos de exacerbação da doença inflamatória intestinal foram observados em pacientes com colite ulcerativa. A média de idade dos pacientes foi de 38,14 ± 14,66 anos. Em todos os pacientes, a duração média da doença (colite ulcerativa e doença de Crohn) foi de 35,43 e 38,85 meses, respectivamente. Cerca de 50% dos casos de infecção apresentaram cultura positiva para Strongyloides stercoralis. A ocorrência de leve exacerbação da doença inflamatória intestinal foi significativamente maior na primavera em comparação com outras estações (OR = 3,58; 95% CI: 0,1-1,04). A maioria dos pacientes com colite ulcerativa foi medicada apenas com salicilatos (53,12%). A maioria dos pacientes com doença de Crohn com atividade classificada como leve ou grave era não fumante (p = 0,058). Essa diferença foi marginalmente significativa. Conclusão: Sugere-se que, em estudos futuros, as evidências de distribuição das infecções por Strongyloides stercoralis em pacientes com doença inflamatória intestinal e história de exacerbação sejam levadas em consideração em conjunto com outros fatores ambientais, como qualidade nutricional e da água de superfície.

Intestinal tuberculosis in a 55-year-old woman with a 30-year history of rheumatoid arthritis.

INTRODUCTION: Tuberculosis (TB) is one of the endemic diseases with a challenging diagnosis in the absence of pulmonary disease. On the other hand, rheumatoid arthritis (RA) is a systemic autoimmune disease with extra-articular manifestations that occur at any age after onset, such as nodules, Sjögren's syndrome, anemia of chronic disease, and pulmonary manifestations, which are more frequently seen in patients with severe, active disease. Here we present a case of RA with intestinal TB. CASE REPORT: A 55-year-old woman with a 30-year history of RA using prednisolone and hydroxychloroquine presented with a nonpositional hypogastric pain and a weight loss of 20 kg over 7 months. No history of biological therapy was recorded. Colonoscopy revealed an ulcerated mass that was suspicious for malignancy. The pathobiological assessments confirmed ulceration and granulation tissue formation, foci of necrotizing granulomatous inflammation in lamina propria with adjacent mild crypt regenerative changes. Also, Ziehl-Neelsen staining for acid-fast bacilli in the granulomas was positive though the polymerase chain reaction assay did not detect the Mycobacterium tuberculosis. Anti-TB medication for 2 weeks eliminated the symptoms. CONCLUSIONS: Intestinal TB in patients with vague abdominal symptoms and relevant physical findings such as pain and palpable mass should be considered to prevent late or misdiagnosis.

Inflammatory Myofibroblastic Tumors in a Case with Hypogastric Discomfort.

BACKGROUND Inflammatory myofibroblastic tumors (IMTs) are scarce tumors with discrete immunohistochemical and molecular attributes which are not related to a particular location. There are different reports about the intrinsic nature of these tumors as benign to possibly malignant. CASE REPORT Here we report the case of a 68-year-old man referred to the Internal Medicine Department of Razi Hospital in Rasht (a city in the north of Iran) due to right lower quadrant (RLQ) discomfort with no specific symptoms. Colonoscopy revealed a mass-like lesion. Polymorphonuclear cells (PMNCs) admixed by some eosinophils were demonstrated histopathologically. Immunohistochemical evaluation was positive for vimentin, CD34, smooth muscle actin, and ALK, and negative for CD117 and desmin. The tumor was successfully removed by surgery with no chemotherapy. No recurrence was reported. CONCLUSIONS We have performed surgical excision of the mass with no chemotherapy and no recurrence. Although recurrence is reported to be low, we recommend long-term follow-up after surgery.

Innumerable Liver Masses in a Patient with Autoimmune Hepatitis and Primary Sclerosing Cholangitis Overlap Syndrome.

BACKGROUND In patients with the diagnosis of autoimmune hepatitis (AIH), the presence of cholestatic features raise the possibility of an overlap syndrome with primary sclerosing cholangitis (PSC). Here, we present a unique case with AIH-PSC overlap syndrome and innumerable liver masses. CASE REPORT A 26-year-old man presented with generalized icterus. Based on the serological findings of hypergamainmunoglobulinemia and positive anti-nuclear antibody tests, together with an abnormal cholangiogram, he was diagnosed with overlap syndrome (AIH-PSC). Liver imaging revealed innumerable liver masses with a benign appearance in the pathological evaluation. To rule out the colon abnormalities that usually coexist with such liver masses, colonoscopy was performed and showed no significant changes. The liver masses were nonmalignant and were resolved after immunosuppressant therapy. CONCLUSIONS Because AIH-PSC overlap syndrome is rare, it is suggested that radiological evaluation of the biliary tree should be performed routinely in adults diagnosed with AIH to reduce the missed diagnosis of overlap syndrome and liver masses.