Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study.

Background: Suicide is a public health issue and a main cause of mortality among adolescents and the youth worldwide, particularly in developing countries. Objectives: The present research is a systematic review aiming to investigate the spatial, geographical, and demographic factors related to suicide among adolescents and the youth. Methods: In this systematic review, two researchers examined PsycINFO, Web of Science, Scopus, and PubMed databases on December 7th, 2022 with no time limits from the beginning of publication until 2022 to identify the primary studies on spatial and geographic analysis on adolescent and youth suicides. Once duplicate studies were identified and removed, the titles and abstracts of studies were examined and irrelevant studies were also removed. Finally, 22 studies were reviewed based on the inclusion criteria. Results: Our findings show that suicide rates are generally higher among men, residents of rural and less densely populated regions, coastal and mountainous regions, natives, 15-29 age group, less privileged populations with social fragmentation, unemployed, divorced or lonely people, those who live in single parent families, people with mental health issues, and those with low levels of education. Conclusions: Stronger evidence supports the effects of geographic and demographic variables on youth and adolescent suicide rates as compared with spatial variables. These findings suggest that policy makers take spatial and demographic factors into consideration when health systems allocate resources for suicide prevention, and that national policymakers integrate demographic and geographic variables into health service programs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023430994.

Personalized medicine in colorectal cancer.

Colorectal cancer (CRC) is a heterogeneous disease with various genetic and epigenetic factors leading to difficulties in response to both the therapy and drug resistance. Moreover, even in tumors with similar histopathological characteristics, different responses and molecular features could be observed because of the genetic basis and its interactions with the living environment. Through personalized medicine, we can classify patients into separate groups according to their genetic and epigenetic features and their susceptibility for a specific disease which could help with choosing the best therapeutic approach. In this review, genetic and epigenetic factors that cause heterogeneity in colorectal cancer are evaluated and proper drug administration in both chemotherapy and target therapy are suggested.

Circulating tumor DNA applications in monitoring the treatment of metastatic colorectal cancer patients.

Colorectal cancer is the third most common cancer worldwide. New cancer treatment strategies such as monoclonal antibodies against growth factor and angiogenesis receptors have improved the overall survival (OS) and progression-free survival (PFS) in metastatic colorectal cancer (mCRC) patients. However, acquired resistance could happen after these therapies. Circulating tumor DNA (ctDNA) is the DNA fraction derived from tumor cells which could be applied as a non-invasive method for detecting tumor mutations before, during, and after therapies. Here, we reviewed most of the studies examining ctDNA as treatment monitoring in mCRC patients who receive different target therapies. Also, we compared ctDNA with other existing cancer-treatment monitoring methods.

Circulating tumor DNA applications in monitoring the treatment of metastatic colorectal cancer patients.

Colorectal cancer is the third most common cancer worldwide. New cancer treatment strategies such as monoclonal antibodies against growth factor and angiogenesis receptors have improved the overall survival (OS) and progression-free survival (PFS) in metastatic colorectal cancer (mCRC) patients. However, acquired resistance could happen after these therapies. Circulating tumor DNA (ctDNA) is the DNA fraction derived from tumor cells which could be applied as a non-invasive method for detecting tumor mutations before, during, and after therapies. Here, we reviewed most of the studies examining ctDNA as treatment monitoring in mCRC patients who receive different target therapies. Also, we compared ctDNA with other existing cancer-treatment monitoring methods.

Helicobacter pylori Eradication With Levofloxacin or Clarithromycin in Dialysis Versus Nonuremic Patients.

INTRODUCTION: Various medication regimens have been used to eradicate Helicobacter pylori in dialysis patients; however, optimal response to treatment is still a challenge. This study aimed to compare response to H pylori eradication in dialysis and nonuremic patients. MATERIALS AND METHODS: In a randomized controlled trial, dialysis patients with dyspepsia and confirmed positive endoscopic biopsy for H pylori were compared to nonuremic patients. Participants were randomly assigned to receive clarithromycin or levofloxacin. H pylori eradication was assessed using stool antigen test 4 weeks later. RESULTS: Forty-four dialysis and 44 nonuremic patients participated in the study. Four dialysis patients and 2 nonuremic patients did not respond to levofloxacin (P = .35). Six dialysis patients and 4 nonuremic patients did not respond to clarithromycin (P = .47). CONCLUSIONS: Response rate to H pylori eradication by clarithromycin and levofloxacin was slightly lower in dialysis patients compare to nonuremic patients. In dialysis patients, response rate to levofloxacin was slightly higher than clarithromycin, but the results were not significantly different.

Does gluten free diet have more implications than treatment of celiac disease?

AIM: This study was aimed to evaluate symptomatic as well as histopathologic response to GFD in patients with gluten-sensitive enteropathies including celiac disease, lymphocytic duodenosis and non-specific duodenitis. BACKGROUND: Gluten-free diet (GFD) is the main treatment of celiac disease. However, its impact on other disorders of gluten sensitivity spectrum is less clear. PATIENTS AND METHODS: In a prospective observational study in Modarres hospital Tehran, Iran, 35 patients with chronic manifestations including low BMI, diarrhea, greasy stool and bloating were evaluated using serology for anti-tTG, endoscopy and histopathology. Patients were categorized in three diagnostic groups accordingly including celiac disease (CD), lymphocytic doudenosis (LD) and non-specific duodenitis (NSD). All patients were put on a GFD for 6 months, and subjective symptomatic response, serology, endoscopy and histopathologic tests were repeated and compared with baselines and among groups. RESULTS: Of the total 35 patients, 5 had CD (14.3%), 9 had LD (25.7%) and 21 (60%) had NSD. Bloating was the most common symptom followed by diarrhea. Majority of patients (80%) had low BMI. All symptoms alleviated following a GFD but bloating was the only significant one. A significant increase was found in total mean BMI (17.3±0.7 v.s. 17.9±0.9). Histopathologic examination showed a complete resolution in 48.5% (n=17) patients, 10 in NSD group, 4 in LD group and 3 in CD group. Final prevalence of gluten-sensitive enteropathy (LD and NSD cases that responded to GFD) was 46.6%. CONCLUSION: GFD may have more implications other than celiac disease. Other gluten-sensitive enteropathies, like LD and NSD, might also respond to this treatment particularly in patients with low BMI.

Effect of addition of vitamin C to clarithromycin-amoxicillin-omeprazol triple regimen on Helicobacter pylori eradication.

BACKGROUND: The use of vitamin C as a supplement with the common regimen for eradication of Helicobacter pylori infection is the subject of ongoing controversy. We conducted a prospective controlled study with the aim of testing whether the vitamin C supplement to the therapy includes lower dosage of clarithromycin could have an acceptable influence on Helicobacter pylori eradication in comparison with routine anti-Helicobacter pylori regimen. MATERIALS AND METHODS: Two hundred and fourteen consecutive patients with the verification of Helicobacter pylori infection via positive Rapid Urease Test (RUT) and histology results were included and divided into two therapy groups: 1) a group without vitamin C (n = 100) that were administered 20 mg omeprazol, 1 g amoxicillin, and 500 mg clarithromycin twice daily for 2 weeks and 2) a triple-plus-vitamin C group (n = 114) that was administered 20 mg omeprazol, 1 g amoxicillin, 250 mg clarithromycin plus 250 mg vitamin C twice daily for 2 weeks. Four weeks after the completion of therapy, each patient was scheduled for urea breath test to assess the success of Helicobacter pylori eradication. RESULTS: Similar eradication of Helicobacter pylori was found between the triple-only group with 500 mg of clarithromycin and the triple with 250 mg of clarithromycin-plus vitamin C group (89% versus 86.8%, P = 0.623). CONCLUSIONS: Adding vitamin C might reduce the needed dosage of clarithromycin for eradication of Helicobacter pylori.

Effects of sedation during upper gastrointestinal endoscopy on arterial oxygen saturation.

BACKGROUND/AIMS: Determination of optimal administered sedatives during endoscopy is vital and necessary for the minimization of their side effects. This study was designed to see the effect of sedation on endoscopy induced arterial oxygen desaturation and determination of sedatives safety during gastrointestinal endoscopy. METHODOLOGY: In this controlled clinical trial, 90 consecutive patients scheduled for diagnostic upper gastrointestinal endoscopy were categorized into 2 groups (45 in each group). The patients in the first group were sedated with midazolam 0.1 mg/kg, propofol 1 mg/kg and fentanyl 1 microg/kg intravenously, while the patients in the second group received saline as a placebo. In both groups, blood pressure, heart rate, and arterial oxygen saturation were measured before and one minute after endoscopy, and compared. RESULTS: No significant differences were found in arterial O2 saturation (p = 0.142) and heart rate (p = 0.154) between the two groups, one minute after endoscopy. Both systolic and diastolic blood pressures were higher in non-sedated group (p < 0.001). CONCLUSION: Concomitant administration of midazolam, propofol, and fentanyl do not cause arterial desaturation, however, it can lead to blood pressure changes one minute after the beginning of endoscopy.

24-hour ambulatory pH-metry in patients with refractory heartburn: a prospective study.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a chronic condition that affects a large proportion of population. The aim of our study was to determine what percentages of patients with persistent heartburn on acid suppressive therapy have evidence of reflux disease while off acid suppressive therapy. METHODS: In a prospective study 48 patients with refractory heartburn from Taleghani Hospital were enrolled who had been on a double dose of proton pump inhibitor (PPI) for 8 weeks without improvement. Because of low index of suspicion for GERD as an etiology, all the patients underwent 24h pH-metry while off PPI. The variables of pH-metry such as the fraction time of pH <4 were evaluated by comparing to normal volunteers. RESULTS: The mean "number of acid refluxes" was 49.98 in upright position and 6.29 in supine position. The mean "longest acid reflux" duration was 2.98 minutes in upright and 3.13 minutes in supine position. The total time fraction of pH <4 was 2.97% in upright position, 1.2 % in supine position and 2.74% in postprandial state. The mean DeMeester score was 10.06 (SD=10.48). However, the difference in the total fraction of time with pH <4 was not significant. CONCLUSION: Our study showed that most of the patients with refractory heartburn did not have acid reflux. Patients with refractory heartburn often do not have evidence of reflux disease on pH monitoring, thus evaluating these patients should be performed while on acid suppressive therapy (using impedance-pH monitoring) in order to clarify the relationship between symptoms and acid and non-acid reflux.