Liver Abscess due to Fasciola hepatica: A Case Report of the North of Iran.

One of the rare manifestations of fascioliasis is liver abscess. In this paper, we report the case of a 38-year-old woman with a liver abscess caused by Fasciola hepatica (F. hepatica). The patient was referred to the clinic with recurrent fever, right upper quadrant (RUQ) pain, and a large abscess in her liver. Despite the consumption of an antibiotic drug, she still had symptoms. The symptoms began to disappear upon starting the consumption of triclabendazole (TCBZ). Fascioliasis can manifest itself with unusual symptoms that provide no specific clue for its diagnosis. Therefore, it is important to consider F. hepatica in the differential diagnosis of liver abscess, especially in endemic regions.

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.

Evaluation of the effect of sofosbuvir and daclatasvir in hospitalized COVID-19 patients: a randomized double-blind clinical trial (DISCOVER).

BACKGROUND: The combination of sofosbuvir and daclatasvir has shown preliminary efficacy for hospitalized patients with COVID-19 in four open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir/daclatasvir to standard care improved clinical outcomes in hospitalized patients with COVID-19. METHODS: This was a placebo-controlled, double-blind, randomized clinical trial in adults hospitalized with COVID-19 at 19 hospitals in Iran. Patients were randomized to oral sofosbuvir/daclatasvir 400/60 mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O2 saturation <95% and compatible symptoms. The primary outcome was hospital discharge within 10 days of randomization. Secondary outcomes included mortality and time to clinical events. The trial is registered on the Iran Registry of Clinical Trials under IRCT20200624047908N1. RESULTS: Between July and October 2020, 1083 patients were randomized to either the sofosbuvir/daclatasvir arm (n = 541) or the placebo arm (n = 542). No significant difference was observed in the primary outcome of hospital discharge within 10 days, which was achieved by 415/541 (77%) in the sofosbuvir/daclatasvir arm and 411/542 (76%) in the placebo arm [risk ratio (RR) 1.01, 95% CI 0.95-1.08, P = 0.734]. In-hospital mortality was 60/541 (11%) in the sofosbuvir/daclatasvir arm versus 55/542 (10%) in the placebo arm (RR 1.09, 95% CI 0.77-1.54, P = 0.615). No differences were observed in time to hospital discharge or time to in-hospital mortality. CONCLUSIONS: We observed no significant effect of sofosbuvir/daclatasvir versus placebo on hospital discharge or survival in hospitalized COVID-19 patients.

Epidemiologic profile of viral hepatitis B and C in North of Iran: results from PERSIAN Guilan Cohort Study (PGCS).

OBJECTIVE: Hepatitis B (HB) and C (HC) are two severe viral infectious diseases with a deleterious impact on global health. This study aimed to evaluate the prevalence of HB and HC in the Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study using immunological and molecular methods. RESULTS: The blood samples were obtained from 10,520 enrolled participants. Complete biochemical and hematological tests, as well as urine analysis, were assessed. The presence of HBsAg, anti-HBs, anti-HBc, and anti-HCV antibodies for all participant and HBeAg and anti-HBe antibodies for HB-positive patients were evaluated. Moreover, HB genomic DNA and HC genomic RNA were extracted from serum samples of HB-positive patients. The real-time PCR assay was employed to quantify the gene copies of hepatitis B and C viruses. HC genotyping was also performed. The prevalence of HB and HC was 0.24% (95% CI 0.16-0.35) and 0.11% (95% CI 0.06-0.19), respectively. Rural participants were significantly more HB-positive than the urban people (P = 0.045), while males were significantly more HC-positive than the females (P = 0.013). The prevalence of HB and HC in this area were lower than those of other geographical locations of Iran, which may be due to different lifestyles or other unknown reasons.

Validation of Omron HBP-1100-E Professional Blood Pressure Measuring Device According to the American Association for the Advancement of Medical Instrumentation Protocol: The PERSIAN Guilan Cohort Study (PGCS).

BACKGROUND: Blood pressure (BP) measurement accuracy is critical to the diagnosis and management of hypertension. The aim of the present study was to validate the Omron HBP-1100-E professional blood pressure measuring device in accordance with the American Association for the Advancement of Medical Instrumentation in Iranian adults. MATERIALS AND METHODS: Simultaneous blood pressure auscultator measurements were obtained by two observers using mercury sphygmomanometers as a reference, sequentially with a measurement by using the Omron HBP-1100-E device. Absolute device-reference blood pressure differences were categorized into three error categories (within 5, 10, and 15 mmHg), and mean device-reference blood pressure difference (standard deviation) was calculated and evaluated using the American Association for the Advancement of Medical Instrumentation criteria. RESULTS: A total of 85 participants (250 paired readings) were enrolled to the study. 26.8%, 55.6%, and 79.6% of the device-reference blood pressure differences agreed to within 5, 10 and 15 mmHg, respectively, for systolic blood pressure, and 39.6%, 69.2%, and 81.6% of measurements for diastolic blood pressure, respectively, and failed to pass the protocol criteria. The mean device-reference blood pressure difference was 8.0 ± 13.1 mmHg for systolic BP and 2.2 ± 11.3 mmHg for diastolic BP, and was >5.0 ± 8.0 mmHg (required criteria). CONCLUSION: Omron HBP-1100-E professional blood pressure monitor is not desirable for measuring the BP for Iranian adults as it overestimates blood pressure in this population.

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.

Validity and inter-observers reliability of blood pressure measurements using mercury sphygmomanometer in the PERSIAN Guilan cohort study.

OBJECTIVE: Accurate measuring of blood pressure is a vital step in both clinical and para-clinical settings. The aims of the present study were to evaluate the validity and inter-observer reliability of measured blood pressures by two trained observers and one expert supervisor in the PERSIAN Guilan cohort study (PGCS). PARTICIPANTS AND METHODS: In a quasi-experimental study, two trained observers and one expert supervisor measured systolic and diastolic blood pressures (SBP and DBP) in 85 included participants. All measurements were done using Riester mercury sphygmomanometer as duplicate for each people. RESULTS: Lack of validity in the total SBP (P = 0.017), DBP in age <50 years (P = 0.039), and DBP in BMI >25 (P=0.019) of first observer and total SBP (P = 0.045), SBP of male (P = 0.019), both SBP and DBP in age >50 years (P = 0.034, P = 0.012) and DBP in BMI <25 (P = 0.001) of second observer were seen. In addition, total inter-rater reliability was found as 12.2% and 27.2% in SBP and DBP, respectively. Age, sex and BMI categorized inter-observer reliability were not more than 15% in SBP of BMI <25 kg/m and 31.6% in DBP of female. The final inter-observer agreement after educational course was higher than 0.7 totally and in all categorical evaluations. CONCLUSION: Based on lack of validity in some conditions and low level of reliability, education of all observers to measure both SBP and DBP accurately is needed. This is more necessary to done before performing the high population surveys.

Combined Evaluation of AFP, CA15-3, CA125, CA19-9, and CEA Tumor Markers in Patients with Hepatitis B and C.

BACKGROUND: This study aimed to determine the role of tumor markers AFP, CA15-3, CA125, CA19-9 and CEA in patients with hepatitis B and C. METHODS: This descriptive cross-sectional study was performed from Oct 2012 to Oct 2014. Serum samples of 129 patients with hepatitis B and C referred to Guilan Liver and Digestive Disease Research Center in Rasht, Iran were collected and checked for the existence of the listed tumor markers by ELISA. RESULTS: No increase in serum levels of tumor marker CA19-9, CEA and CA15-3 were seen in patients with hepatitis (P>0.05). In patients with hepatitis B, increase in CA125 were observed (P=0.03). In hepatitis C patients, there was an increase in AFP levels (P=0.03). CONCLUSION: The levels of AFP and CA125 markers were high in hepatitis C and hepatitis B, respectively. However, the increased levels were not seen is malignancy. Due to the small sample size, further study is necessary to find the reasons of the increase.

Use of oral direct factor Xa inhibiting anticoagulants in elective hip and knee arthroplasty: a meta-analysis of efficacy and safety profiles compared with those of low-molecular-weight heparins.

Assessing the efficacy and safety profiles of new oral direct Factor Xa (FXa) inhibiting anticoagulants compared with low-molecular-weight heparins (LMWHs) in elective total hip and knee arthroplasty (THA and TKA). The literature review only searched for randomised-controlled trials (RCTs) published before September 2011. Five eligible THA RCTs with a total of 12,184 patients and 5 eligible TKA RCTs with a total of 13,169 patients were identified. Mantel- Haenszel random-effects model was used to create meta-analyses of pooled data for each surgical group. The primary efficacy outcome was the risk of venous thromboembolism (VTE) and all-cause mortality, and the primary safety outcome was the risk of major bleeding. The THA and TKA primary efficacy outcome meta-analyses calculated relative risks (RR) of 0.55 (95% confidence interval 0.32 to 0.94) and 0.68 (95% confidence interval 0.53 to 0.87), respectively in favor of the oral direct FXa inhibitors. The primary safety outcome meta-analyses for the THA and TKA surgical groups revealed an RR of 1.27 (95% confidence interval 0.56 to 2.86) and 0.94 (95% confidence interval 0.44 to 1.98), which shows no significant difference between oral FXa inhibitors and LMWHs. This review demonstrated that oral direct FXa inhibitors have a superior efficacy to LMWHs when used as thromboprophylaxis in both THA and TKA. The safety profile of these new oral anticoagulants was not significantly different to that of LMWHs.