Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts.

OBJECTIVE: We aimed to determine the predictive capacity and diagnostic yield of a 10-fold increase in serum IgA antitissue transglutaminase (tTG) antibody levels for detecting small intestinal injury diagnostic of coeliac disease (CD) in adult patients. DESIGN: The study comprised three adult cohorts. Cohort 1: 740 patients assessed in the specialist CD clinic at a UK centre; cohort 2: 532 patients with low suspicion for CD referred for upper GI endoscopy at a UK centre; cohort 3: 145 patients with raised tTG titres from multiple international sites. Marsh 3 histology was used as a reference standard against which we determined the performance characteristics of an IgA tTG titre of ≥10×ULN for a diagnosis of CD. RESULTS: Cohort 1: the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 54.0%, 90.0%, 98.7% and 12.5%, respectively. Cohort 2: the sensitivity, specificity, PPV and NPV for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 50.0%, 100.0%, 100.0% and 98.3%, respectively. Cohort 3: the sensitivity, specificity, PPV and NPV for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 30.0%, 83.0%, 95.2% and 9.5%, respectively. CONCLUSION: Our results show that IgA tTG titres of ≥10×ULN have a strong predictive value at identifying adults with intestinal changes diagnostic of CD. This study supports the use of a no-biopsy approach for the diagnosis of adult CD.

Effects of a gluten challenge in patients with irritable bowel syndrome: a randomized single-blind controlled clinical trial.

Non-celiac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS) frequently overlap. Although, gluten-free diet (GFD) and low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improve the IBS clinical picture, many aspects remain unclear. Therefore, we designed a study to evaluate gluten tolerance, anxiety and quality of life in a specific study population. Fifty IBS patients were asked to follow a low FODMAP strict GFD for 6 weeks and were then randomly allocated to the following groups for a further 6 weeks: (A) receiving 8 g/day of gluten for 2 weeks; gluten-tolerating subjects received 16 g/day for 2 weeks and then 32 g/day for a further 2 weeks; (B) continuing to follow a low FODMAP strict GFD; and (C) receiving a gluten-containing diet. After the first 6 weeks, symptom scores significantly improved. Pain severity, bloating and total score were significantly decreased in the GFD and in the high-gluten groups, while the satiety score significantly increased in group C. Between-group analysis revealed significant differences for pain severity (p = 0.02), pain frequency (p = 0.04) and impact on community function (p = 0.02) at the end of the study. Our findings suggest that low FODMAP strict GFD could be prescribed in IBS patients and would reduce anxiety and improve the quality of life.

Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study.

Background: Histological changes induced by gluten in the duodenal mucosa of patients with non-coeliac gluten sensitivity (NCGS) are poorly defined. Objectives: To evaluate the structural and inflammatory features of NCGS compared to controls and coeliac disease (CeD) with milder enteropathy (Marsh I-II). Methods: Well-oriented biopsies of 262 control cases with normal gastroscopy and histologic findings, 261 CeD, and 175 NCGS biopsies from 9 contributing countries were examined. Villus height (VH, in µm), crypt depth (CrD, in µm), villus-to-crypt ratios (VCR), IELs (intraepithelial lymphocytes/100 enterocytes), and other relevant histological, serologic, and demographic parameters were quantified. Results: The median VH in NCGS was significantly shorter (600, IQR: 400−705) than controls (900, IQR: 667−1112) (p < 0.001). NCGS patients with Marsh I-II had similar VH and VCR to CeD [465 µm (IQR: 390−620) vs. 427 µm (IQR: 348−569, p = 0·176)]. The VCR in NCGS with Marsh 0 was lower than controls (p < 0.001). The median IEL in NCGS with Marsh 0 was higher than controls (23.0 vs. 13.7, p < 0.001). To distinguish Marsh 0 NCGS from controls, an IEL cut-off of 14 showed 79% sensitivity and 55% specificity. IEL densities in Marsh I-II NCGS and CeD groups were similar. Conclusion: NCGS duodenal mucosa exhibits distinctive changes consistent with an intestinal response to luminal antigens, even at the Marsh 0 stage of villus architecture.

Direct and indirect medical costs of functional constipation: a population-based study.

BACKGROUND: Constipation causes a large number of medical visits each year and imposes significant financial toll on healthcare systems worldwide. So the present community-based study was conducted in order to estimate attributable direct and indirect costs to functional constipation (FC) and to provide an overview of related physician visits in general population of Iran. METHODS: From May 2006 to December 2007, a total of 19,200 adult persons (aged 16 and above) were drawn randomly in Tehran province, Iran (response rate 94%). Participants who reported any gastrointestinal symptoms (2,790 persons) were referred to assigned physicians to be questioned about symptoms of functional bowel disorders according to the Rome III criteria. Direct and indirect costs to FC were calculated. Attributable costs were reported as purchasing power parity dollars (PPP$). RESULTS: Of the total 18,180 consenting participants in this study, 435 (2.4%) had FC according to Rome III criteria. Mean total cost of constipation per person was 146.84 PPP$, of which 128.68 PPP$ was related to direct costs and 18.16 PPP$ to indirect costs. Higher educated persons (189.75 PPP$), those above 64 years of age (373.42 PPP$), subjects with BMI of less than 18.5 kg/m(2) (510.84 PPP$), and widowed persons (258.50 PPP$) had the highest costs. CONCLUSIONS: This study determined that although the economic burden of FC does not seem to be substantial in comparison to other major health problems, it still exacts a substantial toll on the health system for two reasons: chronicity and ambiguity of symptoms.

Prognostic value of microRNA-125a/b family in patients with gastric cancer: a meta-analysis.

AIM: This meta-analysis was designed to reassess the prognostic and clinicopathologic values of the microRNA-125 family in GC patients. BACKGROUND: The miR-125 family (including miR-125a, miR-125b) has been reported as being pivotal prognostic biomarkers of gastric cancer (GC). However, there is controversy about the role of the miR-125 family in predicting the progression of GC. METHODS: The miR-125 family (including miR-125a, miR-125b) has been reported as being pivotal prognostic biomarkers of gastric cancer (GC). However, there is controversy about the role of the miR-125 family in predicting the progression of GC. RESULTS: The electronic databases of PubMed, ISI Web of Science, Scopus, and Cochrane Library were systematically searched for relevant studies. Overall survival (OS) rate as the primary outcome from each study was extracted. The overall hazard ratio (HR or survival rate in patients with GC) and odds ratio (OR) with 95% confidence interval (CI) was calculated to evaluate the association between miR-125 family expression and prognosis and susceptibility to gastric cancer. The quality of evidence was evaluated using the Newcastle-Ottava Scale (NOS). The extracted data was combined based on the random-effects model. CONCLUSION: The low expression of miR-125 family predicts poor OS in GC patients. Thus, the miR-125 family may be helpful as a potential biomarker for the prognosis of gastric cancer.

An algorithmic approach to gastrointestinal bleeding in patients receiving antithrombotic agents.

Gastrointestinal bleeding is an overwhelming complication of patients taking antithrombotic agents. These drugs pose a challenge to physicians in the management of bleeding to establish hemostasis without putting these patients at a higher risk for thromboembolism. This study aims to propose an algorithmic approach to four major groups of patients receiving antithrombotic agents (single antiplatelet agents, dual antiplatelet agents, anticoagulants and direct oral anticoagulants) to decide when and how these drugs should be held or restarted to offset between the risk of re-bleeding and thromboembolism. Four case-based algorithms are proposed in this article based on some relevant articles. Having designed four case-based algorithms, we are hoping to guide physicians who face a dilemma on the management of patients receiving antithrombotics when gastrointestinal bleeding occurs. Patients using antithrombotics referred for gastrointestinal bleeding were stratified into four groups based on the medication which is used as an antithrombotic agent and four algorithms were designed which are presented here. We have made an attempt to have a stepwise approach to four cases relevant to the study and have an evaluation on the management of their antithrombotic agents during an episode of gastrointestinal bleeding. It is widely accepted that antithrombotic agents should be restarted as soon as possible after the establishment of hemostasis in a patient taking antithrombotics referring for gastrointestinal bleeding. The time for resuming these drugs is different based on the severity of bleeding, the probability of thromboembolic events, and the nature of the antithrombotic medication which is used by the patient.

The correlation between vitamin D levels and demographics in patients with gastrointestinal disorders; a cross-sectional study.

AIM: The aim of the present study was to evaluate vitamin D levels, in correlation with age, body mass index (BMI), gender and ethnicity, in patients with gastrointestinal disorders (GID). BACKGROUND: Vitamin D deficiency (VDD) is a global health issue, affecting over 1 billion people. A great body of evidence has shown that it can lead to increased morbidity and mortality. Furthermore, latitude, sedentary lifestyle, limited sunlight exposure, ageing and the presence of comorbidities and chronic illnesses, places patients at an increased risk of VDD. METHODS: 305 consecutive patients, with GID, were assessed for vitamin D levels, using a two-step competitive binding immunoenzymatic assay. Patients were then classified as adequate (50-150nmol/l), insufficient (25-50nmol/l) and deficient (<25nmol/l). RESULTS: 62% of the investigated subjects had low vitamin D levels. From this group, 132 patients (43.3%) had insufficient vitamin D levels, 57 (18.7%) had deficient levels and 116 (38%) had adequate levels. Age was not significantly different in the 3 groups (p=0.29). Interestingly, vitamin D levels were significantly lower in men (39.23±23.62) compared to women (50.68±24.46) (p=0.0001). The BMI was significantly higher in patients with insufficient vitamin D levels. Being of Asian ethnicity had a positive influence on vitamin D levels (B=0.076) (p<0.0001). 71.4% of patients, with IBD, and 60% of patients, with abnormal liver function, had low vitamin D levels. CONCLUSION: VDD has a high prevalence in patients with GID in particular IBD and liver disease in the United Kingdom. Routine vitamin D testing and supplementations in the case of deficiency and suboptimal level of vitamin D for patients with hepatobiliary, pancreatic, kidney, malabsorptive and restrictive diseases/surgeries is recommended.

The effect of working in an auto factory on functional constipation and bowel habits.

AIM: The aim of the present study was to evaluate the factors associated with functional constipation (FC) and to determine a normal range of bowel movement (BM) in an Iranian Auto factory's workers. BACKGROUND: The digestive system may be affected by workplace conditions. Some occupational conditions can affect the bowel habit and FC. METHODS: In this cross-sectional study, 3590 workers who worked in Tehran suburb in 2017 were evaluated. The workers worked in morning or rotatory shifts and in the official and non-official sections. In addition to demographic and stool frequency questions, workers were asked to complete the Rome IV Questionnaire. RESULTS: The normal range of BM frequency was determined between one and three per day. The BM frequency had a significant association with age (P=0.002), marital status (P=0.024), education (P=0.011), exposure to chemical materials (P<0.001), and work section (P<0.001). The total prevalence of FC was 9.7% which was greater among rotatory shift working than among only morning shift workers (10% vs 6%; P=0.02). Independent factors associated with FC were found as age (for 30- 40 years old: OR=1.88; 95% CI (1.20, 3.03) and for ≥41 years old: OR=1.91; 95% CI (1.12,3.17)), smoking (OR=1.52; 95% CI (1.20,1.93)) and work section (for Paint section: OR=0.33; 95% CI (0.12,0.87), for montage section: OR=0.44; 95% CI (0.18,1.10), for press & platform section: OR=0.12; 95% CI (0.05,0.37)). CONCLUSION: Occupational condition may make a difference in bowel habit. Rotatory shift, official working, and smoking may increase the risk of constipation.

Lack of health care professional's awareness for management of celiac disease may contribute to the under diagnosis of celiac disease.

AIM: We assessed the knowledge of physicians regarding diagnosis and treatment of celiac disease (CD). BACKGROUND: Specialists as the main therapist group of CD patients may play crucial role in the diagnosis and treatment of CD. Therefore, training and ensuring their capabilities is important. METHODS: The population was specialists including Gastroenterologist, GI fellow, consultants, residents and general practitioners graduated in Medical Sciences Universities in Iran. The examination was the experts made and aimed to assess the educational needs of physicians and explore their failures in the diagnosis and treatment of CD with the key feature approach. Data was collected using a questionnaire that its validity and reliability was confirmed by experts (r = 91.6%). The total score was 150 with the classification of participants to the following categories: good (112- 150), intermediate (39-112) and weak ( ≤38). RESULTS: Out of 300 participants, 197 questionnaires were returned (Response rate = 66%). The mean age of the participants was 42.67 years (SD = 7.9 years) with majority were male (63.6%). Average score of participates who had less than three year's experience was significantly higher than others (P≤0.05). Only 12.1% and 9.8% of specialists have got the excellent score for diagnosis and treatment, respectively. CONCLUSION: It may conclude that specialists have had performance gap and around 90% needed training based on the principles of instructional design in order to improve their knowledge and skills to do and practice their assigned tasks. Therefore, development of training packages according to the principles of instructional design is suggested.

Clinicopathologic Features of Colorectal Polyps in Shahid Beheshti University of Medical Sciences (SBMU).

Aim: This study was designed to report epidemiologic findings of polyps in Iranian patients, and predict histology of polyp regarding to demographic and colonoscopic findings. Background: Classification of colorectal polyps had been revised in the past two decades and there is a need for polyp categorization in the Iranian Health System. Patients and methods: In this retrospective study, the medical records of patients with colonoscopic diagnosis of polyp in pathology departments of SBMU affiliated teaching hospitals were reviewed. Patient's slides evaluated and demographics findings were assessed. The anatomical location, macroscopic appearance including size and histological assessment of all polyps were recorded. Results: From total number of 1106 polyps (detected in 862 patients), adenomatous polyps (638 [57.7%]) were the most prevalent findings, followed by colon mucosal tag (184[16.6%]), hyperplastic and serrated polyps (122[11%]), inflammatory polyps (110[9.9%]), hamartomatous (21[1.9%]), and malignant lesions (13[1.2%]). Multivariate logistic regression showed age (each one year increasing age; odds ratio [OR] = 1.026, 95%confidence interval [CI] = 1.016­1.036, p < 0.0001), location of polyp (right colon; OR = 1.905, 95%CI = 1.366­2.656, p < 0.0001), and polyp size of 5-10 mm (OR = 1.662, 95%CI = 1.214­2.276, p = 0.002), and polyp size of >10 mm (OR = 2.778, 95%CI = 1.750­4.411, p< 0.0001) were independently associated with neoplastic polyps. Also, polyp size of >10 mm (OR= 2.613, 95%CI= 1.083-6.307, p=0.033), tubulovillous pattern of polyp (OR= 3.508, 95%CI= 1.666-7.387, p=0.001) and villous pattern of polyp (OR= 10.444, 95%CI= 4.211-25.905, p<0.0001) were associated with high grade dysplasia in neoplastic polyps. Conclusion: Increased age, location of polyp (right colon), increased size of polyp and villous component of polyp could classify patients in high risk groups.

Network analysis of grade II into grade III transition in rectum cancer patients.

AIM: Finding important differential genes between grade II and grade III of rectum cancer was the aim of this study. BACKGROUND: Colorectal (CRC) cancers (CRC) are known as the third diagnosed cancer and the second leading to death cancers. Life style is an important risk factor of CRCs. Diagnosis of rectum cancer estimated as 44% of colon cancer. METHODS: Differentially expressed genes (DEGS) related to grade II into grade II in 6 patients are retrieved from gene expression omnibus (GEO) and investigated by protein-protein interaction (PPI) network analysis. Central nodes of the network are identified and enriched to determine biochemical pathways. Action map is illustrated for the central genes. RESULTS: Among 15 central genes including AKT1, PRDM10, GAPDH, TP53, SRC, EGFR, ALB, INS, CTNNB1, EGF, IL6, RHOA, DECR1, ACACA, GMPS role of AKT1 is highlighted due to prominent role in the integrity of the network and participation in the most determined pathways. However, significant regulatory effect of INS, AKT1, EGF, EGFR, and CTNNB1 is tinted in action map. CONCLUSION: It seems that AKT1, EGFR, and TP3 are suitable drug targets to prevent rectum cancer progression.

A rapid and sensitive assay to identify HLA-DQ2/8 risk alleles for celiac disease using real-time PCR method.

AIM: To perform a simple, rapid and sensitive Real-time PCR based SYBR Green method to determine the human leukocyte antigen (HLA)-DQ 2/8 alleles in celiac disease (CD) patients. BACKGROUND: Many molecular techniques are available to determine the HLA-DQ2 and DQ8 alleles, but they are too expensive and have many steps that make them difficult to use. METHODS: To determine the HLA-DQ 2/8 alleles we have developed a new real-time PCR assay, using SYBR Green technique with melting curve analysis on genomic DNA isolated from 75 CD patients and 94 healthy controls. The specific primers to examine HLA-DQA1*05, HLA-DQB1*02 and HLA-DQB1*0302 alleles were used and results were compared with commercially available kits. RESULTS: Using this method, the presence of HLA-DQ2 and HLA-DQ8 alleles were determined with sensitivity and specificity 80% and 100% respectively and compared to low resolution commercially available kits, the results of this method were more efficient. The frequency of DQ2 and DQ8 in patients was 76% and 29%, respectively and overall 96% of patients were carries DQ2 and/or DQ8 alleles. CONCLUSION: The result of this study showed that Real-time PCR using SYBR Green method with melting curve analysis has good efficiency to identify the HLA-DQ2/8 risk alleles.

Influence of working in auto factory on gastroesophageal reflux disease.

AIM: Present study aimed to evaluate association between job -related factors and gastroesophageal reflux disease (GERD) among Iranian auto factory's workers. BACKGROUND: Many of the gastrointestinal disorders may be caused as the result of stress-related occupations and biorhythm disruption. METHODS: We performed a cross-sectional study on 3590 Iranian Auto factory employees. GERD symptoms, demographic information, work shift, work section and history of some gastrointestinal disease were asked from all employees by physician. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for GERD symptoms according to the potential risk factors. RESULTS: The prevalence of GERD was 25.57%, which was higher in rotatory shift (91.6%) than the fixed shift (8.4%) (P-value = 0.009). Smoking (OR: 1.31; 95% CI: (1.09, 1.57)), working in official section (P-value < 0.001), history of GERD (OR: 8.63; 95 % CI (6.53, 11.40)), history of peptic ulcer (OR: 2.96; 95 % CI (2.08, 4.20)), family history of gastrointestinal cancers (OR: 1.47; 95 % CI (1.19, 1.81)) were the factors associated with GERD symptoms. CONCLUSION: The prevalence of GERD in the rotatory shift was more than the fixed shift. Smoking, family history of gastrointestinal cancers and peptic ulcer could be associated with GERD symptoms. Working in the special job with high activity, may probably lead to decrease in the risk of reflux.

Person centered prediction of survival in population based screening program by an intelligent clinical decision support system.

AIM: To survey person centered survival rate in population based screening program by an intelligent clinical decision support system. BACKGROUND: Colorectal cancer is the most common malignancy and major cause of morbidity and mortality throughout the world. Colorectal cancer is the sixth leading cause of cancer death in Iran. In this survey, we used cosine similarity as data mining technique and intelligent system for estimating survival of at risk groups in the screening plan. METHODS: In the first step, we determined minimum data set (MDS). MDS was approved by experts and reviewing literatures. In the second step, MDS were coded by python language and matched with cosine similarity formula. Finally, survival rate by percent was illustrated in the user interface of national intelligent system. The national intelligent system was designed in PyCharm environment. RESULTS: Main data elements of intelligent system consist demographic information, age, referral type, risk group, recommendation and survival rate. Minimum data set related to survival comprise of clinical status, past medical history and socio-demographic information. Information of the covered population as a comprehensive database was connected to intelligent system and survival rate estimated for each patient. Mean range of survival of HNPCC patients and FAP patients were respectively 77.7% and 75.1%. Also, the mean range of the survival rate and other calculations have changed with the entry of new patients in the CRC registry by real-time. CONCLUSION: National intelligent system monitors the entire of risk group and reports survival rates by electronic guidelines and data mining technique and also operates according to the clinical process. This web base software has a critical role in the estimation survival rate in order to health care planning.

The effect of education on the knowledge of patients with celiac disease.

AIM: The aim of this study was to investigate the effects of education on patients' knowledge of celiac disease, in an Iranian population. BACKGROUND: Education can increase patients' knowledge regarding their disease, leading to improvements in their health. METHODS: This cross-sectional study was conducted on patients who had been diagnosed with celiac disease. The patients attended an educational meeting in September, 2016. During the educational meeting information regarding the epidemiology, diagnosis and treatment of celiac disease was provided to the study subjects. Each patient completed a questionnaire regarding celiac disease before and after the educational meeting. The questionnaires were scored. Study data was analyzed using SPSS version 20. RESULTS: 90 patients were recruited (69 [77%] were women). Analysis of questionnaire responses showed that except for awareness of cross contamination with gluten, the education meeting significantly increased the knowledge of patients with celiac disease regarding epidemiology, diagnosis and treatment (p=0.001). CONCLUSION: The result of this study shows that an educational meeting can increase the knowledge of CD patients in treatment. Increasing patients' knowledge may lead to improvements in patients' health.

Evaluation of liver cirrhosis and hepatocellular carcinoma using Protein-Protein Interaction Networks.

AIM: In the current study, we analysised only the articles that investigate serum proteome profile of cirrhosis patients or HCC patients versus healthy controls. BACKGROUND: Increased understanding of cancer biology has enabled identification of molecular events that lead to the discovery of numerous potential biomarkers in diseases. Protein-protein interaction networks is one of aspect that could elevate the understanding level of molecular events and protein connections that lead to the identification of genes and proteins associated with diseases. METHODS: Gene expression data, including 63 gene or protein names for hepatocellular carcinoma and 29 gene or protein names for cirrhosis, were extracted from a number of previous investigations. The networks of related differentially expressed genes were explored using Cytoscape and the PPI analysis methods such as MCODE and ClueGO. Centrality and cluster screening identified hub genes, including APOE, TTR, CLU, and APOA1 in cirrhosis. RESULTS: CLU and APOE belong to the regulation of positive regulation of neurofibrillary tangle assembly. HP and APOE involved in cellular oxidant detoxification. C4B and C4BP belong to the complement activation, classical pathway and acute inflammation response pathway. Also, it was reported TTR, TFRC, VWF, CLU, A2M, APOA1, CKAP5, ZNF648, CASP8, and HSP27 as hubs in HCC. In HCC, these include A2M that are corresponding to platelet degranulation, humoral immune response, and negative regulation of immune effector process. CLU belong to the reverse cholesterol transport, platelet degranulation and human immune response. APOA1 corresponds to the reverse cholesterol transport, platelet degranulation and humoral immune response, as well as negative regulation of immune effector process pathway. CONCLUSION: In conclusion, this study suggests that there is a common molecular relationship between cirrhosis and hepatocellular cancer that may help with identification of target molecules for early treatment that is essential in cancer therapy.

The Burden of HIV in Iran: Insights from the Global Burden of Disease Study 2010.

OBJECTIVES: To evaluate the HIV/AIDS burden in Iran from 1980 to 2010 using the Global Burden of Disease Study 2010 (GBD 2010). METHODS: The burden of HIV/AIDS in Iran was obtained from a systematic study from 1990 to 2010 by the GBD team. The GBD 2010 disability weights were used to calculate the HIV/AIDS Disability Adjusted Life Years (DALY) based on the HIV prevalence reported by the Joint United Nations Program on HIV/AIDS (UNAIDS) estimation. Mortality data were obtained from the vital registration and statistics system of Iran. In the current study, the results are discussed, and the potential solutions are provided for observed deficiencies. RESULTS: HIV/AIDS-related DALYs (3.6 per 100,000 in 1990, and 154 per 100,000 in 2010) and death (0.07 per 100,000 in 1990, and 3 per 100,000 in 2010) had increased in Iran from 1990 to 2010. The majority of individuals who died of HIV were between 15 to 49 years old. The estimated rank of HIV/AIDS burden compared with the burden of other leading disease was 152nd in 1990 and considerably increased to 37th in 2010 in Iran. CONCLUSION: Since the majority of HIV/AIDS DALYs and deaths occur among young people, the burden of HIV/AIDS still remains high in Iran. Due to the limitations of the GBD study, National and Sub-National Burden of Diseases (NASBOD) study is being conducted in Iran to calculate the burden of diseases, including HIV/AIDS.

The Helicobacter pylori eradication in the group receiving standard -dose and group continue taking amoxicillin for 4 weeks; a clinical trial study.

AIM: The aim of this study was to evaluate the Helicobacter pylori eradication in the group receiving standard -dose twice a day for two weeks and continue taking amoxicillin for 4 weeks. BACKGROUND: Helicobacter pylori is the major etiological cause of chronic gastritis, gastric and duodenal ulcers, gastric cancer and lymphoma. Therefore, patients should be treated after diagnosis of H. pylori infection. PATIENTS AND METHODS: A total of 66 consecutive patients with rapid urease test during endoscopy or biopsy positive for H. pylori were enrolled in this clinical trial study during 2013-2014. Patients were divided randomly into two groups. Group A (standard dose) received omeprazole (20 mg), amoxicillin (1 g), and clarithromycin (500 mg), all two times a day for two weeks. Group B received standard dose like group A and in patients with H.pylori infection amoxicillin were continued for 4 weeks. After completion of treatment, patients did not receive any treatment for a month and then stool antigen was performed to evaluate the H.pylori. RESULTS: The rate of successful HP eradication was significantly higher in group A (90.9% V.s 63.6%; p=0.017). Inflation and bitter mouth were found in 8 and 13 patients in group A and 7 and 9 patients in group B, respectively. The incidence of adverse effects was the same (p=0.437). CONCLUSION: Increased duration of antibiotic therapy to four weeks significantly raises the rate of successful HP eradication with standard triple therapy without significant increase in adverse effects.

Burden of Hepatitis C in Iran Between 1990 and 2010: findings from the Global Burden of Disease Study 2010.

BACKGROUND: Hepatitis C virus (HCV) is the foremost cause of deaths attributable to cirrhosis and hepatocellular carcinoma. The Global Burden of Disease study 2010 (GBD 2010) quantifies and compares the degree of health loss as a result of diseases, injuries, and risk factors by age, sex, and geography overtime. This study aimed to present and critique the burden of hepatitis C and its trend in Iran between 1990 and 2010 by using the GBD study 2010. METHODS: We used the results of GBD 2010 for Iran to measure rates and trends of mortality, causes of deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability adjusted life years (DALYs) due to hepatitis C. Hepatitis C was defined as the presence of hepatitis C virus in the serum. Data were presented in three categories: acute hepatitis C, cirrhosis secondary to hepatitis C, and liver cancer secondary to hepatitis C. RESULTS: HCV infection (including the three categories of the study) led to 57.29, 59.92, and 66.45 DALYs (per 100,000 population) in 1990, 2000, and 2010, respectively. DALYs and death rates showed a slight decreasing trend for HCV cirrhosis; however, DALYs and death rates increased for acute hepatitis and liver cancer due to patients with HCV. The majority of deaths and DALYs were in individuals aged 70 years and above in all three categories of HCV. YLLs made the greatest contributions to DALYs. CONCLUSION: DALYs due to HCV infection are increasing in Iran according to GBD 2010; however, the estimations of DALYs using GBD 2010 are mostly from model-based data and there are significant uncertainties for extrapolated data. In this regard, a comprehensive study such as the National and Subnational Burden of Diseases (NASBOD) study would be needed to estimate and calculate precisely prevalence and burden of HCV-related diseases at national and subnational levels.

Comparison of half-dose and full-dose triple therapy regimens for Helicobacter pylori eradication in patients with end-stage renal disease.

AIM: The aim of this study was to compare the half-dose and full-dose triple therapy regimens for Helicobacter pylori (Hp) eradication in patients with end-stage renal disease. BACKGROUND: H. Pylori is one the most important causes of dyspepsia in patients with end-stage renal disease (ESRD). PATIENTS AND METHODS: Sixty-six patients with ESRD were enrolled in the study with Hp infection and peptic disease with a need of Hp eradication. Patients were randomly assigned to full-dose (A=35 patients) or half-dose group (B=31 patients). Patients received clarithromycin 500 mg, amoxicillin 1000 mg and omeprazole 20 mg twice daily in group A and clarithromycin 250 mg and amoxicillin 500 mg twice daily and omeprazole 20 mg once daily in group B for two weeks. Patients provided stool samples 4 weeks of completing study to assess the success of Hp eradication by Hp-specific stool antigen. Finally, the rate of eradication and complications were compared between two groups. RESULTS: The successful Hp eradication was achieved in 26 patients (74%) in group A and in 22 patients (74%) in group B. The difference between 2 groups was not statistically significant (p=0.973) (per protocol analysis). CONCLUSION: Half-dose triple-therapy with clarithromycin, amoxicillin and omeprazole is as effective as full-dose triple-therapy to eradicate the Hp in patients with ESRD. According to lower toxicity level, complications and cost in half-dose regimen in this subset of patients, this protocol is advised.