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1.  The Prevalence of Non-alcoholic Fatty Liver Disease and Diabetes Mellitus in an Iranian Population 
Type II diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) are important causes of morbidity and mortality worldwide. We aimed to estimate the prevalence of DM in the context of NAFLD.
In this cross-sectional study, we studied 5052 participants, aged 18 years and older, of a baseline population-based cohort in northern Iran (N=6143). The prevalence of DM was estimated in individuals with and without NAFLD. The association between NAFLD and T2DM was evaluated using logistic regression with the adjustment of confounding effects of age, sex, body mass index, lipid profiles, and fasting insulin.
In men, the prevalence (95% confidence interval) of T2DM was 5.34% (4.35%-6.34%) and 15.06% (13.12%-17.00%) in individuals without and with NAFLD, respectively (p <0.001). In women without NAFLD, the prevalence was 8.27% (6.83%-9.71%) while in the presence of NAFLD, the prevalence was 27.21% (24.59%-29.83%), (p <0.001). In univariate analysis, the chance of having T2DM was 3.700 (3.130-4.380) times more in patients with NAFLD compared with subjects without NAFLD (p<0.001). This chance was reduced (Odds Ratio=1.976, 95% CI: 1.593-2.451, p <0.001) after removing the effects of other variables.
The prevalence of T2DM is increased in the context of NAFLD. This condition may be considered as an independent predictor of T2DM.
PMCID: PMC5471107
Non-alcoholic fatty liver disease; Diabetes mellitus; Non-communicable disease; Prevalence; Iran
3.  Body Roundness Index and Waist-to-Height Ratio are Strongly Associated With Non-Alcoholic Fatty Liver Disease: A Population-Based Study 
Hepatitis Monthly  2016;16(9):e39575.
A strong association between obesity and non-alcoholic fatty liver disease (NAFLD) has been reported.
This study was conducted to evaluate if new obesity indices, including a body shape index (ABSI) and body roundness index (BRI), have stronger associations with NAFLD than waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR).
In this cross-sectional study, we utilized the data of 4,872 participants aged 18 - 74 years from a cohort study conducted among 6,143 subjects in northern Iran. Logistic regression analysis was performed on NAFLD as the outcome and obesity measures (based on Z-score values) as potential predictors. Receiver operating characteristic (ROC) analyses were conducted, in which NAFLD was considered as a reference variable and obesity measures as classification variables. The discriminatory ability of the obesity measures was reported based on area-under-the-curves, and the related cut-off points of BRI and WHtR were determined using the Youden index (YI).
Based on our results, BRI (OR = 5.484 for men and OR = 3.482 for women) and WHtR (OR = 5.309 for men and OR = 3.854 for women) showed a higher association with NAFLD than ABSI (OR = 1.363 for men and OR = 1.003 for women) and WHR (OR = 3.123 for men and OR = 1.628 for women). The optimal cut-off points for BRI were 4.00 (sensitivity = 82.7%, specificity = 70.8%) for men and 5.00 (sensitivity = 83.3%, specificity = 71.7%) for women. The optimal cut-off points for WHtR were 0.533 (sensitivity = 82.7%, specificity = 70.8%) for men and 0.580 (sensitivity = 83.3%, specificity = 71.7%) for women.
While BRI and WHtR have equally strong associations with NAFLD, ABSI and WHR have weaker associations with NAFLD than BRI and WHtR.
PMCID: PMC5091031  PMID: 27822266
Non-Alcoholic Fatty Liver Disease; Obesity; Waist-to-Height Ratio
4.  Association between Pattern of Gastritis and Gastroesophageal Reflux Disease in Patients with Helicobacter Pylori Infection 
Reflux disease is a common gastrointestinal problem. The association between reflux disease and gastritis pattern is controversial. AIM: To determine the association between reflux disease and gastritis pattern in patients with Helicobacter pylori (H. pylori) infection.
470 patients with dyspepsia and reflux disease were enrolled in this study. The inclusion criteria were willing to participate in the study, age over 40 years, and having the criteria of ROME III for at least 3 months. Patients with history of H. pylori eradication therapy during the 3 months before the study, a history of gastric surgery, and gastric cancer were excluded. All of the participants underwent upper endoscopy and two biopsy samples were taken from antrum, body, and fundal areas.
H. pylori infection rate was 367 (78.1%) with mean age of 59.8 ± 11.4 years. Of them 131 patients (35.7%) were male. Reflux disease was detected in 273 (74.4%) patients. 216 (58.9%) and 102 (27.8%) patients had non-erosive reflux disease (NERD) and gastroesophageal reflux disease (GERD), respectively. Corpus predominant and antral predominant gastritis were seen in 72 (19.6%) and 129 (35.2%) patients, respectively. Antral gastritis was significantly associated with GERD (p<0.01). In regression analysis, antral predominant gastritis had a significant association with GERD (OR=1.92; 95%CI: 1.22- 3.12). The same result was observed in mild to moderate antral and greater curvature gastritis (OR= 1.26; 95%CI: 0.25-6.40 and OR= 3.0; 95%CI: 0.63-14.17, respectively).
According to these finding ,we could suggest that the pattern of gastritis could be associated with reflux disease and GERD.
PMCID: PMC5045673  PMID: 27698970
Gastroesophageal Reflux; GERD; Gastritis; Esophagus
5.  Fatty liver index vs waist circumference for predicting non-alcoholic fatty liver disease 
World Journal of Gastroenterology  2016;22(10):3023-3030.
AIM: To determine the discriminatory performance of fatty liver index (FLI) for non-alcoholic fatty liver disease (NAFLD).
METHODS: The data of 5052 subjects aged over 18 years were analyzed. FLI was calculated from body mass index, waist circumference (WC), triglyceride, and gamma glutamyl transferase data. Logistic regression analysis was conducted to determine the association between FLI and NAFLD. The discriminatory performance of FLI in the diagnosis of NAFLD was evaluated by receiver operating characteristic analysis. Area under the curves (AUCs) and related confidence intervals were estimated. Optimal cutoff points of FLI in the diagnosis of NAFLD were determined based on the maximum values of Youden’s index.
RESULTS: The mean age of men and women in the study population were 44.8 ± 16.8 and 43.78 ± 15.43, respectively (P = 0.0216). The prevalence of NAFLD was 40.1% in men and 44.2% in women (P < 0.0017). FLI was strongly associated with NAFLD, so that even a one unit increase in FLI increased the chance of developing NAFLD by 5.8% (OR = 1.058, 95%CI: 1.054-1.063, P < 0.0001). Although FLI showed good performance in the diagnosis of NAFLD (AUC = 0.8656 (95%CI: 0.8548-0.8764), there was no significant difference with regards to WC (AUC = 0.8533, 95%CI: 0.8419-0.8646). The performance of FLI was not significantly different between men (AUC = 0.8648, 95%CI: 0.8505-0.8791) and women (AUC = 0.8682, 95%CI: 0.8513-0.8851). The highest performance with regards to age was related to the 18-39 age group (AUC = 0.8930, 95%CI: 0.8766-0.9093). The optimal cutoff points of FLI were 46.9 in men (sensitivity = 0.8242, specificity = 0.7687, Youden’s index = 0.5929) and 53.8 in women (sensitivity = 0.8233, specificity = 0.7655, Youden’s index = 0.5888).
CONCLUSION: Although FLI had acceptable discriminatory power in the diagnosis of NAFLD, WC was a simpler and more accessible index with a similar performance.
PMCID: PMC4779925  PMID: 26973398
Non-alcoholic fatty liver disease; Fatty liver index; Waist circumference; Body mass index; Optimal cutoff points; Discriminatory performance
6.  Decrease expression and clinicopathological significance of miR-148a with poor survival in hepatocellular carcinoma tissues 
Diagnostic Pathology  2015;10:135.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, mainly due to its high rates of postoperative recurrence and metastasis. Please remove, it currently ranks as the third most common cause of cancer-related deaths. MiRNAs are a set of small, single-stranded, non-coding RNA molecules that negatively regulate gene expression at the post-transcriptional level. In this study, we demonstrated the down-regulation of miR-148a in HCC and non-cancerous tissues using qRT-PCR.
Ninety six HCC samples and their noncancerous normal liver tissues were collected. Total mRNA including miRNA was extracted, and miR-148a expression was determined using qRT-PCR. Furthermore, the correlation between the miR-148a expression and clinicopathological parameters was investigated.
The result showed that reduction of miR-148a expression was associated with TNM stage, metastasis, and number of tumor nodes. Multivariate Cox proportional hazards model analysis showed that low expression of miR-148a was independently associated with recurrence of HCC in the current study. Moreover, our result showed that lower expression in tumor tissues in comparison with corresponding normal control tissues.
Down-regulation of miR-148a is related to HCC carcinogenesis and deterioration of HCC. MicroRNA-148a may act as a suppressor miRNA of HCC, and it is therefore a potential prognostic biomarker for HCC patients.
PMCID: PMC4528397  PMID: 26248880
7.  Prevalence of Non-Alcoholic Fatty Liver Disease and Its Predictors in North of Iran 
Iranian Journal of Public Health  2014;43(9):1275-1283.
Nonalcoholic fatty liver disease (NAFLD) is one of the aspects of metabolic syndrome (MetS). Due to the increase of MetS in Iran, this study was conducted to determine the prevalence of NAFLD, its potential predictors and their sex distribution in north of Iran, Amol.
In 2008 this population based cross-sectional study included 5023 adult individuals who were randomly selected from Amol healthcare centers. Blood analysis and hepatic sonography was performed for each individual and Clinical histories were reviewed. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Chi-square test, univariate and multivariate logistic regression were used to analyze data.
The prevalence of NAFLD and metabolic syndrome was 43.8% and 29.6% respectively. Both NAFLD and metabolic syndrome were significantly more prevalent in women. There was a stronger association between these two factors in women which may indicate MetS has a much more potency to result in NAFLD in women. The strongest predictors of NAFLD in men were waist circumference>102 cm, serum ALT ≥40 (U/L) and the age group of 40-60 years. The strongest predictors of NAFLD in women were waist circumference>88 cm, the age groups of 40-60 and >60 years.
The observed prevalence is alarming because almost 7out of 10 subjects with MetS had NAFLD. As high waist circumference was an important predictor of NAFLD in both sexes, health care policies to reduce the incidence of obesity in the country will have an important impact on the occurrence of NAFLD.
PMCID: PMC4500430  PMID: 26175982
Non-Alcoholic fatty liver disease (NAFLD); Metabolic syndrome; Risk factors
8.  A Population Based Study on Hepatitis B Virus in Northern Iran, Amol 
Hepatitis Monthly  2014;14(8):e20540.
Viral hepatitis is a major health problem worldwide. Change in transmission patterns of hepatitis B makes it necessary to re-evaluate its prevalence and risk factors.
We aimed to determine the prevalence of HBV infection and its related risk factors in Amol city, Northern Iran.
Patients and Methods:
As a population based study, a cluster sampling approach was used and 6146 individuals from the general population of urban and rural areas of Amol, Iran, from both genders and different ages were enrolled. Inclusion criteria were willingness to participate in the study, being a lifelong resident in Amol city or its surrounding areas with Iranian nationality. Ten milliliters (10 mL) of blood was taken from each study subject and checked regarding hepatitis B markers including HbsAg, HBsAb and HBcAb using a third generation ELISA. The prevalence of HBV infections and its potential risk factors were recorded.
The prevalence of HBsAg, HBsAb and HBcAb were estimated as 0.9%, 30.7% and 10.5%, respectively. The mean age of all participants was 43.9 (95% CI: 43.4, 44.3) in females and 55.6 in (n = 3472) males. In our study, there was a significant association between family history of hepatitis, rural residency and presence of HBsAg. There was also a positive correlation between HBcAb and family history of hepatitis, history of other types of hepatic diseases, history of tattooing, traditional phlebotomy, male gender and age. In backward logistic regression, a significant association was found between history of hepatitis in first-degree family members (OR = 13.35; 95% CI: 6.26, 28.47) and place of residence (OR = 2.32; 95% CI: 1.27, 4.22) with presence of HBsAg. There was also a positive correlation between history of hepatitis among first-degree family members (OR = 2.49; 95% CI: 1.52, 4.08), history of tattooing (OR = 2.13; 95% CI: 1.33, 3.42), history of previous hepatitis (OR = 1.87; 95% CI: 1.06, 3.28), male sex (OR = 1.36; 95% CI: 1.12, 1.66) and age (OR = 1.03; 95% CI: 1.03, 1.04) with presence of HBcAb.
The prevalence of hepatitis B in Amol City and its surrounding areas was about one percent, a lower rate than other reports from Iran.
PMCID: PMC4165985  PMID: 25237372
Hepatitis B Virus; Infection; HBsAg; Prevalence; Epidemiology
10.  Prevalence and Risk Factors of Hepatitis C Virus Infection in Amol City, North of Iran: A Population-Based Study (2008-2011) 
Hepatitis Monthly  2013;13(12):e13313.
Hepatitis C Virus (HCV) infection is one of the most important causes of chronic liver disease and related problems in the world .There are few population-based studies on the prevalence and risk factors of hepatitis C infection in Iran, which could not provide enough information. Moreover, the prevalence and risk factors of hepatitis C infection are not similar in all parts of Iran.
The aim of this survey was to determine the prevalence and risk factors of HCV infection in the general population of the city of Amol, north of Iran.
Patients and Methods
This was a population-based study. Using a cluster sampling approach, 6145 individuals of both genders and different ages were involved from general population of urban and rural areas of Amol, The inclusion criteria were Iranian nationality, willing to participate in the study, and lifelong residence in Amol city and surrounding areas. Anti-hepatitis C antibody was measured by a third generation of ELISA. The positive results were confirmed by Recombinant Immuno Blot Assay (RIBA) and quantitative HCV-RNA polymerase chain reaction (PCR) tests. Potential risk factors of HCV transmission were recorded.
The mean age of participants was 42.70 ± 17.10 years. Of these participants, 57.2% (n = 3483) were male. Anti-HCV antibody was positive in 12 individuals from which five were RIBA positive. Three of these subjects were PCR positive. The prevalence of HCV was more predominant among males than females. The common risk factors among the study subjects included history of minor or major surgery (34.7%), unsterile punctures (21.2%), history of traditional phlebotomy (5.8%), and history of hepatitis among close relatives (5.7%). In univariate regression analysis, unsterile punctures and history of infection in family members were associated with HCV infection.
We confirm that in Amol city and surrounding areas, the prevalence of true HCV infection is 0.05%, which is lower than that previously reported from Iran.
PMCID: PMC3867021  PMID: 24358039
Hepacivirus; Epidemiology; Polymerase Chain Reaction; Urban Population; Rural Population
11.  Fulminant Hepatic Failure due to Primary Hepatic Lymphoma: a Case Report 
Primary hepatic lymphoma is a rare malignancy usually presenting with symptoms of fever, hepatomegaly, jaundice and weight loss. This picture mimics infectious and inflammatory disorders and thus delays the diagnosis. Here, we present a 47-year old man with prolonged fever who underwent several investigations and, in the meantime, developed fulminant hepatic failure before the diagnosis could be reached.
PMCID: PMC3990175  PMID: 24829689
Diffuse Large B-Cell Lymphoma; Fulminant Hepatic Failure; Fever of Unknown Origin
12.  Association between Helicobacter pylori and Serum Leptin in Iranian Dyspeptic Patients 
To investigate any possible relationship between serum leptin level and H. pylori infection in dyspeptic Iranian adults.
A total of 153 dyspeptic patients referring to Firoozgar hospital for esophagogastroduodenoscopy were enrolled in the study. Serum leptin level was measured before endoscopy, after overnight fasting. Two biopsy specimens were taken from antrum for each patient during endoscopy: one to detect H. pylori infection by Rapid Urease Test (RUT) and the other evaluated by an expert pathologist, blind to the RUT results and patients. Serum leptin level was compared between H.pylori-positive negative groups.
A total of 153 dyspeptic patients with the mean age of 43.2±14.3 years were evaluated. The overall prevalence of H.pylori infection was 49.6%. H.pylori infection was significantly associated with serum leptin level (p<0.001). In addition, we found a significant relationship between serum leptin level and gender (p<0.02). Furthermore, serum leptin level was correlated with age (r=0.17, p=0.0031). However, the H.pylori-positive group was older in comparison to the H.pylori negative group (45.65±13.9 vs. 40.7±14.13, p=0.035). The two groups were not significantly different in terms of gender, height, weight or BMI.
H.pylori infection may influence leptin production. Advanced age might expose the individual to H.pylori infection and consequently influence the leptin level.
PMCID: PMC3990176  PMID: 24829687
Helicobacter pylori; Leptin; Dyspeptic
13.  Thyroid Dysfunction and Choleduocholithiasis 
Disturbances in lipid metabolism which occur during hypothyroidism lead to the formation of gallstones. This study aims to evaluate the thyroid function pattern in patients with common bile duct (CBD) stones.
This case-control study recruited 151 patients with preliminary diagnoses of CBD stone who underwent ERCP (cases). The control group comprised healthy people who met the study criteria in the same hospital. The control group underwent ultrasonography to exclude any asymptomatic bile duct lithiasis. A questionnaire that included demographic and anthropometrics data were completed by an assigned physician. Morning blood samples that followed 12 hours of fasting were taken from all participants for measurements of serum total thyroxin (T4), serum thyroid stimulating hormone (TSH), fasting blood sugar (FBS), triglycerides (TG), total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL).
The mean TSH in patients (2.59 ± 4.86mg/dl) was higher than the control group (2.53± 4.13 9mg/dl). In subclinical hypothyroidism, serum TSH levels higher than 5 MU/L were found in 30.6% of cases compared with 22.5% of controls [OR: 1.53; 95 % confidence interval (95% CI): 0.968-2.438). Hypothyroidism was detected in 10.8% of the control group and in 11.3% of cases (OR: 1.87; 95% CI: 0.578-2.043). The mean total cholesterol levels in cases was higher than the control group (p=0.61).The levels of TG (p=0.05), HDL (73.35 vs. 46.41; p<0.01) and LDL (64.81.88 vs. 111.04; p<0.01) was statistically significant between both groups.
There is an association between thyroid disorders and the presence of bile duct stones. Thyroid testing in patients with gallstone and bile duct stones is recommended because hypothyroidism may be a predisposing factor for stone passage from the gallbladder.
PMCID: PMC3990180  PMID: 24829684
Choledocholithiasis; Thyroid hormones; Obesity
14.  Comparing Efficacy of Preoperative neo-Adjuvant Chemotherapy and Surgery versus Surgery Alone in Patients with Resectable Gastroesophageal Cancer 
Recent researches have led to find strategies to prevent relapse and to improve survival for gastric cancer patients, including preoperative neo-adjuvant approaches. However, the efficacy of some neo-adjuvant regimens including 5-fluorouracil, cisplatin, and docetaxel have been less investigated. The present study evaluated the outcome and mid-term survival of patients with gastric cancer who undergoing this regimen.
In a randomized double-blinded controlled trial performed at the Firoozgar hospital in Tehran in 2011-12, 61 patients were randomly assigned to treatment (32 to neo-adjuvant chemotherapy with docetaxel, cisplatin and 5-fluorouracil (5-FU) before surgery and 27 to surgery alone). The present study tried to assess the efficacy of neoadjuvant chemotherapy regarding improvement of mid-term survival, complications, and R0 resection status.
The two groups were matched in terms of gender, mean age, cancer location, and TNM staging. However, R0 resection in the former group was 85.7%; while this indicator in the isolated surgery group was significantly lower (61.5%). Regarding WHO performance, no significant difference was observed across the two groups. Patients in neo-adjuvant chemotherapy group were followed for mean follow-up time 10.32 months and those who categorized in isolated surgery group were followed for mean follow-up time 10.88 months. Mid-term mortality rate in the two groups was 14.3% and 15.4%, respectively (p = 0.866). In this regard, 3-, 6-, and 9-month survival rate in neo-adjuvant chemotherapy group was 96.4%, 89.3%, and 85.7%, respectively. These survival rates in the surgery group were 92.3%, 88.5%, and 84.6%, respectively. Multivariable logistic regression analysis showed that among all study variables, only R0 resection status could predict mid-term mortality.
Neo-adjuvant chemotherapy and surgery compare to surgery alone more improve R0 resection status, but mid-term survival rate is similar in the two regiments. R0 resection status can effectively predict appropriate mid-term survival in undertreated patients.
PMCID: PMC3915424  PMID: 24505539
Gastroesophageal junction; Mortality; Chemotherapy; Surgery
15.  Association Between Irritable Bowel Syndrome and Restless Legs Syndrome: A Comparative Study With Control Group 
As a common gastrointestinal (GI) disorder, irritable bowel syndrome (IBS) has been reported to be associated with some psychological and neurological factors. This study aimed to evaluate the prevalence rate of restless legs syndrome (RLS) in a sample of IBS patients and to compare this prevalence with that of matched healthy controls.
This prospective comparative study was conducted in Tehran, Iran during 2010-2011. Based on the Rome III criteria, a total number of 225 definite IBS patients and 262 age- and sex-matched healthy controls were recruited in the final assessment to compare the prevalence rate of RLS between the 2 groups.
RLS was significantly more frequent in IBS group (25.3% vs 6.5%, P < 0.001) which led to an odds ratio (OR) of 4.89 (95% CI, 2.75-8.70). IBS patients with co-morbid RLS significantly suffered more from stomach pain (96.5% vs 86.3%, OR = 4.36 [95% CI, 1.00-19.12]), nausea (40.4% vs 21.4%, OR = 2.48 [95% CI, 1.30-4.73]) and vomiting (10.5% vs 2.4%, OR = 4.82 [95% CI, 1.31-17.76]).
By enrolling a considerable number of IBS patients and healthy controls, our study showed a significantly higher prevalence of RLS in IBS patients. Surprisingly, a higher prevalence rate of RLS was also accompanied with a more severe discomfort and stomach pain in IBS patients. It seems that screening patients with IBS for RLS may lead to greater identification of RLS and improved treatment for both conditions.
PMCID: PMC3479257  PMID: 23106004
Irritable bowel syndrome; Restless legs syndrome; Control groups
16.  Iranian hereditary hemochromatosis patients: Baseline characteristics, laboratory data and gene mutations 
Hereditary hemochromatosis (HH) is the most common autosomal recessive disorder in white people, characterized by highly abnormal uptake of iron from the gastrointestinal tracts. Recently, mutation studies have focused to detect the genes responsible for HH.
In this cross-sectional study, 12 HH patients were recruited, who were referred to Firoozgar Hospital, Tehran, Iran. In addition to the clinical assessments, a complete laboratory evaluation, imaging modalities, histopathologic assessment, atomic absorption spectrophotometry and gene mutation study were performed. The genetic study for HFE gene mutation was examined for all of the patients since 2006, while non-HFE mutation was conducted since December 2010 (only for 1 of them).
Twelve patients were evaluated consisting of 11 men and 1 woman, with the mean age of 39.58±12.68 yr. The average of atomic iron loads was 13.25±4.83-fold higher than normal standards. Four patients had heterozygotic mutation of H63D (33.3%). There was no significant difference in either the iron load of liver (P=0.927) and heart (P=0.164) or serum concentration of ferritin (P=0.907) and TIBC (P=0.937) between the HFE-mutant and without HFE mutation HH cases.
In contrast to other studies, C282Y mutation was not detected in any of our Iranian HH patients. Heterozygotic mutations of H63D (HFE) and TFR2 (non-HFE) genes were found to be more common in these patients. Similar to previous reports, these mutations were not found to be significantly associated with severity of presentation in HH patients.
PMCID: PMC3560564  PMID: 23018356
hereditary hemochromatosis; gene mutation; iron overload
17.  Gender Role in Irritable Bowel Syndrome: A Comparison of Irritable Bowel Syndrome Module (ROME III) Between Male and Female Patients 
Irritable bowel syndrome (IBS) is a widespread chronic health condition which is significantly more prevalent in women. We conducted a gender difference analysis by comparing findings of men and women to determine whether any significant differences exist or not.
This single-center study was conducted in Tehran, Iran during 2009-2010. IBS was diagnosed on the basis of Rome III criteria. A simple "10 point" objective questionnaire was used.
A total number of 144 IBS patients including 44 (30.6%) males and 100 (69.4%) females with the mean age of 37.50 ± 11.50 years, were assessed. The only differently observed symptom was nausea which was significantly more prevalent in females (49% vs 18.2%, P < 0.001). The commonest subtype of IBS in male patients was diarrhea predominant IBS (38.6%); while, constipation predominant IBS was the most frequent type among females (38%). Moreover, the frequency of loose, mushy or watery stools within the last 3 months was significantly higher among males (2.11 ± 1.67 vs 1.37 ± 1.50, P = 0.009).
We report that gender is important in IBS. Although qualitative comparison of different subtypes of IBS between male and female failed to meet the statistically significant level, the answers to the corresponding questions of ROME III IBS module suggest the higher prevalence of bowel movements and looser stool in males. Moreover, nausea was reported more often by females.
PMCID: PMC3271257  PMID: 22323990
Gender identity; Irritable bowel syndrome; Questionnaire; ROME III
18.  Promising effect of infliximab on the extent of involvement in ulcerative colitis 
Ulcerative colitis (UC) is a disabling disease with increasing incidence in Iran. In spite of combined medical therapy, some patients eventually undergo total colectomy. Infliximab has proved itself as a rescue therapy and even as an early aggressive therapy for severe extensive UC. Meantime, there are concerns about its complications. The aim of this study was to evaluate the efficacy of infliximab in Iranian refractory UC patients.
This multi centric case-series study included 29 UC patients receiving two to three of the drugs prednisolone, AZT/6MP and 5ASA but yet having flare-ups. At first, the extent of colon involvement was determined by colonoscopy; then the drug was administered at baseline, 2nd week and 6th week and colonoscopy repeated afterwards. Clinical and laboratory data were also recorded.
In first endoscopy 18 patients (62%) out of 29 suffered from pancolitis and none had normal results. In second examination (done on 19 patients), one was normal and only 8 of 18 (27.6%) had pancolitis. Considering missing cases, at least in 33.3% of patients the drug has reduced the extreme extent of colon involvement. Also a wilcoxon signed ranks test revealed significant reduction of the disease extension after this treatment (p = 0.008). There were only one leucopenic and one hypotensive reactions in short term. The drug showed effectiveness in the term of disease modifying, too.
These data show the usefulness of the drug in refractory UC. Longer follow ups and controlled trials are needed.
PMCID: PMC3063437  PMID: 21448377
Infliximab; Colitis; Ulcerative; Colon
19.  Colonic diverticular abscess presenting as chronic diarrhea: a case report 
Cases Journal  2009;2:9389.
Several complications have been reported with diverticular disease of colon. Perforation of the diverticulum of colon may lead to development of abdominal abscesses which can have diverse manifestations.
Case presentation
This report describes a 72 year-old woman presented with a one month history of non-bloody diarrhea, abdominal pain, and low grade fever. Computed tomography scan confirmed presence of a large local air-fluid level within the culdesac area. Laparotomy revealed a large pelvic abscess which was surrounded between rectosigmoid and uterus with severe tissue necrosis of rectosigmoid colon and uterus.
Although rarely reported, abdominal abscesses due to colonic diverticulitis may present as refractory chronic diarrhea.
PMCID: PMC2806879  PMID: 20076780
20.  Takayasu's arteritis associated with Crohn's disease: a case report 
The simultaneous presence of Takayasu's arteritis and Crohn's disease in a patient seems to be rare. To our knowledge, no patient with the combination of Crohn's disease and Takayasu's arteritis has been reported from our region.
Case presentation
Herein we present the case of a 22-year-old Iranian woman previously diagnosed as Crohn's disease and who had subsequently developed Takayasu's arteritis.
Clinical suspicion, proper imaging, and consideration of the differential diagnosis are important for the correct diagnosis and management of patients with this coincidence.
PMCID: PMC2323385  PMID: 18353173

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