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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
2.  Periorbital Ecchymosis (Raccoon Eye) and Orbital Hematoma following Endoscopic Retrograde Cholangiopancreatography 
Case Reports in Gastroenterology  2017;11(1):134-141.
Endoscopic retrograde cholangiopancreatography (ERCP) is a conventional technique for diagnosis and treatment of pancratobiliary diseases, which is associated with various complications, including pancreatitis, hemorrhage, cholangitis, perforation, and mortality. In our case, a 69-year-old woman with positive hepatobiliary symptoms underwent ERCP, at the end of which a rare complication (raccoon eye) occurred, which was hypothesized to be due to amyloidosis, but the patient refused to complete the diagnostic procedure and became symptom free after 3 weeks. Racoon eye or periorbital ecchymosis is caused by blood tracking into periorbital tissues, which is frequently observed after head trauma but is also observed in systemic diseases, such as amyloidosis, neuroblastoma, and surgical interventions. To the best of our knowledge, this is the first report of raccoon eye after ERCP; further reports will help to confirm that this complication should also be considered before performing ERCP and that complete diagnostic tests for the predisposing diseases prior to ERCP are necessary.
PMCID: PMC5465703
Eye; Ecchymosis; Cholangiopancreatography; Endoscopic retrograde cholangiopancreatography
3.  Association between Nicotinamide Phosphoribosyltransferase and de novo Lipogenesis in Nonalcoholic Fatty Liver Disease 
Medical Principles and Practice  2017;26(3):251-257.
This study explored the association between serum nicotinamide phosphoribosyltransferase (NAMPT) and hepatic de novo lipogenesis (DNL) in nonalcoholic fatty liver disease (NAFLD) and determined whether or not this association is sex dependent.
Subjects and Methods
In this cross-sectional study, 62 consecutive patients (32 males, 30 females) with NAFLD were recruited. Serum NAMPT (by ELISA), palmitic acid, and the DNL index of erythrocyte membranes as markers of hepatic DNL (by gas chromatography) were analyzed. The controlled attenuation parameter (CAP) and body impedance analyzer were used to assess hepatic and body fat, respectively. Univariate and multiple linear regressions (to adjust for confounders) were used to analyze the association of serum NAMPT with palmitic acid, DNL index, CAP, and body fat.
The respective values of serum NAMPT (2.44 ± 1.03 vs. 2.45 ± 1.13 ng/mL, p = 0.98), DNL index (3.11 [2.60–3.71] vs. 3.05 [2.40–3.59], p = 0.90), and palmitic acid (20.55% [15.34–24.04] vs. 22.64% [21.15–25.95], p = 0.07) were not significantly different between men and women, but those of CAP (326 [300–340] vs. 300 [261.25–329], p = 0.002) and body fat (37.71 ± 3.80 vs. 26.60 ± 5.70, p < 0.001) were significantly higher in women. In women, serum NAMPT had a significant negative association with the DNL index (β = −0.56, p = 0.01). The DNL index also had a significant negative association with body fat (β = −0.46, p = 0.02). In men, the only significant association was the positive association between serum NAMPT and CAP (β = 0.35, p = 0.035).
Higher serum NAMPT in women was associated with a lower hepatic DNL index, while in men it was associated with higher hepatic fat and had no association with the DNL index. Therefore, the serum NAMPT level interpretation for NAFLD prognosis is probably sex dependent.
PMCID: PMC5588391  PMID: 28092906
Nicotinamide phosphoribosyltransferase; Nonalcoholic fatty liver; De novo lipogenesis
4.  Hirschsprung Disease Diagnosis: Calretinin Marker Role in Determining the Presence or Absence of Ganglion Cells 
Iranian Journal of Pathology  2016;11(4):409-415.
Hirschsprung disease is a complex genetic disorder of the enteric nervous system (ENS), often called congenital aganglionic megacolon and characterized by the absence of enteric neurons along a variable length of the intestine. The definitive diagnosis of Hirschsprung disease relies on histologic and/or histochemical staining of sections from suction rectal biopsies. Calretinin immunohistochemistry (IHC) may be a useful in its diagnosis. This study aimed to proof the usefulness of immunohistochemical staining for calretinin in rule out of Hirschsprung disease.
Paraffin blocks and slides were retrieved from the pathology archives of Ali Asghar Hospital, Tehran, Iran from 2007 to 2011 with pathology report based on the presence (14 patients) or absence (70 patients) of ganglion cells and transitional zone anatomical region (10 patients). Slides were stained with hematoxylin and eosin method to confirm the initial diagnosis was verification again. After preparing the slides, they were stained by IHC for calretinin. Then, the results were analyzed using SPSS software.
In most patients, IHC for calretinin provided highly compatible results with hematoxylin-eosin findings in diagnosis of Hirschsprung disease. The values of specificity and accuracy between calretinin and standard histology (H&E) compared by the Fisher exact test declared calretinin presented significantly higher specificity and accuracy values than H&E staining (P <0.0001).
Calretinin IHC overcomes most of the difficulties encountered using the histology hematoxylin-eosin. Then, IHC for calretinin is a good ancillary method used by pathologists in diagnosis of Hirschsprung disease.
PMCID: PMC5563939  PMID: 28855933
Hirschsprung disease; Calretinin; Immunohistochemistry; ganglion cell; intrinsic nerve fibers
5.  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
6.  Opium use, cigarette smoking, and alcohol consumption in relation to pancreatic cancer 
Medicine  2016;95(28):e3922.
Supplemental Digital Content is available in the text
Background and Aims:
Although several studies have suggested opium as a risk factor for cancers of the esophagus, stomach, larynx, lung, and bladder, no previous study has examined the association of opium with pancreatic cancer. We aimed to study the association between opium use and risk of pancreatic cancer in Iran, using a case-control design. We also studied the association of cigarette smoking and alcohol consumption with pancreatic cancer, for which little information was available from this population.
Cases and controls were selected from patients who were referred to 4 endoscopic ultrasound centers in Tehran, Iran. We recruited 316 histopathologically (all adenocarcinoma) and 41 clinically diagnosed incident cases of pancreatic cancer, as well as 328 controls from those with a normal pancreas in enodosonography from January 2011 to January 2015. We used logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
After adjustment for potential confounders, opium use (OR 1.91; 95% CI 1.06–3.43) and alcohol consumption (OR 4.16; 95% CI 1.86–9.31) were significantly associated with an increased risk of pancreatic cancer. We did not find an association between ever tobacco smoking and pancreatic cancer risk (OR 0.93; 95% CI 0.62–1.39).
In our study, opium use and alcohol consumption were associated with an increased risk of pancreatic cancer, whereas cigarette smoking was not.
PMCID: PMC4956779  PMID: 27428185
alcohol; opium; pancreatic cancer; tobacco
7.  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
8.  Rural Residency has a Protective Effect and Marriage is a Risk Factor for NAFLD 
Hepatitis Monthly  2016;16(7):e38357.
Non-alcoholic fatty liver disease (NAFLD) is considered the leading cause of liver disease worldwide. Although many previous studies have evaluated the potential risk factors of NAFLD, few studies have determined the effect of residency or marriage status on NAFLD.
We aim to evaluate whether residency and marriage status increased the risk factors for NAFLD.
Materials and Methods
We utilized data from 5,052 participants, 18 years and older, from a cohort study conducted using 6,140 participants in northern Iran. The population was divided into 16 subgroups according to sex and age; the age groups had an interval of 10 years. We randomly selected the subjects from each subgroup in proportion to the size of each subpopulation group. Logistic regression analyses were conducted on NAFLD as an outcome of marriage status, residency (rural vs. urban), and other potential risk factors.
We found that NAFLD had an inverse association with rural living in men (OR = 0.513, 0.422 - 0.622, P value < 0.001) and women (OR = 0.431, 0.345 - 0.539, P value < 0.001). Furthermore, we determined that NAFLD had a direct association with marriage status for men (OR = 2.770, 2.004 - 3.831, P value < 0.001) and women (OR = 1.241, 1.033 - 1.490, P value = 0.0209).
While rural living has a protective effect on NAFLD, marriage may be a potential risk factor for this condition.
PMCID: PMC5018359  PMID: 27642349
Rural Living; Marriage; NAFLD
9.  Polymorphism of IL-28B Gene (rs12979860) in HCV Genotype 1Patients Treated by Pegylated Interferon and Ribavirin 
Iranian Journal of Pathology  2016;11(3):216-221.
Nowadays, the immune response to hepatitis C (HCV) treatment has become a crucial issue mostly due to the interleukin 28B (IL-28B) polymorphism effects in chronic HCV patients. The aim of this study was to detect the polymorphism of IL-28B gene (rs12979860) in HCV genotype 1 patients treated with pegylated Interferon and Ribavirin.
From the 2010 to 2012, a total of 115 peripheral blood mononuclear cells (PBMCs) of HCV patients who presented to Gastrointestinal & Liver Disease Research Center (GILDRC), Firoozgar Hospital, Tehran, Iran were enrolled in this retrospective cross sectional study. Samples were then categorized based on the presence of sustained virologic response (SVR and no-SVR). Variables including age, gender, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels of the two groups were investigated based on different IL-28B genotypes.
Analysis by the variables of age and gender showed a mean age ± SD of 42.1±14.0 and gender variability of 44 females (38.2%) and 71 males (61.8%). Adding up these results, the analysis of ALT levels revealed that there was between 293 and 14 mg/ml; AST levels ranged between 217 and 17 mg/ml; the viral load (HCV RNA) ranged between 7,822,000 and 50 IU/ml; the prevalence of CC, CT and TT genotypes were 90.9%, 54% and 25.0%.
IL-28B polymorphism has an effective impact on the therapeutic response to ribavirin and peginterferon combination therapy in chronic HCV patients infected by different genotypes. This polymorphism is crucial in natural clearance.
PMCID: PMC5079454  PMID: 27799970
Chronic HCV infection; Sustained virologic response; Interleukin 28B polymorphism
10.  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
11.  Psychological Reactions among Patients with Chronic Hepatitis B: a Qualitative Study 
Journal of Caring Sciences  2016;5(1):57-66.
Introduction: Hepatitis B is the most prevalent type of viral hepatitis. Psychological reactions among patients with hepatitis B infection is considerably different and affects their decision about treating and following up the disease. The present study aims at explaining the psychological demonstrations experienced by these patients.
Methods: In this qualitative study, a total of 18 patients with hepatitis B (8 women and 10 men) were selected by purposive sampling method. Data were collected by unstructured in-depth interviews during 2014-2015 in the medical centers of three cities in Iran. All interviews were recorded, typed and analyzed by the conventional content analysis approach.
Results: By analyzing the data, the main theme including psychological instability, with three sub-themes were emerged: grief reaction (stupor, denial, anger and aggression), emotional challenges (worry and apprehension, contradiction with beliefs, fear of deprivation, fear of stigma, waiting for death and prognosis ambiguity) and inferiority complex (social withdrawal, sense of humiliation and embarrassment and sense of guilt and blame) were acquired.
Conclusion: The findings indicate that patients with hepatitis B experience various psychological reactions that need to be controlled and managed by themselves or healthcare providers. Thus, implementation of health interventions with emphasis on psychological care to prevent problems and execution of educational and consultation programs about hepatitis especially by medical centers and mass media is seems necessary.
PMCID: PMC4794545  PMID: 26989666
Patients; Hepatitis B; Qualitative research; Psychology; Chronic disease
12.  Sensitive High-Resolution Melting Analysis for Screening of KRAS and BRAF Mutations in Iranian Human Metastatic Colorectal Cancers 
Investigations of methods for detection of mutations have uncovered major weaknesses of direct sequencing and pyrosequencing, with their high costs and low sensitivity in screening for both known and unknown mutations. High resolution melting (HRM) analysis is an alternative tool for the rapid detection of mutations. Here we describe the accuracy of HRM in screening for KRAS and BRAF mutations in metastatic colorectal cancer (mCRCs) samples.
Materials and Methods:
A total of 1000 mCRC patients in Mehr Hospital, Tehran, Iran, from Feb 2008 to May 2012 were examined for KRAS mutations and 242 of them were selected for further assessment of BRAF mutations by HRM analysis. In order to calculate the sensitivity and specificity, HRM results were checked by pyrosequencing as the golden standard and Dxs Therascreen as a further method.
In the total of 1,000 participants, there were 664 (66.4%) with wild type and 336 (33.6%) with mutant codons 12 and/or 13 of the KRAS gene. Among 242 samples randomly checked for the BRAF gene, all were wild type by HRM. Pyrosequencing and Dxs Therascreen results were in line with those of the HRM. In this regard, the sensitivity and specificity of HRM were evaluated as 100%.
The findings suggest that the HRM, in comparison with DNA sequencing, is a more appropriate method for precise scanning of KRAS and BRAF mutations. It is also possible to state that HRM may be an attractive technique for the detection of known or unknown somatic mutations in other genes.
PMCID: PMC5454650  PMID: 28122448
High-Resolution Melting (HRM); mutation analysis; metastatic colorectal cancer (mCRC)
13.  Prevalence of Metabolic Syndrome and Its Components in the Iranian Adult Population: A Systematic Review and Meta-Analysis 
Metabolic syndrome (MetS) increases the risk of most non-communicable diseases; gathering information about its prevalence can be very effective in formulating preventive strategies for metabolic diseases. There are many different studies about the prevalence of MetS in Iran, but the results and the study populations of these studies are very different; therefore, it is very important to have an overall estimation of its prevalence in Iran.
This study systematically reviewed the findings of all available studies on MetS in the adult Iranian population and estimated the overall prevalence of MetS in this population.
Data Sources:
International databases (Scopus, ISI Web of Science, and PubMed) were searched for papers published from January, 2000 to December, 2013 using medical subject headings (MeSH), Emtree, and related keywords (metabolic syndrome, dysmetabolic syndrome, cardiovascular syndrome, and insulin resistance syndrome) combined with the words “prevalence” and “Iran.” The Farsi equivalent of these terms and all probable combinations were used to search Persian national databases (IranMedex, Magiran, SID, and Irandoc).
Study Selection:
All population-based studies and national surveys that reported the prevalence of MetS in healthy Iranian adults were included.
Data Extraction:
After quality assessment, data were extracted according to a standard protocol. Because of between-study heterogeneity, data were analyzed by the random effect method.
We recruited the data of 27 local studies and one national study. The overall estimation of MetS prevalence was 36.9% (95% CI: 32.7 - 41.2%) based on the Adult Treatment Panel III (ATP III) criteria, 34.6% (95% CI: 31.7 - 37.6%) according to the International Diabetes Federation (IDF), and 41.5% (95% CI: 29.8 - 53.2%) based on the Joint Interim Societies (JIS) criteria. The prevalence of MetS determined by JIS was significantly higher than those determined by ATP III and IDF. The prevalence of MetS was 15.4% lower in men than in women (27.7% versus 43.1%) based on the ATP III criteria, and it was 11.3% lower in men based on the IDF criteria; however according to the JIS criteria, it was 8.4% more prevalent in men.
There is a high prevalence of MetS in the Iranian adult population, with large variations based on different measurement criteria. Therefore, prevention and control of MetS should be considered a priority.
PMCID: PMC4706734  PMID: 26756015
Metabolic Syndrome; Prevalence; Meta-Analysis; Iran
14.  The 10-year Absolute Risk of Cardiovascular (CV) Events in Northern Iran: a Population Based Study 
Materia Socio-Medica  2015;27(3):158-162.
The present study was conducted to estimate 10-year cardiovascular disease events (CVD) risk using three instruments in northern Iran.
Material and methods:
Baseline data of 3201 participants 40-79 of a population based cohort which was conducted in Northern Iran were analyzed. Framingham risk score (FRS), World Health Organization (WHO) risk prediction charts and American college of cardiovascular / American heart association (ACC/AHA) tool were applied to assess 10-year CVD events risk. The agreement values between the risk assessment instruments were determined using the kappa statistics.
Our study estimated 53.5%of male population aged 40-79 had a 10 –year risk of CVD events≥10% based on ACC/AHA approach, 48.9% based on FRS and 11.8% based on WHO risk charts. A 10 –year risk≥10% was estimated among 20.1% of women using the ACC/AHA approach, 11.9%using FRS and 5.7%using WHO tool. ACC/AHA and Framingham tools had closest agreement in the estimation of 10-year risk≥10% (κ=0.7757) in meanwhile ACC/AHA and WHO approaches displayed highest agreement (κ=0.6123) in women.
Different estimations of 10-year risk of CVD event were provided by ACC/AHA, FRS and WHO approaches.
PMCID: PMC4499282  PMID: 26236160
10-year cardiovascular risk; Framingham risk score; ACC/AHA tool; WHO risk prediction charts; Northern Iran
15.  Clinical, Endoscopic, and Histopathological Aspects of Sigmoid Actinomycosis; A Case Report and Literature Review 
Actinomycosis is a rare and chronic infectious disease caused by a non-spore gram- positive, anaerobic bacterium that rarely infects the colon, in particular the left colon.
A 53-year-old woman was referred to us due to chronic abdominal pain, bloating, a few episodes of bloody-mucous rectal discharge, and change of bowel habits. Her medical history and physical examination were unremarkable. Colonoscopy revealed a polypoid mass like lesion located 20 cm proximal to the anal verge above the rectosigmoid junction. Several biopsy samples were taken. Histopathological evaluation showed actinomycosis infection. Consequently the patient was treated with intravenous and then six months oral penicillin. Her complaints and colonic mass resolved totally.
Diagnosis of colonic actinomycosis is not an easy task. It is advisable to keep this infection in mind among the differential diagnoses of unusual abdominal masses. Colonoscopy and histopathological examination can be the preferred modality for diagnosis of colonic actinomycosis infection.
PMCID: PMC4293800  PMID: 25628853
Actinomycosis; Left colon; Sigmoid; Penicillin
16.  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
17.  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
18.  Correlation of Tissue Transglutaminase Antibody with Duodenal Histologic Marsh Grading 
Recent guidelines have proposed that there is a correlation between tissue transglutaminase (tTG) antibody titers and degrees of duodenal biopsy, and that duodenal biopsy can be omitted in some patients with high levels of tTG antibody. Using data of registered patients in a gastrointestinal clinic we aimed to assess the correlation between tissue transglutaminase antibody with duodenal histologic Marsh grading in Iranian patients with celiac disease.
We retrospectively reviewed hospital files of registered patients in the gastrointestinal clinic of Firoozgar Hospital, Tehran, Iran. Demographic, laboratory, and histology data of those who had tTG titer and pathology reports of duodenal biopsy based on the modified Marsh classification were extracted and used for the study.
159 patients with available tTG titer and pathology reports were enrolled in our study. Mean ±SD of the patients was 35.6±15.2 and 100 (62.9%) of them were women. 133 out of 153 patients had villous atrophy (Marsh IIIa-IIIc). Anemia was the most common sign and bloating, abdominal pain, and diarrhea were the first three common symptoms in these patients. Mean tTG titers was significantly higher in patients graded as Marsh III (p for trend=0.003). Our results showed that tTG titer more than 9 folds higher than the kit’s cut-off value was about 97.2% sensitive for Marsh II and more duodenal damage.
There was a correlation between tTG titers and degrees of duodenal damage in patients with celiac disease. Duodenal biopsy is not always necessary for diagnosing celiac disease and when tTG level is more than 9 folds higher than the manufacture’s recommended cut-off value it can be avoided. Meanwhile small intestinal biopsy should always be considered in case of high clinical suspicion, regardless of the results of serologic testing.
PMCID: PMC4119669  PMID: 25093060
Celiac disease; Tissue Transglutaminase Antibody; Histology; Marsh Grading
19.  Clinical and Pathological Features of Non-Functional Neuroendocrine Tumors of Pancreas: A Report from Iran 
Pancreatic neuroendocrine tumors (PNETs) are rare tumors with variable malignant potential, prognosis, and survival. We aimed to assess the characteristics of patients with non- functional PNET in our hospital.
From Nov 2010 to Nov 2013 , all patients who came to endosonography unit of Shariati hospital , Tehran , Iran , and had pancreatic lesions were assessed . Tumor samples were obtained through fine needle aspiration. Various characteristics of the non- functional PNET were recorded and patients were followed up to three years.
Twenty eight non func-PNET cases, aged 37-72 years were identified, 15 (53.6%) of whom were men. Fifteen (53.6%) tumors were located in the head and 5(17.8%) in the body of the pancreas. The mean tumor size was 3.9 Cm and 10.7% , 28.6%, 32.1%, and 28.6% of the patients were at stages I, II, III and IV, respectively. Of the patients, 12 (43%) underwent surgery, 3 (10.7%) received chemotherapy, and 13 (46.4%) received no treatment. During the mean follow-up of 16 months, the disease had progressed in 3 (10.7%) patients and 10 (35.7%) had died. In univariate analysis, tumor size>3Cm and Ki-67>20% were correlated with survival rate but not in multivariate analysis.
Iranian patients with non- functional PNET present similar characteristics to world patients. There is a need to establish efficacy of tumor samples which are obtaining through fine needle aspiration for assessing tumor grading.
PMCID: PMC4119672  PMID: 25093063
Neuroendocrine Tumors; Epidemiology; Survival
21.  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
22.  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
23.  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
24.  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
25.  Patient-to-Patient Transmission of Hepatitis C at Iranian Thalassemia Centers Shown by Genetic Characterization of Viral Strains 
Hepatitis Monthly  2013;13(1):e7699.
Hepatitis C is prevalent among thalassemia patients in Iran. It is mainly transfusion mediated, in particular among patients treated before 1996 when blood screening was introduced.
The current study aimed to investigate why patients still seroconvert to anti-HCV in Iranian thalassemia centers.
Patients and Methods
During 2006-2007 sera were sampled from 217 anti-HCV positive thalassemia patients at nine thalassemia centers in Tehran and Amol city, where 34 (16%) patients had been infected after 1996. The HCV subtype could be determined by sequencing and phylogenetic analysis of partial NS5B and/or 5׳NCR-core region in 130 strains.
1a (53%) was predominant followed by 3a (30%), 1b (15%), and one strain each of 2k, 3k and 4a. Phylogenetic analysis revealed 19 clades with up to five strains diverging with less than six nucleotides from each other within subtypes 1a and 3a. Strains in seven clades were from nine patients infected between 1999 and 2005 and similar to strains from eight patients infected before 1996, indicating ongoing transmission at the centers. Further epidemiological investigation revealed that 28 patients infected with strains within the same clade had frequently been transfused at the same shift sitting on the same bed. An additional eight patients with related strains had frequently been transfused simultaneously in the same room.
The results suggest nosocomial transmission at these thalassemia centers both before and after the introduction of blood screening. Further training of staff and strict adherence to preventive measures are thus essential to reduce the incidence of new HCV infections.
PMCID: PMC3622054  PMID: 23585766
Hepatitis C; Thalassemia; Iran

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