Epidemiology of Uninvestigated Gastrointestinal Symptoms in Adolescents: A Population-based Study Applying the Rome II Questionnaire.
Sohrabi S, Nouraie M, Khademi H, Baghizadeh S, Nasseri-Moghaddam S, Malekzadeh R.
J Pediatr Gastroenterol Nutr. 2010 Jun 9
Abstract
OBJECTIVES:: Gastrointestinal (GI) disorders in early life contribute to a lower quality of life and more persistent GI symptoms during the rest of life. Epidemiologic data on adolescence GI disorders are scarce. We aimed to perform a population-based study to assess the prevalence of GI symptoms in adolescents and their relation to sex, age, and socioeconomic status. MATERIALS AND METHODS:: A multistage random sample of Tehran middle and high school students (ages 14-19 years) was selected. A validated Persian version of the Rome II questionnaire was used to measure the frequency of different GI disorders as well as demographic socioeconomic variables. RESULTS:: A total of 1436 participants were enrolled in the study, 736 (51.3%) of whom were men. Mean (SD) age was 16.9 (1.8) years. The frequency of at least 1 GI symptom was 32.4%. The 4 most prevalent GI symptoms were bloating (16.9%), heartburn (4.9%), incontinence (4.3%), and irritable bowel syndrome (4.1%). Bloating, irritable bowel syndrome, and proctalgia fugax were significantly more common in girls (P < 0.05). Incontinence was significantly more prevalent in lower socioeconomic status levels (P = 0.01). In logistic regression, age was a risk factor for abdominal bloating and dysphagea and a protective factor for incontinence. CONCLUSIONS:: Our study indicates that GI symptoms are common among adolescents. Girls are more prone to these disorders. Special psychological and medical interventions are necessary for high-risk groups.
Psoriasis and Coeliac disease; is there any relationship?
Zamani F, Alizadeh S, Amiri A, Shakeri R, Robati M, Alimohamadi SM, Abdi H, Malekzadeh R.
Acta Derm Venereol. 2010 May;90(3):295-6.
Induction of cytotoxic T lymphocytes primed with Tumor RNA-loaded Dendritic Cells in esophageal squamous cell carcinoma: preliminary step for DC vaccine design.
Gholamin M, Moaven O, Farshchian M, Mahmoudi M, Sankian M, Memar B, Forghani MN, Malekzadeh R, Rajabi-Mashhadi MT, Abbaszadegan MR.
BMC Cancer. 2010 Jun 7;10(1):261
Abstract
ABSTRACT: BACKGROUND: Dendritic Cells (DC) are potent antigen presenting cells with the ability to prime naive T cells and convert them to cytotoxic T-lymphocytes (CTL). We evaluated the capability of autologous DCs transfected with total tumor and normal RNA to induce cytotoxic CTL as the preliminary step to design a DC-based vaccine in the esophageal squamous cell carcinoma (ESCC). METHODS: Monocytes-derived DCs were electroporated with either total tumor RNA or normal RNA. T cells were then primed with tumor RNA transfected DCs and lytic effects of the generated CTL were measured with Cytotoxicity assay and IFN-gamma Release Elispot assay. RESULTS: Cytotoxicity was induced against DCs loaded with tumoral RNA (%24.8+/-5.2 SEM) while in normal RNA-loaded DCs, it was minimal (%6.1+/-2.4 SEM) and significantly lower (p < 0.05). INF-gamma secretion was more than 2-folds higher in tumoral RNA-loaded DCs when compared with normal RNA-loaded DCs (p < 0.05). CONCLUSION: Electroporating DCs with tumor RNA generated tumor antigen presenting cells which in turn enhanced cytotoxic effects of the T cells against ESCC. This may be a useful autologous ex vivo screening tool for confirming the lytic effects of primed T cells on tumors and evaluate probable further adverse effects on noncancerous tissues. These data provide crucial preliminary information to establish a total tumor RNA-pulsed DC vaccine therapy of ESCC.
Liver histology and HBV DNA levels in chronically HBV infected patients with persistently normal alanine aminotransferase.
Montazeri G, Rahban M, Mohamadnejad M, Zamani F, Hooshyar A, Fazlolahi A, Abedian S, Ghoujeghi F, Estakhri A, Montazeri F, Razjoyan H, Mamarabadi M, Alimohamadi M, Tavangar SM, Malekzadeh R.
Arch Iran Med. 2010;13(3):193-202.
Abstract
BACKGROUND: Data on histological activity and HBV DNA levels in patients with chronic HBV infection and persistently normal alanine aminotransferase levels are sparse. We aimed to investigate the histological activity and HBV DNA levels in these patients. METHODS: There were 132 patients with HBeAg negative chronic HBV infection and persistently normal alanine aminotransferase levels that were included prospectively. Data were dichotomized according to the median levels. Associations of histology with HBV DNA and other variables were assessed. RESULTS: A total of 80 patients were male. The median age was 36 years. The median baseline HBV DNA was 2.9Log10 IU/mL. There were 50 cases (38%) with a total score > or = 5, 53 cases (40.2%) had grade > or = 4 and 40 cases (30.3%) had stage > or = 2. A baseline HBV DNA <2000 IU/mL was seen in 24 cases (48%) of those with total score > or = 5, 28 cases (53%) of those with grade > or = 4 and 9 cases (22.5%) with stage > or = 2. Multivariate analysis of baseline HBV DNA above the median level significantly predicted the total score, grade and stage with an adjusted odds ratio of 5.43, 3.47, and 4.23, respectively when compared to below median values. A second liver biopsy was performed in 61 patients. The median time interval between the two biopsies was 40 months. Total scores of 23 cases (38%) progressed by > or = 2 scores and the HBV DNA of 18 cases (22.5%) increased by > or = 1 Log10 IU when compared to baseline values. CONCLUSION: HBeAg negative chronic HBV infection with persistently normal alanine aminotransferase is not a silent disease. Active liver disease may be seen in such patients with viral loads less than 2000 IU/mL.
Interactions between Glutathione-S-Transferase M1, T1 and P1 polymorphisms and smoking, and increased susceptibility to esophageal squamous cell carcinoma.
Moaven O, Raziee HR, Sima HR, Ganji A, Malekzadeh R, A'rabi A, Abdollahi A, Memar B, Sotoudeh M, Naseh H, Nekoui N, Razavipour A, Gholamin M, Dadkhah E, Farshchian M, Abbaszadegan MR.
Cancer Epidemiol. 2010 Jun;34(3):285-90. Epub 2010 Apr 20.
Abstract
BACKGROUND: A complex of genetic and environmental factors is involved in carcinogenesis of the esophageal squamous cell carcinoma (ESCC). Glutathione-S-Transferases (GSTs) are phase-II enzymes playing role in detoxification of carcinogen electrophiles. Genetic polymorphisms of GSTM1, GSTT1 and GSTP1 in association with some environmental factors and their impact on esophageal cancer susceptibility were assessed in the Iranian population. METHODS: Genomic DNA of peripheral blood leukocytes from 148 confirmed esophageal cancer cases and 137 healthy individuals as control group was assayed for restriction fragment length polymorphisms in the GSTP1 loci by PCR amplification followed by digestion with Alw26I. Deletion of the GSTM1 and GSTT1 genes was detected by multiplex PCR. A data-mining method based on decision trees was applied to produce a predictive model of interactions between genotypes. RESULTS: Smoking was independently associated with ESCC (p<0.05, OR: 2.286, 95% CI=1.311-3.983). Smoking along with GSTP1 Val/Val genotype was associated to ESCC (p<0.001, OR: 3.886, 95% CI=1.830-8.251), while non-smokers with GSTP1 Val/Val were significantly more frequent in non-cancerous group. (p=0.007, OR: 0.507, 95% CI=0.309-0.830). CONCLUSIONS: Data-mining methods are useful tools to map out a scheme for predicting complex relations and combinations of different genotypes. Genotyping analysis of GSTP1 together with assessment of smoking seems to be important in determining the risk of ESCC in the Iranian population.
p16INK4a hypermethylation and p53, p16 and MDM2 protein expression in Esophageal Squamous Cell Carcinoma.
Taghavi N, Biramijamal F, Sotoudeh M, Khademi H, Malekzadeh R, Moaven O, Memar B, A'rabi A, Abbaszadegan MR.
BMC Cancer. 2010 Apr 13;10:138.
Abstract
BACKGROUND: Tumor suppressor genes p53 and p16INK4a and the proto-oncogene MDM2 are considered to be essential G1 cell cycle regulatory genes whose loss of function is associated with ESCC carcinogenesis. We assessed the aberrant methylation of the p16 gene and its impact on p16INK4a protein expression and correlations with p53 and MDM2 protein expressions in patients with ESCC in the Golestan province of northeastern Iran in which ESCC has the highest incidence of cancer, well above the world average. METHODS: Cancerous tissues and the adjacent normal tissue obtained from 50 ESCC patients were assessed with Methylation-Specific-PCR to examine the methylation status of p16. The expression of p16, p53 and MDM2 proteins was detected by immunohistochemical staining. RESULTS: Abnormal expression of p16 and p53, but not MDM2, was significantly higher in the tumoral tissue. p53 was concomitantly accumulated in ESCC tumor along with MDM2 overexpression and p16 negative expression. Aberrant methylation of the p16INK4a gene was detected in 31/50 (62%) of esophageal tumor samples, while two of the adjacent normal mucosa were methylated (P < 0.001). p16INK4a aberrant methylation was significantly associated with decreased p16 protein expression (P = 0.033), as well as the overexpression of p53 (P = 0.020). CONCLUSIONS: p16 hypermethylation is the principal mechanism of p16 protein underexpression and plays an important role in ESCC development. It is associated with p53 protein overexpression and may influence the accumulation of abnormally expressed proteins in p53-MDM2 and p16-Rb pathways, suggesting a possible cross-talk of the involved pathways in ESCC development.
Seroprevalence of hepatitis C virus: the first population-based study from Iran.
Merat S, Rezvan H, Nouraie M, Jafari E, Abolghasemi H, Radmard AR, Zaer-Rezaii H, Amini-Kafiabad S, Maghsudlu M, Pourshams A, Malekzadeh R, Esmaili S.
Int J Infect Dis. 2010 Mar 31.
Abstract
OBJECTIVE: Early studies on blood donors point to a seroprevalence of approximately 0.25% for hepatitis C virus (HCV) infection in Iran. However, the true prevalence in the general population is unknown. The objective of this study was to determine the prevalence of HCV infection in the general population of Iran. METHODS: We randomly selected 6583 subjects from three provinces in Iran for inclusion in the study. Subjects were aged between 18 and 65 years. Anti-hepatitis C antibody was tested by a third-generation ELISA test. A recombinant immunoblot assay (RIBA) test was used to confirm the results. Risk factors were recorded and a multivariate analysis was performed. RESULTS: A total of 5684 plasma samples were tested. After confirmatory tests, we found 50 cases of HCV. The overall weighted prevalence of anti-HCV was 0.5%. The rate was significantly higher in men (1.0%) than in women (0.1%). In multivariate analysis, male sex, history of intravenous drug abuse, and imprisonment were significantly associated with anti-HCV. CONCLUSIONS: We found the prevalence of HCV infection in Iran to be higher than previous estimates. It appears that the rate is rising, and in the future, hepatitis C will replace hepatitis B as the most common cause of chronic viral liver disease in Iran. Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Comparison of colonic transit time between patients with constipation-predominant irritable bowel syndrome and functional constipation.
Ansari R, Sohrabi S, Ghanaie O, Amjadi H, Merat S, Vahedi H, Khatibian M.
Indian J Gastroenterol. 2010 Mar;29(2):66-8. Epub 2010 May 5.
Abstract
BACKGROUND/AIM: Functional constipation (FC) and constipation-predominant IBS (C-IBS) are two main subtypes of constipation. Using radio-opaque markers is an easy and cost effective method to measure colonic transit time (CTT). We designed this study to compare the CTT between these two groups of constipated patients. METHODS: Patients with chronic constipation of no organic etiology were classified as having FC or C-IBS according to the Rome II criteria. All patients ingested 10 radio opaque markers daily for six days. A plain abdominal X-ray was taken on the seventh day. To calculate the total and segmental colonic transit time in hours, number of markers in right and left colonic and rectosigmoid area were counted and multiplied by 2.4. The mean total and segmental colonic transit time were compared between the two groups. RESULTS: A total of 100 patients (50 FC and 50 C-IBS) were enrolled. The mean (SD) total CTT was not significantly different between FC patients (52.2 [35.5] h) and C-IBS patients (41.2 [31.6] h; p = 0.10). The mean rectosigmoid transit time was significantly slower in FC patients (19.9 [15.5] h) compared to C-IBS patients (11.9 [10.6] h; p = 0.003). CONCLUSION: Rectosigmoid transit time in FC patients is slower than in C-IBS patients.
Ethnic and geographic differentiation of Helicobacter pylori within Iran.
Latifi-Navid S, Ghorashi SA, Siavoshi F, Linz B, Massarrat S, Khegay T, Salmanian AH, Shayesteh AA, Masoodi M, Ghanadi K, Ganji A, Suerbaum S, Achtman M, Malekzadeh R, Falush D.
PLoS One. 2010 Mar 22;5(3):e9645.
Abstract
The bacterium Helicobacter pylori colonizes the human stomach, with individual infections persisting for decades. The spread of the bacterium has been shown to reflect both ancient and recent human migrations. We have sequenced housekeeping genes from H. pylori isolated from 147 Iranians with well-characterized geographical and ethnic origins sampled throughout Iran and compared them with sequences from strains from other locations. H. pylori from Iran are similar to others isolated from Western Eurasia and can be placed in the previously described HpEurope population. Despite the location of Iran at the crossroads of Eurasia, we found no evidence that the region been a major source of ancestry for strains across the continent. On a smaller scale, we found genetic affinities between the H. pylori isolated from particular Iranian populations and strains from Turks, Uzbeks, Palestinians and Israelis, reflecting documented historical contacts over the past two thousand years.
Coeliac disease in autoimmune liver disease: A cross-sectional study and a systematic review.
Mirzaagha F, Azali SH, Islami F, Zamani F, Khalilipour E, Khatibian M, Malekzadeh R.
Dig Liver Dis. 2010 Mar 15.
Abstract
BACKGROUND: Several studies have reported an association between coeliac disease and autoimmune liver disease, but there is little information on the prevalence of coeliac disease in certain autoimmune liver diseases, particularly from non-European, non-American countries. AIMS: To investigate prevalence of coeliac disease in autoimmune liver disease in Iran and to summarize previous literature. METHODS: We investigated prevalence of coeliac disease among 100 autoimmune liver disease patients and compared it with the prevalence in healthy individuals. We also performed an extensive search of the English literature in PubMed Database. RESULTS: We found substantially elevated prevalence of coeliac disease in patients with overlap syndrome (10-15%) compared to the general population (0.1-1%). To a lesser extent, the prevalence was high in patients with autoimmune hepatitis (2-4%). In our systematic review, prevalence of coeliac disease in autoimmune hepatitis in the majority of studies was 4% or more; several studies also reported such prevalence in primary biliary cirrhosis. CONCLUSIONS: Since coeliac disease is common among patients with autoimmune liver disease, screening autoimmune liver disease patients for coeliac disease is indicated. Although the magnitude of benefit from a gluten-free diet in reversing autoimmune liver disease in patients with coeliac disease is controversial, it may reduce the risk of further complications of coeliac disease.
Overlapping gastroesophageal reflux disease and irritable bowel syndrome: increased dysfunctional symptoms.
Yarandi SS, Nasseri-Moghaddam S, Mostajabi P, Malekzadeh R.
World J Gastroenterol. 2010 Mar 14;16(10):1232-8.
Abstract
AIM: To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both. METHODS: Six thousand four hundred and seventy six patients presented to the Gastro-intestinal (GI) clinic with symptoms of functional dysfunction of GI tract, 1419 patients (62.0% women, 38.0% men; mean age: 37.4 +/- 11.5 years) met Rome II or Rome III criteria (depending on the year of diagnosis) for IBS. 2658 patients were diagnosed with GERD based on clinical presentation and endoscopic findings. We assessed other functional symptoms (epigastric pain, nausea, vomiting, belching, constipation and diarrhea) in patients suffering from GERD, IBS or both. RESULTS: Among IBS subjects, 63.6% (69.0% women, 31.0% men; mean age: 36.4 +/- 10.3 years) also had GERD, whereas 34.7% of the non-IBS patients had GERD [odds ratio (OR) = 3.2, 95% confidence interval (CI): 2.9-3.7, P < 0.0001]. Among patients with GERD, 33.9% of subjects met Rome criteria compared to 13.5% of non-GERD patients (OR = 3.6, 95% CI: 3.1-4.3, P < 0.0001). Prevalence of all functional symptoms was higher in overlapping GERD and IBS subjects, when compared with their prevalence in the IBS subjects without GERD or GERD only subjects (P < 0.05). CONCLUSION: This finding shows that in overlapping GERD and IBS, other functional abnormalities of the GI tract are also highly prevalent, suggesting a common underlying dysfunction.
Development of a low-cost real-time reverse transcriptase-polymerase chain reaction technique for the detection and quantification of hepatitis C viral load.
Shahzamani K, Merat S, Rezvan H, Mirab-Samiee S, Khademi H, Malekzadeh R, Sabahi F.
Clin Chem Lab Med. 2010 Jun;48(6):777-84.
Abstract
BACKGROUND: It is necessary to develop a highly specific and sensitive assay to quantify the exact amount of hepatitis C virus (HCV) RNA in blood of patients with hepatitis C. For this reason, a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay for quantification of HCV RNA in human plasma was developed. METHODS: A pair of primers as well as hybridization probes were selected. A real-time RT-PCR was set up and optimized. To establish the sensitivity of the assay, a serial dilution of HCV standards and reference sera, including the six major HCV genotypes, was used. The performance of the assay was evaluated with 191 known HCV-RNA positive and 100 negative samples. RESULTS: The real-time assay had a sensitivity of 50 IU/mL, with a dynamic range of detection between 10(3) and 10(6) IU/mL. The coefficients of variation of threshold cycle values in intra- and inter-day-runs were <1.77% and 3.40%, respectively. Measurement of HCV-RNA positive samples yielded reproducible data with 100% specificity. CONCLUSIONS: The high sensitivity, simplicity, reproducibility, wide dynamic range, and low cost of this real-time HCV RNA quantification makes this method especially suitable for monitoring viral load during therapy and tailoring of treatment schedules accordingly.
Investigation of NQO1 genetic polymorphism, NQO1 gene expression and PAH-DNA adducts in ESCC. A case-control study from Iran.
Marjani HA, Biramijamal F, Rakhshani N, Hossein-Nezhad A, Malekzadeh R.
Genet Mol Res. 2010 Feb 9;9(1):239-49.
Abstract
We evaluated the effect of NQO1 genetic variation on PAH-DNA adducts in esophageal squamous cell carcinoma (ESCC) in northeast Iran. Golestan Province in northeast of Iran has one of the highest esophageal cancer incidences in the world. The study included 93 ESCC cases and 50 control individuals who were seen at the clinical cancer center in Golestan province. NQO1 C609T genotypes were determined by PCR-RFLP analysis. NQO1 gene expression in tissue samples was determined by quantitative real-time PCR. Immunohistochemical techniques were used to detect PAH-DNA adducts in ESCC and normal esophageal tissues. The distributions of NQO1 genetic polymorphism between cases and the control group were not significantly different. NQO1 gene expression was not higher in tumor tissues than in normal esophageal tissues adjacent to the ESCC; expression was higher in tumor tissues that had the NQO1 T allele. NQO1 gene expression was high in normal esophageal tissues. The level of PAH-DNA adducts was significantly higher in ESCC tissues of cases than in normal tissues adjacent to tumor tissues and in normal esophageal tissues of healthy controls. There were no significant differences between the adduct levels of normal esophageal tissues of patients and controls. There was also no significant relationship between cigarette smoking and PAH-DNA adducts. We concluded that PAHs are a risk factor for ESCC and that PAH-DNA adducts have potential as a biomarker for risk of ESCC.
Five common cancers in Iran.
Kolahdoozan S, Sadjadi A, Radmard AR, Khademi H.
Arch Iran Med. 2010;13(2):143-6. Abstract
Iran as a developing nation is in epidemiological transition from communicable to non-communicable diseases. Although, cancer is the third cause of death in Iran, it;s mortality are on the rise during recent decades. This mini-review was carried out to provide a general viewpoint on common cancers incidence in Iran and to explain incidental differences that may help us to establish early detection programs and investigate population risk factors. A detailed PubMed, Scopus and Google scholar search were made from 2000 to 2009. The basic inclusion criteria were all relevant studies focused on cancer epidemiological data from Iran. Overall age-standard incidence rate per 100 000 population according to primary site is 110.43 in males and 98.23 in females. The five most common cancers (except skin cancer) are stomach, esophagus, colon-rectum, bladder and leukemia in males, and in females are breast, esophagus, stomach, colon-rectum and cervix uteri. The incidence rates of gastrointestinal cancers are high in Iran (it is one of the known areas with a high incidence of GI cancers). Breast cancer mainly affects Iranian women about a decade earlier than Western countries and younger cases are affected by an increasing rate of colorectal cancer in Iran, near the Western rates.
Seroprevalence and risk factors of hepatitis A virus infection in Iran: a population based study.
Merat S, Rezvan H, Nouraie M, Abolghasemi H, Jamali R, Amini-Kafiabad S, Maghsudlu M, Pourshams A, Malekzadeh R.
Arch Iran Med. 2010;13(2):99-104.
Abstract
BACKGROUND: In older studies, the seroprevalence of hepatitis A virus infection has been reported to be over 95% in Iranians. Most of these studies were performed on volunteer blood donors. Studies on the general population are sparse. The purpose of this study was to determine the current seroprevalence of hepatitis A virus infection in the general population of Iran. METHODS: During 2006, 1869 subjects between 18 and 65 years of age were randomly selected from the general population of three Iranian provinces (Tehran, Golestan, and Hormozgan). Subjects were interviewed and a plasma sample was obtained for serologic testing for anti-hepatitis A virus. Univariate and multivariate analysis was performed to identify risk factors. RESULTS: The seroprevalence of hepatitis A virus in Tehran, Golestan and Hormozgan was 85%, 99%, and 96%, respectively. The overall seroprevalence of hepatitis A virus in the general population of the three provinces studied was 86% and did not differ between the two genders. The prevalence in younger subjects and in urban populations was under 70%. In multivariate analysis, older age, being married, and level of the father's education was associated with hepatitis A virus seropositivity.CONCLUSION: The seroprevalence of hepatitis A virus still appears to be too elevated for recommending routine vaccination in the general population. However, the trend towards a lower prevalence in younger age groups and people from urban areas points towards the possible benefit of vaccination in these subgroups.
Transplantation of allogeneic bone marrow mesenchymal stromal cell-derived hepatocyte-like cells in homozygous familial hypercholesterolemia.
Mohamadnejad M, Pournasr B, Bagheri M, Aghdami N, Shahsavani M, Hosseini LA, Taghiabadi E, Azizi H, Heidari I, Akhlaghpoor S, Calandra S, Malekzadeh R, Baharvand H.
Cytotherapy. 2010 Jan 18.
A modification of the Brunt system for scoring liver histology of patients with non-alcoholic fatty liver disease.
Merat S, Khadem-Sameni F, Nouraie M, Derakhshan MH, Tavangar SM, Mossaffa S, Malekzadeh R, Sotoudeh M.
Arch Iran Med. 2010 Jan;13(1):38-44.
Abstract
BACKGROUND: Nonalcoholic steatohepatitis is a common cause of chronic liver disease. It is important to have a uniform and validated method for scoring liver histology in these patients. Therefore, we propose a modification of the Brunt system by scoring the four histologic features separately and reporting their sums as the nonalcoholic steatohepatitis activity index. METHODS: A nonalcoholic steatohepatitis activity index was defined which scored the grade of disease activity between 0 and 12 according to four histologic features: steatosis, hepatocyte ballooning, portal inflammation, and lobular inflammation. Fibrosis was separately scored between 0 and 4. A total of 60 liver specimens collected from nonalcoholic steatohepatitis patients were scored by two pathologists at the time of biopsy and after three months. Liver enzyme levels were also correlated with the histologic score. RESULTS: The intra-rater agreement (weighted kappa) for various variables of the scoring system was between 0.59 and 0.80 for one pathologist and 0.78 to 0.95 for the other. The repeatability of the nonalcoholic steatohepatitis activity index was excellent with only 4% of the repeated measures out of the acceptable range of agreement. In addition, liver enzyme levels strongly correlated with the nonalcoholic steatohepatitis activity index. CONCLUSION: This system provides a fine graduation of liver histologic damage in nonalcoholic steatohepatitis and is well suited for use in clinical trials or natural history studies.
Long-term protection provided by hepatitis B vaccine and need for booster dose: a meta-analysis.
Poorolajal J, Mahmoodi M, Majdzadeh R, Nasseri-Moghaddam S, Haghdoost A, Fotouhi A.
Vaccine. 2010 Jan 8;28(3):623-31. Epub 2009 Nov 1. Review.
Abstract
The duration of protection provided by hepatitis B vaccine is still unknown but can be estimated through long-term follow-up studies. Electronic databases and conference databases to December 2008 were searched. Reference lists of articles were screened and the studies authors and manufacturers were contacted for additional unpublished references. Randomized clinical trials and prospective cohort studies addressing the long-term protective effect of hepatitis B vaccine were included in this meta-analysis. We assessed 42 separate cohorts involving overall 11,090 subjects; 34 cohorts involving 9356 subjects were included in the final meta-analysis. Results indicate that the overall cumulative incidence of HBV breakthrough infection 5-20 years post-primary vaccination was 0.007 [95% CI: 0.005 to 0.010] with a variation among studies from 0 to 0.094. Available data do not allow us to exclude an increased risk for infection with time since vaccination. We conclude that the protection provided by three or four doses of monovalent HB vaccine persists for at least two decades in the great majority of immunocompetent individuals. Additional studies are needed for assessing vaccine efficacy for longer periods of time and the need of booster doses in different subgroups of population.
Long-term follow-up of common bile duct diameter after endoscopic sphincterotomy in patients with common bile duct stones.
Kolahdoozan S, Sotoudehmanesh R, Khatibian M, Ali-Asgari A, Shahraeeni S, Zeinali F.
Indian J Gastroenterol. 2010 Jan;29(1):22-5. Epub 2010 Apr 6.
Abstract
BACKGROUND AND AIMS: To determine the time to normalization of common bile duct (CBD) diameter after endoscopic sphincterotomy and stone extraction in patients with choledocholithiasis. METHODS: Patients with CBD dilation due to choledocholithiasis were enrolled. CBD diameter was measured by transabdominal ultrasonography before, and repeated after one, three, six and twelve months after endoscopic sphincterotomy and stone extraction, until normalization of CBD diameter. RESULTS: Of 115 cases enrolled over a 36-month period, CBD diameter reversed to normal in 71 (61.7%) patients after one month. Of the remaining 44 patients, CBD diameter reversed to normal in 36 patients (including 3 in whom repeat ERCP revealed choledocholithiasis) at the end of three months. CBD diameter had not reversed to normal diameter in 8 (18.2%) patients; none of these patients had symptoms. Two of them had asymptomatic dilated CBD after 6 months with no abnormal liver function tests (LFT); the duct reversed to normal at the last follow-up (month 12). CONCLUSIONS: Asymptomatic CBD dilation may persist in a minority of patients (18% at the end of 3 months) after removal of CBD stones. A dilated CBD can be attributed to retained choledocholithiasis within the first month, if it is associated with symptoms and abnormal LFT.
Pictogram use was validated for estimating individual's body mass index
Keshtkar AA, Semnani S, Pourshams A, Khademi H, Roshandel G, Boffetta P, Malekzadeh R.
J Clin Epidemiol. 2010 Jun;63(6):655-9. Epub 2009 Nov 12.
Abstract
OBJECTIVE: We designed this study to assess the validity and reliability of pictogram for estimating body mass index (BMI). STUDY DESIGN AND SETTING: Participants of Golestan cohort study during 2000-2004 were recruited in this study. Demographic and anthropometric information (weight, height, and BMI) were collected on all participants. A set of drawings (pictogram) ranging from very lean to obese were used to assess the individual's perception of their body size. Sensitivity and specificity of each pictogram score were calculated and cutoff points were determined using sensitivity/specificity plots. We used receiver operating characteristic curves to assess the validity of pictogram scores. RESULTS: Of the 15,437 subjects enrolled in the study, 6,574 (42.6%) were males and 8,863 (57.4%) were females. Their mean+/-standard deviation age was 52.58+/-9.28 years. Pictogram scores 1, 2, and 3 were assigned to normal participants; pictogram score 4 was selected by overweight subjects, and finally, pictogram scores equal or higher than 5 were selected by obese ones (area under curve: 0.83-0.85). CONCLUSION: According to our results, pictogram is a valid measure for discriminating obese or overweight from normal individuals, and for distinguishing obese from overweight or normal individuals. So it can be concluded that body image pictogram is valid for discriminating normal and obese individuals.
A case-control study on risk factors of osteoporosisin patients with Crohn's disease.
Vahedi H, Momtahen S, Olfati G, Abtahi A, Hosseini S, Kazzazi AS, Khademi H, Rashtak S, Khaleghnejad R, Tabrizian T, Hamidi Z, Nouraie M, Malekzadeh F, Merat S, Nasseri-Moghaddam S, Sotoudehmanesh R, Larijani B.
Arch Iran Med. 2009 Nov;12(6):570-5.
Abstract
BACKGROUND: Osteoporosis has been frequently reported in patients with inflammatory bowel diseases, especially Crohn's disease. METHODS: All consecutive Crohn's disease patients who attended the GI Clinics at Shariati Hospital, Tehran, Iran, from 2004 to 2007 were evaluated. A BMD-DEXA assessment was performed for all patients. Among those patients diagnosed with osteoporosis (T score
Gastric cancer in Iran: epidemiology and risk factors
Malekzadeh R, Derakhshan MH, Malekzadeh Z.
Arch Iran Med. 2009 Nov;12(6):576-83. Review
Abstract
Although the global incidence of gastric cancer has been decreased dramatically in recent decades, it is the most common cancer in north and northwest Iran. The wide variation in incidence across different geographical areas and higher proportion of cardia cancer are two main characteristics of gastric cancer in Iran. Current investigations indicate that a high prevalence of H.pylori infection, high dietary intake of salt and smoking are the main environmental factors of gastric cancer in Iran. Gastroesophageal reflux disease is another contributing factor in populations with a higher incidence of gastric cardia cancer. While interventions on modifiable environmental risk factors should be considered as the main modality to reduce gastric cancer development, surveillance programmes for early detection of cancer in highly selected groups may increase overall survival rates in potential patients in this country.
Comparison of breast cancer survival in two populations: Ardabil, Iran and British Columbia, Canada.
Sadjadi A, Hislop TG, Bajdik C, Bashash M, Ghorbani A, Nouraie M, Babaei M, Malekzadeh R, Yavari P.
BMC Cancer. 2009 Oct 28;9:381.
Abstract
BACKGROUND: Patterns in survival can provide information about the burden and severity of cancer, help uncover gaps in systemic policy and program delivery, and support the planning of enhanced cancer control systems. The aim of this paper is to describe the one-year survival rates for breast cancer in two populations using population-based cancer registries: Ardabil, Iran, and British Columbia (BC), Canada. METHODS: All newly diagnosed cases of female breast cancer were identified in the Ardabil cancer registry from 2003 to 2005 and the BC cancer registry for 2003. The International Classification of Disease for Oncology (ICDO) was used for coding cancer morphology and topography. Survival time was determined from cancer diagnosis to death. Age-specific one-year survival rates, relative survival rates and weighted standard errors were calculated using life-tables for each country. RESULTS: Breast cancer patients in BC had greater one-year survival rates than patients in Ardabil overall and for each age group under 60. CONCLUSION: These findings support the need for breast cancer screening programs (including regular clinical breast examinations and mammography), public education and awareness regarding early detection of breast cancer, and education of health care providers.
Achalasia: a review of Western and Iranian experiences.
Mikaeli J, Islami F, Malekzadeh R.
World J Gastroenterol. 2009 Oct 28;15(40):5000-9. Review.
Abstract
Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta-analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, is the most effective treatment for achalasia. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.
Oesophageal cancer in Golestan Province, a high-incidence area in northern Iran - a review.
Islami F, Kamangar F, Nasrollahzadeh D, Møller H, Boffetta P, Malekzadeh R.
Eur J Cancer. 2009 Dec;45(18):3156-65. Epub 2009 Oct 1. Review.
Abstract
Golestan Province, located in the south-east littoral of the Caspian Sea in northern Iran, has one of the highest rates of oesophageal cancer (OC) in the world. We review the epidemiologic studies that have investigated the epidemiologic patterns and causes of OC in this area and provide some suggestions for further studies. Oesophageal squamous cell carcinoma (OSCC) constitutes over 90% of all OC cases in Golestan. In retrospective studies, cigarettes and hookah smoking, nass use (a chewing tobacco product), opium consumption, hot tea drinking, poor oral health, low intake of fresh fruit and vegetables, and low socioeconomic status have been associated with higher risk of OSCC in Golestan. However, the association of tobacco with OSCC in this area is not as strong as that seen in Western countries. Alcohol is consumed by a very small percentage of the population and is not a risk factor for OSCC in this area. Other factors, such as polycyclic aromatic hydrocarbons, N-nitroso compounds, drinking water contaminants, infections, food contamination with mycotoxins, and genetic factors merit further investigation as risk factors for OSCC in Golestan. An ongoing cohort study in this area is an important resource for studying some of these factors and also for confirming the previously found associations.
The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome.
Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R.
Dig Dis Sci. 2010 May;55(5):1385-90. Epub 2009 Jun 9.
Abstract
Herbal remedies, particularly peppermint, have been reported to be helpful in controlling symptoms of irritable bowel syndrome (IBS). We conducted a randomized double-blind placebo-controlled study on 90 outpatients with IBS. Subjects took one capsule of enteric-coated, delayed-release peppermint oil (Colpermin) or placebo three times daily for 8 weeks. We visited patients after the first, fourth, and eighth weeks and evaluated their symptoms and quality of life. The number of subjects free from abdominal pain or discomfort changed from 0 at week 0 to 14 at week 8 in the Colpermin group and from 0 to 6 in controls (P < 0.001). The severity of abdominal pain was also reduced significantly in the Colpermin group as compared to controls. Furthermore, Colpermin significantly improved the quality of life. There was no significant adverse reaction. Colpermin is effective and safe as a therapeutic agent in patients with IBS suffering from abdominal pain or discomfort.
Cohort Profile: The Golestan Cohort Study-a prospective study of oesophageal cancer in northern Iran.
Pourshams A, Khademi H, Malekshah AF, Islami F, Nouraei M, Sadjadi AR, Jafari E, Rakhshani N, Salahi R, Semnani S, Kamangar F, Abnet CC, Ponder B, Day N, Dawsey SM, Boffetta P, Malekzadeh R.
Int J Epidemiol. 2010 Feb;39(1):52-9. Epub 2009 Mar 30
