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Mosallaie Pour HR, Sivandzadeh GR, Ejtehadi F, Safarpour AR, Shahramian I, Tahani M, Taghavi SA, Aminisefat A. Recipient-associated risk factors for post-liver transplantation biliary complications: A cohort study. Indian J Gastroenterol 2024:10.1007/s12664-023-01479-w. [PMID: 38172464 DOI: 10.1007/s12664-023-01479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/26/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Biliary complications (BCs) are a well-documented post-liver transplantation concern with potential implications for patient survival. This study aims at identifying risk factors associated with the development of BCs in recipients after liver transplantation (LT) and exploring strategies for their management. METHODS We conducted a retrospective analysis of 1595 adult patients (age > 18 years) who underwent LT surgery between 2019 and 2021. The study assessed the incidence of BCs in this cohort. RESULTS Of 1595 patients, 178 (11.1%) experienced BCs, while 1417 (88.8%) did not exhibit any signs of such complications. Patients who developed BCs were found to have a significantly lower average age (p < 0.001) and longer cold ischemic times (p < 0.001) compared to those without BCs. Variables such as sex, body mass index (BMI), model for end-stage liver disease (MELD) score, primary diagnosis, type of anastomosis, hepatectomy technique, type of transplanted liver and mortality did not demonstrate statistically significant differences between the two groups (p > 0.05). Univariate logistic regression analysis revealed that a cold ischemic time exceeding 12 hours and duct-to-duct anastomosis were positive predictors for BC development (odds ratios of 6.23 [CI 4.29-9.02] and 1.47 [CI 0.94-2.30], respectively). Conversely, increasing age was associated with a protective effect against BC development, with an odds ratio of 0.64 (CI 0.46-0.89). CONCLUSION Our multi-variate analysis identified cold ischemia time (CIT) as the sole significant predictor of post-liver transplantation biliary complications. Additionally, this study observed that advancing patient age had a protective influence in this context. Notably, no significant disparities were detected between hepatectomy techniques and the etiology of liver disease types in the two study groups.
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Affiliation(s)
- Hamid Reza Mosallaie Pour
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Reza Sivandzadeh
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iraj Shahramian
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Tahani
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Seyed Alireza Taghavi
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Aminisefat
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
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Bordbar M, Helfroush MS, Danyali H, Ejtehadi F. Wireless capsule endoscopy multiclass classification using three-dimensional deep convolutional neural network model. Biomed Eng Online 2023; 22:124. [PMID: 38098015 PMCID: PMC10722702 DOI: 10.1186/s12938-023-01186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Wireless capsule endoscopy (WCE) is a patient-friendly and non-invasive technology that scans the whole of the gastrointestinal tract, including difficult-to-access regions like the small bowel. Major drawback of this technology is that the visual inspection of a large number of video frames produced during each examination makes the physician diagnosis process tedious and prone to error. Several computer-aided diagnosis (CAD) systems, such as deep network models, have been developed for the automatic recognition of abnormalities in WCE frames. Nevertheless, most of these studies have only focused on spatial information within individual WCE frames, missing the crucial temporal data within consecutive frames. METHODS In this article, an automatic multiclass classification system based on a three-dimensional deep convolutional neural network (3D-CNN) is proposed, which utilizes the spatiotemporal information to facilitate the WCE diagnosis process. The 3D-CNN model fed with a series of sequential WCE frames in contrast to the two-dimensional (2D) model, which exploits frames as independent ones. Moreover, the proposed 3D deep model is compared with some pre-trained networks. The proposed models are trained and evaluated with 29 subject WCE videos (14,691 frames before augmentation). The performance advantages of 3D-CNN over 2D-CNN and pre-trained networks are verified in terms of sensitivity, specificity, and accuracy. RESULTS 3D-CNN outperforms the 2D technique in all evaluation metrics (sensitivity: 98.92 vs. 98.05, specificity: 99.50 vs. 86.94, accuracy: 99.20 vs. 92.60). In conclusion, a novel 3D-CNN model for lesion detection in WCE frames is proposed in this study. CONCLUSION The results indicate the performance of 3D-CNN over 2D-CNN and some well-known pre-trained classifier networks. The proposed 3D-CNN model uses the rich temporal information in adjacent frames as well as spatial data to develop an accurate and efficient model.
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Affiliation(s)
- Mehrdokht Bordbar
- Department of Electrical Engineering, Shiraz University of Technology, Shiraz, Iran
| | | | - Habibollah Danyali
- Department of Electrical Engineering, Shiraz University of Technology, Shiraz, Iran
| | - Fardad Ejtehadi
- Department of Internal Medicine, Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Rezaei SMA, Mohammadi F, Eftekhari MH, Ejtehadi F, Ghaem H, Mohammadipoor N. The effects of zinc supplementation on the metabolic factors in patients with non-alcoholic fatty liver disease: a randomized, double-blinded, placebo-controlled clinical trial. BMC Nutr 2023; 9:138. [PMID: 38012749 PMCID: PMC10683204 DOI: 10.1186/s40795-023-00776-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic factors including obesity, dyslipidemia, insulin resistance, oxidative stress, and elevated inflammatory factors. Zinc (Zn) supplementation has been investigated as a potential adjunctive therapy in managing NAFLD outcomes. METHODS In this randomized, double-blinded, controlled clinical trial, 50 overweight or obese participants with NAFLD were randomized into 2 groups of 25 and received either 30 mg of daily Zn or a placebo for 8 weeks. Both groups were invited to follow a balanced energy-restricted diet and physical activity recommendations. RESULTS Based on the between-group comparison, Zn supplementation caused a significant increase in the Zn level (P < 0.001) and a significant decrease in weight (P = 0.004), body mass index (BMI) (P = 0.002), waist circumference (P = 0.010), aspartate transaminase (AST) (P = 0.033), total cholesterol (TC) (P = 0.045), and low-density lipoprotein cholesterol (LDL-C) (P = 0.014), but it had no significant effect on alanine transaminase (ALT), fasting blood sugar (FBS), insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high-density lipoprotein (HDL), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), and total antioxidant capacity (TAC) (P > 0.05). CONCLUSION The results of the present study indicated that 8-week supplementation of 30 mg daily Zn may increase the Zn serum level and decline anthropometric parameters, AST, TC, and LDL-C in NAFLD patients, so further research is suggested in the future. TRIAL REGISTRATION The trial was retrospectively registered at IRCT.ir as IRCT20191015045113N1 (December/8/2019).
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Affiliation(s)
- Seyed Mohammad Amin Rezaei
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Eftekhari
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Ghaem
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Mohammadipoor
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Ejtehadi F, Firoozifar M, Shakeri J, Jafari P, Sivandzadeh GR, Motazedian N, Shamsaeefar A, Niknam R, Shahramian I, Tahani M. Predictive Score for Early Successful Tracheal Extubation After Liver Transplant: A Case-Control Study. EXP CLIN TRANSPLANT 2023; 21:735-742. [PMID: 37885289 DOI: 10.6002/ect.2023.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES Prolonged tracheal intubation and mechanical ventilation after liver transplant increase postoperative complications. Hence, timely extubation should be considered; however, a standard clinical criteria set or scoring system to select patients has not been established for early extubation after livertransplant.We investigated the factors that affect early extubation to design a predictive scoring system for early extubation. MATERIALS AND METHODS This study is a case-control study of adult liver transplant patients. Preoperative, intraoperative, and postoperative clinical data were collected. Early extubation was defined as tracheal extubation immediately or up to 6 hours posttransplant. The variables were compared between the early extubation group and the delayed extubation (>6 hours) group. RESULTS Our study enrolled 237 patients; among them, 57 patients (24%) were in the early extubation group, and 180 (76%) were in the delayed extubation group. Multiple logistic regression analysis showed that postoperative base excess level at admission to the intensive care unit, number of units of packed red blood cells transfused during surgery, urine volume, and excess base level 6 hours after surgery were the main predictors of successful early extubation. CONCLUSIONS The initial base excess level at the entrance to the intensive care unit(postsurgery) and 6 hours after surgery, packed red blood cell volume transfused during surgery, and urine volume 6 hours after surgery are the main predictors for a successful early tracheal extubation.These factors are considered for the Shiraz Extubation Predictor formula.
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Affiliation(s)
- Fardad Ejtehadi
- From the Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ejtehadi F, Taghavi AR, Ejtehadi F, Shahramian I, Niknam R, Moini M, Tahani M. Prevalence of Colonic Polyps Detected by Colonoscopy in Symptomatic Patients and Comparison Between Different Age Groups. What Age Should be Considered for Investigation? Pol Przegl Chir 2023; 96:15-21. [PMID: 38353090 DOI: 10.5604/01.3001.0053.3997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
<b>Introduction:</b> The Burden of Colorectal cancer (CRC) as one of the most common malignancies is considerable worldwide, with 1.8 million diagnoses each year. Although it is well established that most CRCs arise from colonic polyps, guidelines and recommendations indicate different ages as starting points for endoscopic examination of the colon, either as cancer screening programs or in symptomatic patients. Most standard guidelines adapt the cut-off age of 50. However, this has been challenged by the results of recent studies. This multicentric prospective study aimed to investigate the frequency, distribution, and histopathological findings of colonic polyps in patients who underwent colonoscopy with special attention to the age group of 40-49-year-olds compared with 50-59 in the population.</br></br> <b>Material and methods:</b> This multicentric, prospective study was designed to enroll adult patients referred to three universityaffiliated endoscopy units. As many as 723 patients met all the inclusion criteria. Data analysis was performed on endoscopic and histopathological characteristics of all detected lesions, including colonic polyps and neoplastic lesions.</br></br> <b>Results:</b> A total of 723 patients with a mean age of 46.03 (16.8) years were included in this study. Rectal bleeding was the most frequent symptom (40.9%). One hundred and thirteen patients (15.6%) were found to have colonic polyps, and 11 cases (1.52%) of CRC were detected. Most polyps were located in the left colon (67.5%). There was no statistical difference in the prevalence of adenomatous polyps between the age group of 40-49 years and 50-59 years (P = 0.77). Detailed examination of data using receiver operating characteristic (ROC) curve analysis not only showed age is a risk factor for the presence of colonic polyps but also revealed the cut-off age of 42.5 for the presence of all types of colonic polyps (44.5 years for adenomatous polyps).</br></br> <b>Conclusion:</b> This study has showed a similar polyp prevalence in the age group of 40-49 years as compared to 50-59. Our study suggests that appropriate colon examination should be performed at a younger age to achieve early detection of colonic polyps, specifically in patients with red flag symptoms.
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Affiliation(s)
- Fardad Ejtehadi
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Reza Taghavi
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farshid Ejtehadi
- Department of Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
| | - Iraj Shahramian
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Moini
- Division of gastroenterology, University of Ottawa, Ottawa, Canada
| | - Masoud Tahani
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
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Ejtehadi F, Anbardar MH, Imanieh MH, Niknam R, Sivandzadeh GR. Organic colonic lesions in patients with irritable bowel syndrome: A comparative study. Rev Gastroenterol Mex (Engl Ed) 2023; 88:208-213. [PMID: 35906157 DOI: 10.1016/j.rgmx.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/15/2021] [Indexed: 11/09/2023]
Abstract
INTRODUCTION AND AIMS Any alarm symptoms in patients with irritable bowel syndrome (IBS) should be carefully evaluated. Colonoscopy is a standard diagnostic procedure for evaluating the colonic mucosa and ruling out probable diseases responsible for patient symptoms. We analyzed the colonoscopy findings in patients with and without IBS. MATERIAL AND METHODS Ninety-six patients with IBS and 101 without IBS were consecutively enrolled in the study. All the patients in the IBS group met the Rome IV criteria, and underwent colonoscopy due to the appearance of red flags. The colonoscopy findings were compared between the 2 groups of patients. RESULTS The main indications for colonoscopy in the IBS group were progressive abdominal pain (36.7%), rectal bleeding with fresh blood (17.7%), and occult blood in stool (12.5%). In the non-IBS group, the most prevalent indicators were rectal bleeding with fresh blood (37.6%), colorectal cancer surveillance (21.8%), and abdominal pain (13.9%). The most common macroscopic findings in the 2 groups were hemorrhoids, polyps, and anal fissure. There were no statistically significant differences with respect to the microscopic and macroscopic findings between groups. CONCLUSIONS We concluded that the prevalence of organic lesions in the colon of patients with IBS was the same as that in the patients without IBS. The Rome IV criteria accurately predicted IBS. Additional evaluation through colonoscopy in IBS should be based on the presence of alarm features.
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Affiliation(s)
- F Ejtehadi
- Centro de Investigación en Gastroenterohepatología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
| | - M H Anbardar
- Departamento de Patología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
| | - M H Imanieh
- Centro de Investigación en Gastroenterohepatología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran.
| | - R Niknam
- Centro de Investigación en Gastroenterohepatología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
| | - G R Sivandzadeh
- Centro de Investigación en Gastroenterohepatología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
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Ejtehadi F, Anbardar MH, Imanieh MH, Niknam R, Sivandzadeh GR. Organic colonic lesions in patients with irritable bowel syndrome: A comparative study. Rev Gastroenterol Mex (Engl Ed) 2023; 88:208-213. [PMID: 35906157 DOI: 10.1016/j.rgmxen.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIMS Any alarm symptoms in patients with irritable bowel syndrome (IBS) should be carefully evaluated. Colonoscopy is a standard diagnostic procedure for evaluating the colonic mucosa and ruling out probable diseases responsible for patient symptoms. We analyzed the colonoscopy findings in patients with and without IBS. MATERIAL AND METHODS Ninety-six patients with IBS and 101 without IBS were consecutively enrolled in the study. All the patients in the IBS group met the Rome IV criteria, and underwent colonoscopy due to the appearance of red flags. The colonoscopy findings were compared between the 2 groups of patients. RESULTS The main indications for colonoscopy in the IBS group were progressive abdominal pain (36.7%), rectal bleeding with fresh blood (17.7%), and occult blood in stool (12.5%). In the non-IBS group, the most prevalent indicators were rectal bleeding with fresh blood (37.6%), colorectal cancer surveillance (21.8%), and abdominal pain (13.9%). The most common macroscopic findings in the 2 groups were hemorrhoids, polyps, and anal fissure. There were no statistically significant differences with respect to the microscopic and macroscopic findings between groups. CONCLUSIONS We concluded that the prevalence of organic lesions in the colon of patients with IBS was the same as that in the patients without IBS. The Rome IV criteria accurately predicted IBS. Additional evaluation through colonoscopy in IBS should be based on the presence of alarm features.
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Affiliation(s)
- F Ejtehadi
- Centro de Investigación en Gastroenterohepatología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
| | - M H Anbardar
- Departamento de Patología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
| | - M H Imanieh
- Centro de Investigación en Gastroenterohepatología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran.
| | - R Niknam
- Centro de Investigación en Gastroenterohepatología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
| | - G R Sivandzadeh
- Centro de Investigación en Gastroenterohepatología, Universidad de Ciencias Médicas de Shiraz, Shiraz, Iran
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Ejtehadi F, Safarpour AR, Nemati R, Aminlari L, Zare E, Sivandzadeh GR, Niknam R. Impact of Multimedia CD Education on the Quality of Colon Preparation; A Single-Blind Randomized Study. Middle East J Dig Dis 2022; 14:431-436. [PMID: 37547506 PMCID: PMC10404098 DOI: 10.34172/mejdd.2022.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/19/2022] [Indexed: 08/08/2023] Open
Abstract
Background: Routine bowel preparation instructions are usually given to patients in the form of oral explanations with written instructions. The purpose of this study was to evaluate the effectiveness of multimedia training in the form of video CDs on the quality of colon preparation and other related indicators. Methods: 201 outpatients in three referral academic colonoscopy centers were randomly assigned to two groups. The first group (n=100) received supplementary video CD education besides the routine instructions (VCD group). The second group (n=101) received only routine instruction, which included oral and printed instructions (non-VCD group). Results: Complete use of colon cleansing medication was statistically and significantly better in the VCD group (P=0.038). Duration of colonoscopy was shorter in the VCD group (P=0.001), demand for conscious sedation was lesser in the VCD group (P=0.049), and the quality of colon preparation was better in the VCD group (P<0.00). There was no statistically significant difference in pain sensation (P=0.1), cecal intubation rate (P=0.3), and technical difficulty of the colonoscopy (P=0.1) in both groups. Conclusion: Supplementary education in the form of multimedia CD increases the patients' compliance to cleansing mediation consumption, improves the quality of bowel preparation, and decreases the duration of colonoscopy with lesser demands for conscious sedation.
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Affiliation(s)
- Fardad Ejtehadi
- Gastroenterohepatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rasoul Nemati
- Gastroenterohepatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ladan Aminlari
- Gastroenterohepatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Zare
- Gastroenterohepatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ramin Niknam
- Gastroenterohepatology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
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Safarpour AR, Fattahi MR, Niknam R, Tarkesh F, Mohammadkarimi V, Boogar SS, Abbasi E, Abtahi F, Sivandzadeh GR, Ejtehadi F, Afshar M, Shamsnia SA, Niknejad N. Alarm of non-communicable disease in Iran: Kavar cohort profile, baseline and 18-month follow up results from a prospective population-based study in urban area. PLoS One 2022; 17:e0260227. [PMID: 35085244 PMCID: PMC8794109 DOI: 10.1371/journal.pone.0260227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023] Open
Abstract
The PERSIAN Kavar cohort study (PKCS) aims to investigate the prevalence, trends, and relevant prognostic risk factors of non-communicable diseases in participants aged 35-70 years living in the urban area of Kavar County. Kavar County is located at the center of Fars province in the southwest of Iran. Overall, 5236 adults aged 35-70 years old were invited to participate in the PKCS. From whom, 4997 people comprising 2419 men and 2578 women met the inclusion criteria and were recruited in the study (participation rate: 95.4%). This study is aimed to follow participants for at least 10 years; it is designed to perform all procedures similar to the primary phase including biological sampling, laboratory tests, physical examinations, and collecting general, nutritional, and medical data at the 5th and 10th years of follow-up. In addition, participants are annually followed-up by phone to acquire data on the history of hospitalization, any major diagnosis or death. At the enrollment phase, trained interviewers were responsible for obtaining general, nutritional, and medical data utilizing a 482-item questionnaire. The results of the baseline phase of this study show that the overweight category was the most prevalent BMI category among the registered participants (n = 2005, 40.14%). Also, almost one-third of Kavar adult population suffered from metabolic syndrome at the baseline phase (n = 1664, 33.30%). The rate of eighteen-month follow-up response was 100% in the PKCS. Hypertension (n = 116, 2.32%), cardiovascular outcomes (n = 33, 0.66%), and diabetes (n = 32, 0.64%) were the most prevalent new-onset NCDs during eighteen months of follow-up in the participants.
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Affiliation(s)
- Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Firoozeh Tarkesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Mohammadkarimi
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Sadeghi Boogar
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Abbasi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Firoozeh Abtahi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Afshar
- Kavar Health System Network, Kavar County, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Shamsnia
- Kavar Health System Network, Kavar County, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasim Niknejad
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
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Safarpour AR, Askari H, Ejtehadi F, Azarnezhad A, Raeis-Abdollahi E, Tajbakhsh A, Abazari MF, Tarkesh F, Shamsaeefar A, Niknam R, Sivandzadeh GR, Lankarani KB, Ejtehadi F. Cholangiocarcinoma and liver transplantation: What we know so far? World J Gastrointest Pathophysiol 2021; 12:84-105. [PMID: 34676129 PMCID: PMC8481789 DOI: 10.4291/wjgp.v12.i5.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023] Open
Abstract
Cholangiocarcinoma (CCA) is a type of cancer with increasing prevalence around the world that originates from cholangiocytes, the epithelial cells of the bile duct. The tumor begins insidiously and is distinguished by high grade neoplasm, poor outcome, and high risk for recurrence. Liver transplantation has become broadly accepted as a treatment option for CCA. Liver transplantation is expected to play a crucial role as palliative and curative therapy for unresectable hilar CCA and intrahepatic CCA. The purpose of this study was to determine which cases with CCA should be subjected to liver transplantation instead of resection, although reported post-transplant recurrence rate averages approximately 20%. This review also aims to highlight the molecular current frontiers of CCA and directions of liver transplantation for CCA.
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Affiliation(s)
- Ali Reza Safarpour
- Department of Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Hassan Askari
- Department of Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Farshid Ejtehadi
- The Princess Alexandra Hospital HNS Trust, Harlow, Essex CM20 1QX, United Kingdom
| | - Asaad Azarnezhad
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617913446, Iran
| | - Ehsan Raeis-Abdollahi
- Department of Basic Medical Sciences, Qom Medical Branch, Islamic Azad University, Qom, Iran
| | - Amir Tajbakhsh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Mohammad Foad Abazari
- Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran 1417653761, Iran
| | - Firoozeh Tarkesh
- Department of Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Alireza Shamsaeefar
- Shiraz Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz 7193711351, Iran
| | - Ramin Niknam
- Department of Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Gholam Reza Sivandzadeh
- Department of Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | | | - Fardad Ejtehadi
- Department of Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
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11
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Sivandzadeh GR, Askari H, Safarpour AR, Ejtehadi F, Raeis-Abdollahi E, Vaez Lari A, Abazari MF, Tarkesh F, Bagheri Lankarani K. COVID-19 infection and liver injury: Clinical features, biomarkers, potential mechanisms, treatment, and management challenges. World J Clin Cases 2021; 9:6178-6200. [PMID: 34434987 PMCID: PMC8362548 DOI: 10.12998/wjcc.v9.i22.6178] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/07/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
It is hypothesized that liver impairment caused by coronavirus disease 2019 (COVID-19) infection might play a central role in severe clinical presentations. Liver injury is closely associated with severe disease and, even with antiviral drugs, have a poor prognosis in COVID-19 patients. In addition to the common hepatobiliary disorders caused by COVID-19, patients with pre-existing liver diseases demand special considerations during the current pandemic. Thus, it is vital that upon clinical presentation, patients with concurrent pre-existing liver disease associated with metabolic dysfunction and COVID-19 be managed properly to prevent liver failure. Careful monitoring and early detection of liver damage through biomarkers after hospitalization for COVID-19 is underscored in all cases, particularly in those with pre-existing metabolic liver injury. The purpose of this study was to determine most recent evidence regarding causality, potential risk factors, and challenges, therapeutic options, and management of COVID-19 infection in vulnerable patients with pre-existing liver injury. This review aims to highlight the current frontier of COVID-19 infection and liver injury and the direction of liver injury in these patients.
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Affiliation(s)
- Gholam Reza Sivandzadeh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
| | - Hassan Askari
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
| | - Ehsan Raeis-Abdollahi
- Department of Medical Sciences, Qom Medical Branch, Islamic Azad University, Qom 1417613151, Iran
| | - Armaghan Vaez Lari
- Department of Physiology, School of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz 6135715794, Iran
| | - Mohammad Foad Abazari
- Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran 1417653761, Iran
| | - Firoozeh Tarkesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
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12
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Ejtehadi F, Sivandzadeh GR, Hormati A, Ahmadpour S, Niknam R, Pezeshki Modares M. Timing of Emergency Endoscopy for Acute Upper Gastrointestinal Bleeding: A Literature Review. Middle East J Dig Dis 2021; 13:177-185. [PMID: 36606214 PMCID: PMC9489462 DOI: 10.34172/mejdd.2021.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/02/2021] [Indexed: 01/07/2023] Open
Abstract
Upper gastrointestinal (GI) bleeding is a common cause for Emergency Department and hospital admissions and has significant mortality and morbidity if it remains untreated. Upper endoscopy is the key procedure for both diagnosis and treatment of acute upper GI bleeding. The aim of this article is to review the optimal timing of endoscopy in patients with acute upper GI bleeding. The cost-effectiveness and the influence of urgent or emergent endoscopy on patients' outcomes are discussed. Also, we compare and contrast the available evidence and guidelines regarding the recommended time points for performing endoscopy in different clinical settings.
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Affiliation(s)
- Fardad Ejtehadi
- Associate Professor of Medicine, Gastroentrohepatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Reza Sivandzadeh
- Assistant Professor of Medicine, Gatroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,Corresponding Author: Gholam Reza Sivandzadeh, MD Department of Internal Medicine, Gasteroenetrohepatology Research Center, Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Namazi Hospital, Zand St., Shiraz, 7193711351, Fars, Iran. Tel: + 98 711 6473236 Fax: + 98 711 6474316
| | - Ahmad Hormati
- Assistant professor of Gastroenterology, Gastrointestinal and Liver Diseases Research Center, Firozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sajjad Ahmadpour
- Assistant Professor of Radiopharmacy, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ramin Niknam
- Associate Professor of Medicine, Gatroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Pezeshki Modares
- Assistant professor of Gastroenterology, Gastrointestinal and Liver Diseases Research Center, Firozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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13
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Asl AA, Lankarani KB, Nikeghbalian S, Kazemi K, Shamsaieefar A, Alizade-Naini M, Fattahi MR, Taghavi SA, Niknam R, Ejtehadi F, Dehghan M, Sivandzadeh G, Ghahramani S, Malek-Hosseini SA. Post liver transplant complications of Budd-Chiari syndrome. Indian J Gastroenterol 2021; 40:281-286. [PMID: 33743161 DOI: 10.1007/s12664-020-01139-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 12/14/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND/PURPOSE Budd-Chiari syndrome (BCS) is a rare, life-threatening disease characterized by hepatic venous outflow obstruction. Liver transplantation (LT) is widely accepted as an effective therapeutic measure for irreversible liver failure due to BCS. There is debate on differences in the post LT course and complications in patients with BCS as compared to non-Budd-Chiari (NBC) patients. METHOD In this retrospective study, data on all patients who received a liver transplant for BCS at the Shiraz Organ Transplantation Center between January 1996 and September 2017 were reviewed and compared to data of a control group who had received liver transplants over the same period but due to other causes (NBC). RESULTS Out of 4225 patients who received liver transplants in the study period, 108 had BCS and an age- and gender-matched control group consisted of 108 NBC cases. The mean ± standard deviation (SD) of model for end-stage liver disease (MELD) scores were 19.1 ± 3 and 20 ± 3 for BCS and NBC groups, respectively (p = 0.33). One-, 3-, 5-, and 10-year survival rates in the BCS group were as follows: 82%, 78%, 76%, and 76% compared with the NBC rates of 83%, 83%, 83%, and 76%, respectively (p = 0.556). There was no difference between the two groups in complication rates after 6 months. In the later period, vascular thrombosis was more common in BCS. CONCLUSIONS Whole-organ LT from deceased donors in patients with BCS had comparable outcomes with LT due to other causes of end-stage liver disease. In most instances, these patients should receive lifelong anticoagulation.
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Affiliation(s)
- Ali Ansari Asl
- Shiraz Transplant Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Kamran B Lankarani
- Health Policy research center, School of Medicine, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran.
| | - Saman Nikeghbalian
- Shiraz Transplant Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Koroush Kazemi
- Shiraz Transplant Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Alireza Shamsaieefar
- Shiraz Transplant Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Mahvash Alizade-Naini
- Gastroenterohepatology Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Mohamad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Seyed Alireza Taghavi
- Gastroenterohepatology Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Masood Dehghan
- Shiraz Transplant Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Gholamreza Sivandzadeh
- Gastroenterohepatology Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
| | - Sulmaz Ghahramani
- Health Policy research center, School of Medicine, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Seyed Ali Malek-Hosseini
- Shiraz Transplant Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran
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14
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Ejtehadi F, Zare E, Shamsaeefar A, Nikeghbalian S, Kazemi K, Nikoupour H, Eghlimi H, Motazedian N, Moghadami M, Malekhosseini SA. Clinical Outcome of Vancomycin-Resistant Enterococcus Colonization Among Liver Transplant Recipients at Shiraz Organ Transplant Center. EXP CLIN TRANSPLANT 2021; 19:806-810. [PMID: 33663359 DOI: 10.6002/ect.2020.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Liver transplant recipients are more susceptible to vancomycin-resistant enterococci colonization than healthy individuals. We investigated the prevalence of vancomycin-resistant enterococci colonization and its effect on the outcomes of liver transplant recipients. MATERIALS AND METHODS Patients who had undergone primary liver transplant at the Shiraz Organ Transplant Center from 2015 to 2017 were enrolled in this study. Demographic characteristics, laboratory test results, duration of stay in the intensive care unit, total duration of hospital stay, and clinical outcome data were extracted from the Shiraz Organ Transplant Center database. Posttransplant outcomes such as graft rejection, mortality, hospital stay, and kidney function tests were included for the first 90 days after transplant. RESULTS A total of 753 liver transplant recipients (470 males and 283 females) were included in this study. Vancomycin-resistant enterococci colonization was identified in 51 patients (6.8%) after transplant at the time of intensive care unit admission. Our study found no significant difference between outcomes for patients with vancomycin-resistant enterococci colonization and outcomes for patients without colonization, including graft rejection, mortality, hospital stay, and kidney function tests. CONCLUSIONS Our study revealed that asymptomatic vancomycin-resistant enterococci colonization in liver transplant patients has no adverse effect on the duration of posttransplant hospital stay, early mortality rate, graft rejection rate, or kidney function compared with noncolonized patients.
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Affiliation(s)
- Fardad Ejtehadi
- From the Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Ejtehadi F, Pashaei MR, Shamsaeefar A, Motazedian N, Sivandzadeh GR, Niknam R, Malekhosseini SA, B Lankarni K. Tenofovir in the treatment of hepatitis B virus infection after liver transplantation, a single center large population study. Gastroenterol Hepatol Bed Bench 2021; 14:154-159. [PMID: 33968342 PMCID: PMC8101521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM This study investigated the safety and efficacy of tenofovir disoproxil fumarate (TDF) compared with lamivudine (LAM) in the prevention of recurrent HBV infection after liver transplantation (LT). BACKGROUND Although the recurrence of hepatitis B virus after liver transplantation (LT) is now very uncommon with both nucleoside and nucleotide analogs represented with lamivudine and tenofovir disoproxil fumarate, respectively, few studies have compared the two classes. METHODS A total of 302 HBV-related post-transplant patients who received liver transplants from deceased donors were enrolled in this retrospective study from 2011 to 2015 in the Shiraz Organ Transplant Center, Iran. The demographic data, kidney function, recurrence, resistance rate, and acute rejections at 1-, 6-, and 12-month intervals and after 12 months were compared on TDF (n=209) and lamivudine (n=93) groups. RESULTS During a median follow-up period of 42.9 months, mean creatinine level was not significantly different between the two groups. Hepatitis B virus recurrence rate as well as acute graft rejection episode had no statistical difference in either group over the study period. CONCLUSION Kidney function, creatinine level, disease recurrence, and acute graft rejection were comparable between tenofovir disoproxil fumarate and lamivudine in patients who received follow-up periods.
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Affiliation(s)
- Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Shamsaeefar
- Shiraz Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Motazedian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Reprint or Correspondence: Nasrin Motazedian, MD. Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail: , ORCID ID: 0000-0001-9534-4014
| | | | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Kamran B Lankarni
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Chorami M, Lankarani KB, Ejtehadi F, Malek-Hosseini SA, Moini M. Hepatitis E Virus Seroprevalence Among Liver Transplant Recipients with Persistent Elevation of Liver Enzymes: A Single Center Report. Arch Iran Med 2021; 24:22-26. [PMID: 33588564 DOI: 10.34172/aim.2021.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic hepatitis E infection has been reported in solid organ transplant recipients following acute hepatitis due to the compromised immune status. Almost all reports are from areas where hepatitis E virus (HEV) genotypes 3 and 4 are the dominant genotypes. This study was conducted to investigate the role of hepatitis E infection as an etiology for liver enzymes elevation in liver transplant recipients from the largest liver transplant program in Iran. METHODS In a prospective study from June to December 2015, in a single liver transplantation center in Iran, all adult liver recipients who were investigated for the etiology of persistent elevation of liver enzymes were tested for HEV serology status. RESULTS Of 122 patients included in the study, 19 (15.6%) were positive for HEV serology. Seropositive patients were significantly older than seronegative ones (mean age 43.79 vs. 31.58, P < 0.001); however, they were not different in other characteristics including sex distribution and mean of liver enzymes in each occasion. Liver biopsies were done in 16 HEV seropositive patients and none of the biopsies showed evidence for acute or chronic viral hepatitis. CONCLUSION In this study, with 15.6% rate of HEV seropositivity in liver recipients with persistent elevation of liver enzymes, we were not able to confirm any clinical evidence for active acute or chronic hepatitis E infection. This could theoretically be attributed to the fact that the dominant prevalent HEV genotype in our endemic area is not associated with a chronic form of infection.
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Affiliation(s)
- Maryam Chorami
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Moini
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Canada
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17
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Babaei A, Taghavi SA, Mohammadi A, Mahdiyar MA, Iranpour P, Ejtehadi F, Mohagheghzadeh A. Comparison of the efficacy of oral fenugreek seeds hydroalcoholic extract versus placebo in nonalcoholic fatty liver disease; a randomized, triple-blind controlled pilot clinical trial. Indian J Pharmacol 2020; 52:86-93. [PMID: 32565595 PMCID: PMC7282687 DOI: 10.4103/ijp.ijp_17_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 09/11/2019] [Accepted: 04/14/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this study is to investigate the therapeutic property of hydroalcoholic extract of Fenugreek seeds in nonalcoholic fatty liver disease (NAFLD) in adult patients. METHODS This randomized, placebo-controlled, parallel trial was conducted from November 2014 to June 2017. Patients aged between 18 and 70 years old with confirmed NAFLD were recruited from the Motahhari clinic, affiliated to Shiraz University of Medical Sciences, Iran. Participants either received 1 g hydroalcoholic extract of Fenugreek seeds or placebo daily for 3 months. The primary outcomes were changes in serum alanine transaminase and FibroScan controlled attenuation parameter score. Secondary outcome measures were changes in other laboratory data, liver stiffness measure, liver steatosis percent, and anthropometric variables. Participants were randomly assigned to the groups using blocked randomization method. Participants, investigators, and statistician were blinded to treatments allocation. RESULTS After screening eighty patients, thirty patients met the inclusion criteria and were divided into two groups (1:1). After 3 months, two and four patients did not complete the trial in Fenugreek and placebo group, respectively. The changes in the anthropometrics, laboratories and FibroScan measurements were not statistically significant between the two groups. CONCLUSION The evidence to prove the efficacy of the Fenugreek seeds' hydroalcoholic extract in NAFLD was not strong enough; hence, further experiments are still needed to assess the possible efficacy of Fenugreek on the treatment of NAFLD.
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Affiliation(s)
- Amirhossein Babaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Alireza Taghavi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Pooya Iranpour
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolali Mohagheghzadeh
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
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18
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Bagheri Lankarani K, Sivandzadeh GR, Zare M, Nejati M, Niknam R, Taghavi AR, Ejtehadi F, Naini MA, Moini M, Anbardar MH, Peymani P. A preliminary report on the use of Midodrine in treating refractory gastroesophageal disease: Randomized Double-Blind Controlled Trial. Acta Biomed 2020; 91:70-78. [PMID: 32191657 PMCID: PMC7569571 DOI: 10.23750/abm.v91i1.8486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023]
Abstract
Background: Gastroesophageal reflux disease (GERD) is a common disease with various clinical presentations. Acid suppression with proton pump inhibitors and lifestyle modification may not lead to satisfactory response in a substantial portion of patients. We investigated the possible effect of midodrine in patients with refractory GERD. Methods: Patients suffering from GERD and were refractory to one-month course of pantoprazole 40mg twice daily entered the study. This was a pilot, randomized, double-blind, and placebo-controlled study. After randomization, one group received Midodrine 5mg before meals for one month, and the other group received placebo for the same period. Meanwhile, pantoprazole was continued 40mg twice daily in both arms. The severity of symptoms was evaluated by the visual scoring system. Quality of life (QoL) in both groups was measured using a standardized version of Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD). Results: A total of twenty patients were enrolled in this study. There was a significant interaction between the groups and time on all measured scores based on QOLRAD questionnaire. All the markers in the Midodrine group had significant improvement over time, but the placebo group did not show any significant improvement. Both visual severity score and total QoL score in Midodrine arm showed a U shape change during 6 weeks. Conclusions: Midodrine before a meal could be useful in alleviating symptoms and improving QoL in the patients with refractory gastroesophageal disease. (www.actabiomedica.it)
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Affiliation(s)
| | | | - Marziyeh Zare
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences.
| | | | | | | | | | | | | | | | - Payam Peymani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran..
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19
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Sepehrimanesh M, Niknam R, Ejtehadi F, Fattahi MR, Safarpour A. Association Between Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome with Gallstone Disease, South Iran: A Population-Based Study. Diabetes Metab Syndr Obes 2020; 13:1449-1458. [PMID: 32431528 PMCID: PMC7200259 DOI: 10.2147/dmso.s246949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022] Open
Abstract
AIM Gallstone disease (GSD), non-alcoholic fatty liver disease (NAFLD), and metabolic syndrome (MetS) are common problems. The aim of this study was to investigate the association between NAFLD, MetS and its components with GSD. MATERIALS AND METHODS This cross-sectional study was conducted as a part of the Kavar Cohort Study (KCS) affiliated to Shiraz University of Medical Sciences, Shiraz, Iran between January 2012 and January 2018. A total of 2239 participants of the general population of the KCS were selected randomly. Ultrasonography for GSD and NAFLD diagnosis and clinical and laboratory assaying for MetS evaluation were performed for the participants. The National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) and Criteria for Clinical Diagnosis of MetS in Iranian Adults (CCDMIA) were used for diagnosis of MetS. RESULTS Overall, 59 patients with GSD and 177 age- and sex- matched participants without gallstones as a comparison group were enrolled. According to GSD groups, NAFLD was observed in 42.4% and 22.6% of patients with and without GSD, respectively, and the difference between the two groups was statistically significant (P = 0.003). MetS was present in 33.9% and 39.0% of GSD subjects, compared with 32.8% and 33.3% of the non-GSD group, based on NCEP/ATPIII and CCDMIA, respectively. Although the mean of all components of MetS except HDL-cholesterol were higher in the GSD group than in the non-GSD group, the difference was only significant in waist circumference (P = 0.041). CONCLUSION The present study found an obvious association between NAFLD and GSD. This study also showed a significant association between increasing waist circumference and risk of GSD. We recommend that patients with GSD should be evaluated for the likelihood of NAFLD and its treatment in addition to lifestyle changes to gain proper weight. However, further researches are needed to clarify the relationship between the nature of GSD, NAFLD, and obesity.
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Affiliation(s)
- Masood Sepehrimanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Niknam R, Moradi J, Jahanshahi KA, Mahmoudi L, Ejtehadi F. Association Between Metabolic Syndrome and Its Components with Severity of Acute Pancreatitis. Diabetes Metab Syndr Obes 2020; 13:1289-1296. [PMID: 32425564 PMCID: PMC7187863 DOI: 10.2147/dmso.s249128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/31/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) and metabolic syndrome (MetS) are common clinical problems with serious complications and high cost of treatment. The relationship between MetS and severity of AP is unknown, and because there are very few published articles, further studies had been recommended. Therefore, we designed this study to estimate the association between MetS and its components with AP severity. PATIENTS AND METHODS In this prospective analytical cross-sectional study, all AP patients who referred to two referral hospitals affiliated with Shiraz University of Medical Sciences between 2016 and 2019 were evaluated. The diagnosis of MetS syndrome as well as follow-up of patients for evaluation of severity and outcome of AP was performed in all enrolled patients. National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) was used for diagnosis of MetS. Bedside Index for Severity in Acute Pancreatitis (BISAP) and revised Atlanta classification (RAC) were used to estimate the severity of AP. Finally, the association between MetS syndrome and its components at different AP severities was compared. RESULTS Of the 214 patients referred to our center, a total of 76 patients with AP were included in this study. Of the included patients, 40 (52.6%) were male and 36 (47.4%) were female. Frequency of patients in Mets and non-MetS groups was 34 (44.74%) and 42 (55.26%), respectively. The gender and mean age difference between Mets and non-MetS groups were not statistically significant. According to Mets groups, 25 (73.5%) and 9 (26.5%) AP patients with MetS had BISAP score of 0-2 and 3-5, respectively. BISAP score in MetS group was significantly higher than non-MetS group (P = 0.022). Overall, 20 (58.8%), 11 (32.4%), and 3 (8.8%) of AP patients with MetS had mild, moderately severe, and severe AP based on RAC, respectively. Severe RAC was significantly higher in the MetS group than in the non-MetS group (P = 0.029). The frequency of complications in MetS group was significantly higher than in non-MetS group (P= 0.008). The length of hospital stay was also significantly higher in the MetS group than in the non-MetS group (P = 0.001). Overall, three patients died, two of whom had MetS and all had severe RAC and BISAP 3-5. Waist circumference, fasting blood sugar, and triglyceride were significantly higher in the severe and moderately severe types of AP group than in the mild AP group, according to RAC. Although, mean of all components of MetS except HDL-cholesterol were higher in BISAP of 3-5 group than BISAP of 0-2 group, the difference was only significant in waist circumference. CONCLUSION The present study showed that there was a significant association between the rate of MetS and its components including waist circumference, hyperglycemia and hypertriglyceridemia with increasing AP severity. This study showed that the incidence of more severe AP in patients with MetS is much higher than in patients without MetS. We recommend that the new studies with larger sample sizes are conducted with careful consideration of confounding factors to investigate the relationship between the severity of MetS and AP as well as the effect of MetS treatment on the nature of AP.
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Affiliation(s)
- Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Moradi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Fardad Ejtehadi Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IranTel +98 917 113 4391Fax +98 713 628 1442 Email
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Birdi H, Kapila A, Tharmaratnam M, Davies N, Patel K, Ejtehadi F, Srinivasaiah N. Two week wait referrals of suspected colorectal cancer in young adults before and after UK NICE [NG12] guideline publication. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Modares Mousavi SR, Geramizadeh B, Anushiravani A, Ejtehadi F, Anbardar MH, Moini M. Correlation between Serum Ferritin Level and Histopathological Disease Severity in Non-alcoholic Fatty Liver Disease. Middle East J Dig Dis 2018; 10:90-95. [PMID: 30013757 PMCID: PMC6040928 DOI: 10.15171/mejdd.2018.96] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/09/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. Recently several parameters, such as serum ferritin, have emerged as possible predictors for the severity of NAFLD and insulin sensitivity. We aimed to investigate the value of serum ferritin level as a useful biomarker for the prediction of histopathological disease severity in non-alcoholic steatohepatitis (NASH), the necro-inflammatory form of NAFLD. METHODS This was a prospective cross sectional study in which demographic, clinical, histological, laboratory, and anthropometric data of 30 adult patients with biopsy-proven NAFLD/NASH were analyzed. RESULTS In our patients population with mean age of 37.9 years and mean BMI of 26.5, statistical analysis did not show a significant difference between the three grades of steatosis in the mean ferritin levels (p = 0.559). It was also observed that ferritin level did not have a significant correlation with the stage of fibrosis (p = 0.228). The mean transferrin saturation did not show significant difference in different stages and grades of NASH (p = 0.260 and 0.944, respectively), either. CONCLUSION Serum ferritin level may not be useful as a single marker for the prediction of histopathological severity of disease in young patients with NASH who are not morbidly obese.
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Affiliation(s)
- Seyed Reza Modares Mousavi
- Division of Gastroenterology, Department of Internal Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Anushiravani
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Moini
- Non-communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Taghavi SA, Niknam R, Alavi SE, Ejtehadi F, Sivandzadeh GR, Eshraghian A. Anatomical Variations of the Biliary Tree Found with Endoscopic Retrograde Cholagiopancreatography in a Referral Center in Southern Iran. Middle East J Dig Dis 2017; 9:201-205. [PMID: 29255577 PMCID: PMC5726332 DOI: 10.15171/mejdd.2017.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND
Anatomical variations in the biliary system have been proven to be of clinical importance. Awareness of the pattern of these variations in a specific population may help to prevent and manage biliary injuries during surgical and endoscopic procedures. Knowledge of the biliary anatomy will be also of great help in planning the drainage of adequate percentage of liver parenchyma in endoscopic or radiological procedures.
METHODS
All consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) from April 2013 to April 2015 at Nemazee Hospital, a referral center in the south of Iran, were included in this cross-sectional study. The patients with previous hepatic or biliary surgery, liver injury or destructive biliary disease were excluded from the study. All ERCPs were reviewed by two expert gastroenterologists in this field. The disagreed images by the two gastroenterologists were excluded. Huang classification was used for categorizing the different structural variants of the biliary tree, and the frequency of each variant was recorded.
RESULTS
Totally, 362 patients (181 men and 181 women) were included in the study. 163 patients (45%)
had type A1 Huang classification (right dominant), which was the most prevalent type among our
patients. 55% of them had non-right dominant anatomy. The result of the Chi-square test revealed
that there was no statistically significant difference between the men and women regarding the
anatomical variations (p = 0.413).
CONCLUSION
The anatomical variation in the biliary system among Iranian patients is comparable to other
regions of the world. Significant proportions of our patients are non-right dominant and may need
bilateral biliary drainage.
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Affiliation(s)
- Seyed Alireza Taghavi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ehsan Alavi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ahad Eshraghian
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ejtehadi F, Fattahi MR, Safaei A, Safarpour AR, Bananzadeh A. Practical Lessons from the Small Bowel Bleeding Lesions: A Case Report on Small Bowel Cavernous Hemangioma. Iran J Med Sci 2017; 42:108-110. [PMID: 28293061 PMCID: PMC5337759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Fardad Ejtehadi
- Gastroenterohepathology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Therapeutic Endoscopy and Advanced ERCP Ward, Department of Gastroenterology and Hepatology, Department of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepathology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Therapeutic Endoscopy and Advanced ERCP Ward, Department of Gastroenterology and Hepatology, Department of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Akbar Safaei
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Reza Safarpour
- Gastroenterohepathology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alimohammad Bananzadeh
- Colorectal Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Alimohammad Bananzadeh, MD; Colorectal Research Center, Shahid Faghihi Hospital, Zand Blvd., Shiraz, Iran Tel: +98 917 1118242 Fax: +98 71 32330724
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Mahmoudi L, Farshad S, Seddigh M, Mahmoudi P, Ejtehadi F, Niknam R. High efficacy of gemifloxacin-containing therapy in Helicobacter Pylori eradication: A pilot empirical second-line rescue therapy. Medicine (Baltimore) 2016; 95:e4410. [PMID: 27759625 PMCID: PMC5079309 DOI: 10.1097/md.0000000000004410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Helicobacter pylori (H pylori) is a common gastric pathogen which is associated with chronic gastritis, peptic ulcer, and gastric cancer. It has worldwide distribution with higher incidence in developing countries. Gemifloxacin is a fluoroquinolone antibiotic with documented in vitro activity against H pylori. Considering that there is no clinical data to verify gemifloxacin efficacy in H pylori eradication, this pilot clinical trial was designed. METHODS This prospective pilot study was performed during February 2014 to February 2015. A regimen of gemifloxacin (320 mg single dose) plus twice daily doses of amoxicillin1g, bismuth 240 mg, and omeprazole 20 mg for 14 days were prescribed for H pylori infected patients in whom a first-line standard quadruple therapy (clarithromycin-amoxicillin-bismuth-omeprazole) had failed. To confirm H pylori eradication a 13C-urea breath test was performed 4 weeks after treatment.Compliance and incidence of adverse effects were evaluated by questionnaires. RESULTS A total of 120 patients were enrolled consecutively; out of which 106 patients achieved H pylori eradication; per-protocol and intention-to-treat eradication rates were 91.4% (95% CI: 85.5-97.6) and 88.3% (95% CI: 75.4-92.4) respectively. Three patients (2.5%) failed to take at least 80% of the drugs and excluded from the final analysis. Adverse effects were reported in 42% of patients, most commonly including nausea (15%) and diarrhea (13.3%), which was intense in 1 patient and led to the discontinuation of treatment. In total, 96.7% (116/120) of the patients took the medications correctly. CONCLUSION This study revealed that gemifloxacin-containing quadruple therapy provides high H pylori eradication rate (≥90% PP cure rate), and this agent can be included in the list of second-line H pylori therapeutic regimens.
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Affiliation(s)
- Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran and Pharmaceutical Science Research Center (PSRC), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz
| | - Shohreh Farshad
- Professor Alborzi Clinical Microbiology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Seddigh
- Pharmaceutical Science Research Center (PSRC), School of Pharmacy
| | - Paria Mahmoudi
- Pharmaceutical Science Research Center (PSRC), School of Pharmacy
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Ramin Niknam and Fardad Ejtehadi, Gastroenterohepatology Research Center (GEHRC), Research Tower, Namazi Hospital, Zand Avenue, Shiraz City, Fars Province, Iran (e-mails: @sums.ac.ir [RN]; [FE])
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Ramin Niknam and Fardad Ejtehadi, Gastroenterohepatology Research Center (GEHRC), Research Tower, Namazi Hospital, Zand Avenue, Shiraz City, Fars Province, Iran (e-mails: @sums.ac.ir [RN]; [FE])
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Abstract
Pancreatic stent proximal migration is a well known complication of pancreatic duct stenting, which occurs in about 5-6% of cases. Serious complications should be avoided by retrieval of the stent via different endoscopic techniques. We report a new technique previously reported only once (in a pancreatic duct with underlying pathology), to remove the proximally migrated pancreatic stent in a normal pancreatic duct by SpyGlass Direct Visualization System (Boston Scientific, Natick, Massachusetts, USA) and SpyBite Forceps (Boston Scientific, Natick, Massachusetts, USA)
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Affiliation(s)
- Aliraza Rahimi
- Therapeutic Endoscopy and Advanced ERCP Ward, Namazi Hospital, Gastroenterology and Hepatology Section, Internal Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fardad Ejtehadi
- Therapeutic Endoscopy and Advanced ERCP Ward, Namazi Hospital, Gastroenterology and Hepatology Section, Internal Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Peptic ulcer disease is a common illness, affecting a considerable number of people worldwide, and its occurrence can be influenced by environmental and genetic factors. Heat shock proteins (HSPs) function mostly as molecular chaperones, and are induced by various stresses. The A to G transition at position 1267 of the HSPA1B gene was shown to correlate with changes in the level of HSPA mRNA expression. Here, the relation between A1267G polymorphism of the HSPAIB gene and risk of peptic ulcer in the Iranian population was evaluated. One hundred subjects, who underwent gastroscopy, took part in the study. DNA samples extracted from the biopsy tissues were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). After gastroscopy, peptic ulcer was diagnosed for 50 patients; among them the distribution of AA/AB/BB genotypes was 10, 88 and 2%, respectively. As for the other 50 subjects (without peptic ulcer) included in the control group, the AA/AB/BB genotypes were identified as 40, 52 and 8%, respectively. A significant association was found between the HSPA1B genotype and peptic ulcer (6.76 OR; 95% CI, 2.26-20.2; p = 0.0006). Thus, the HSPA1B A1267G polymorphism may be a marker of susceptibility to peptic ulcer.
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Ejtehadi F, Ejtehadi F, Teb JC, Arasteh MM. A safe and practical decontamination method to reduce the risk of bacterial colonization of ultrasound transducers. J Clin Ultrasound 2014; 42:395-398. [PMID: 24615794 DOI: 10.1002/jcu.22142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 11/01/2013] [Accepted: 01/27/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Hospital-acquired infections is a major concern affecting patient management, in which medical instruments and devices play an important role. The purpose of this study was to determine the degree of bacterial contamination of the sonographic probe and describe an effective, safe, and practical decontamination method. METHODS The study's sample consisted of 50 patients. Cultures were taken from the probe surface both after each examination and after the probes had been wiped clean with a dry, nonsterile paper towel. Cultures were also taken randomly from the coupling gel. RESULTS Initial cultures were positive in 49 cases (98%) for aerobic and in 26 cases (52%) for anaerobic bacteria. Cultures obtained after cleaning the probe were positive in only 21 cases (42%) for aerobic and in 12 cases (24%) for anaerobic bacteria. The most common bacteria isolated in the aerobic cultures were Streptococcus aureus and Staphylococcus epidermidis, and in the anaerobic cultures were Peptococcus spp. and Peptostreptococcus spp. All cultures taken from the coupling gel were negative. CONCLUSIONS Sonographic probes may act as a medium for bacterial contamination and transmission. Cleaning of the probe with a dry, nonsterile paper towel is an easy, effective, low-cost, and device-friendly method that can reduce this risk.
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Affiliation(s)
- Farshid Ejtehadi
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
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Ejtehadi F, Anushiravani A, Bananzadeh A, Geramizadeh B. Gastrointestinal basidiobolomycosis accompanied by liver involvement: a case report. Iran Red Crescent Med J 2014; 16:e14109. [PMID: 25593711 PMCID: PMC4270646 DOI: 10.5812/ircmj.14109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/28/2013] [Accepted: 02/18/2014] [Indexed: 11/16/2022]
Abstract
Introduction: Basidiobolomycosis is a rare disease that, unlike other fungal infections, affects immunocompetent individuals. It is caused by an environmental saprophyte named the fungus Basidiobolus ranarum. Basidiobolomycosis usually appears as a subcutaneous infection. GI basidiobolomycosis is an emerging disease, and the colon is the most frequent involved part of the GI tract. Case Presentation: The present study presents a middle-aged lady suffered from basidiobolomycosis with concomitant lesions in the cecum and liver involvement. This disease is extremely rare in adults and only a few cases have been reported so far. Conclusions: GI basidiobolomycosis is a very rare disease which resembles as an infiltrative, infectious, or inflammatory process. Concomitant liver and bowel involvement is extremely rare too. It is an aggressive disease which has a high mortality rate despite treatments like surgical resection and prolonged antifungal therapy.
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Affiliation(s)
- Fardad Ejtehadi
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Amir Anushiravani
- Internal medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Alimohammad Bananzadeh
- Colorectal Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Alimohammad Bananzadeh, Colorectal Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7112331006, E-mail:
| | - Bita Geramizadeh
- Transplant Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Dabbaghmanesh M, Sadegholvaad A, Ejtehadi F, Omrani G. Persistence of goitre in children post-salt iodization in Islamic Republic of Iran: autoimmune status. East Mediterr Health J 2009. [DOI: 10.26719/2009.15.3.584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dabbaghmanesh MH, Sadegholvaad A, Ejtehadi F, Omrani GR. Persistence of goitre in children post-salt iodization in Islamic Republic of Iran: autoimmune status. East Mediterr Health J 2009; 15:584-590. [PMID: 19731774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We evaluated the prevalence of autoimmune thyroiditis in a random sample of 1188 schoolchildren aged 8-13 years with normalized iodine intake in the Islamic Republic of Iran. The prevalence of goitre was 39.6%; the majority had palpable but non-visible goitre. Of a subsample of 500 children, median urinary iodine excretion (18/8 microg/dL) indicated normal iodine intake. Thyroid peroxidase (TPO) antibody was positive in 3.7% of children and was significantly correlated with the prevalence of goitre and hypothyroidism. No correlation was seen between urinary iodine excretion and positive TPO antibody, mean TPO antibody, hypothyroidism or prevalence of goitre. Autoimmune thyroiditis explains some cases of goitre but other goitrogenic factors need to be evaluated.
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Affiliation(s)
- M H Dabbaghmanesh
- Department of Internal Medicine, Endocrine and Metabolism Research Centre, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran.
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Dabbaghmanesh MH, Sadegholvaad A, Ejtehadi F, Ranjbar-Omrani G. The role of iron deficiency in persistent goiter. Arch Iran Med 2008; 11:157-161. [PMID: 18298292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Iodine deficiency has been identified as a significant public health problem in Iran. The main strategy for controlling iodine deficiency was nationwide salt iodination. Over 10 years after starting this program, goiter is still endemic in school children. Iron deficiency may have interfered with the iodine intervention program. The objective of the present study was to evaluate the relationships between iron status, thyroid hormone profile, and the prevalence of goiter 11 years after implementation of the salt iodination program. METHODS In this study which was conducted in Marvdasht, Shiraz, 1188 students aged eight to 13 years were enrolled. Goiter was graded according to the classification by the World Health Organization (WHO). Serum concentrations of thyroid hormones and thyroid stimulating hormone were determined using commercial kits. The urinary iodine level was measured using the digestion method. RESULTS Goiter was endemic (39.6%); the majority of participants had grade 1 thyromegally. Despite the endemic status of goiter in southern Iran, the urine content of iodine reflected a normal iodine intake. The prevalence of iron deficiency was 16.4%. The iron-deficient patients had a significantly higher thyroid stimulating hormone level and lower free T4 concentrations than those with a normal serum ferritin level (P<0.001). CONCLUSION Iron supplementation may improve thyroid metabolism in children but we still have to investigate the role of other goitrogens in this area.
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Abstract
Selenium deficiency can have adverse effect on thyroid metabolism and response to iodine supplementation. The aim of this study was to determine relationship between prevalence of goiter, thyroid hormone profile, urinary iodine and serum selenium concentrations in Iranian schoolchildren. In a cross- sectional study, 1188 schoolchildren in the age group of 8-13 years were evaluated for goiter prevalence. Urine and serum samples were collected from 500 children and assayed for urinary iodine concentration, thyroid hormone profile and serum selenium concentration. The overall goiter prevalence was 39.6% and the median urinary iodine excretion, indicated to an adequate iodine intake. The mean serum selenium concentration was 119.1 +/- 31 mug/l with significant difference between boys and girls (108.4 +/- 26.2 mug/l vs 127.7 +/- 32.1 mug/l). An increase in free T4 concentration was observed in those with a lower selenium level and there was a significant relationship between the presence or absence of goiter and serum selenium concentration. Selenium supplementation may be an advisable measure to optimize thyroid hormone metabolism and decrease the prevalence of goiter in schoolchildren with low serum selenium concentration.
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