iradj maleki

 Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) marked by rectal and colon inflammation, leading to relapsing symptoms. Its prevalence is increasing, particularly in developed nations, impacting patients’ health. While its exact cause remains unclear, genetic and environmental factors are implicated, elevating the risk of colorectal cancer (CRC). Colectomy, though declining, is still performed in select UC cases, necessitating further study.

 We analyzed data from the Iranian Registry of Crohn’s and Colitis (IRCC) to examine UC patients undergoing colectomy. We collected demographic and clinical data from 91 patients, focusing on dysplasia. Statistical analyses assessed dysplasia risk factors.

 Patients with dysplasia were older at diagnosis and surgery compared to those without dysplasia. Age emerged as a significant risk factor for dysplasia in UC patients undergoing colectomy. No significant associations were found between dysplasia and other factors.

 Age plays a crucial role in dysplasia risk among UC patients undergoing colectomy. Older age at diagnosis and surgery may indicate a higher risk of dysplasia and CRC. Clinicians should consider age when managing UC patients and implementing screening protocols. Further research with larger samples is needed to confirm these findings.

Individuals with compromised immune systems are more susceptible to novel coronavirus (COVID-19), and data are limited on the relationship between opium and tobacco use and COVID-19 mortality.

This study aimed to determine the effect of opium and tobacco use, as well as the effect of different consumption intensities of these substances, on the outcomes of patients with COVID-19. Patients and

In this cross-sectional study, 900 patients with a clinical diagnosis of COVID-19 who were referred to Imam Khomeini Hospital in Sari, Iran, were reviewed. Data collection was conducted through the patient information registry system and telephone contact with patients or their companions. Statistical analysis was performed using SPSS 25 software. Chi-Square, Fisher's exact, and Mann-Whitney tests were used for comparisons between groups. A P-value of 0.05 or lower was considered statistically significant.

Death and systolic blood pressure were significantly higher (P = 0.023 and P = 0.01, respectively), and erythrocyte sedimentation rate was significantly lower in tobacco smokers (P = 0.046). Additionally, cardiovascular disease, pulmonary disease, and multiple co-morbidities were significantly higher in opioid users (P < 0.001, P = 0.004, and P = 0.014, respectively), and fatigue was significantly lower in the group that did not use opioids (P = 0.009). No statistically significant relationship was found in any of the subgroups of opioid and tobacco users in terms of death or discharge (P > 0.05).

In a global context where COVID-19 mutations are prevalent, any amount of tobacco and opium use should be considered a risk factor.

 Changes in the intestinal microbial flora may contribute to the occurrence and intensification of functional constipation (FC). Probiotics have shown promise as a potential alternative treatment for constipation.

 The main goal of this study is to assess the effects of an Iranian multispecies synbiotic supplement on FC.

 This randomized controlled trial (RCT) recruited 115 adult patients who met the Rome IV criteria for FC after fulfilling the inclusion criteria. They were randomly assigned to receive either psyllium (n = 57) or psyllium plus synbiotic (n = 58) daily for 4 weeks. The treatment response was evaluated based on changes in stool consistency (based on the Bristol scale), bloating severity, and constipation intensity (based on the Wexner Constipation Scoring System), and those with a partial to excellent response were considered treatment successes.

 The two groups did not differ in terms of sex, age, and BMI. The downward trend of stool consistency, bloating, as well as, constipation intensity was significant after 2 weeks of synbiotic-containing intervention. Treatment success after 4 weeks was 75.44% in the synbiotic group, compared to 30.91% in the psyllium-alone group (P < 0.001), indicating the superior efficiency of the synbiotic. Neither treatment exhibited adverse effects (P = 0.924), although psyllium was found to be less tolerable than the synbiotic (P = 0.026).

 Multispecies synbiotic intake for 4 weeks may be a promising treatment option for FC, given its striking favorable effects on constipation severity, safety, and tolerability.

Covid-19 is the name of the disease caused by the new SARS-Cov-2 virus. Thus far, numerous non-specific therapies have been employed for this viral infection, however, the majority of these medications have proven to be ineffective and have been correlated with a multitude of adverse effects for patients. Therefore, the use of medicinal plants has received a lot of attention. The current study aims to investigate the effects of the supplemental drug Curcumex on the healing process in outpatients with COVID-19.

The present study, which is a double-blind randomized controlled clinical trial, was conducted on outpatients with covid-19 which has the code of ethics number IR.MAZUMS.REC.1400.593 from Mazandaran University of Medical Sciences. The inclusion criteria for this study include patients who had a ground glass appearance in the CT scan of the chest, the presence of clinical symptoms such as dry cough, shortness of breath, fever, weakness, diarrhea, headache, runny nose, or having a history of contact with a corona patient or recent travel to High-risk areas and people who had a positive PCR result in the nasopharyngeal swab were defined. Curcumex is a new herbal medicine that contains a combination of black pepper, turmeric, and ginger. Black pepper is hot in nature and has astringent, anti-bloating, and digestive properties. Antioxidant and anti-inflammatory effects have been reported for this plant, which can be useful in COVID-19 disease. The sample size was equal to 60 people who were divided into 2 intervention and control groups of 30 people. Both groups received routine medications prescribed for outpatients. In addition to these treatments, one group received curcumex (containing 170 mg of ginger, 4 mg of black pepper, and 340 mg of turmeric) daily, and the control group received a placebo.

The results of the current study indicated that the average duration of all clinical symptoms measured in this study was significantly less in the intervention group than in the control group (shortness of breath: 2.13 days vs. 3.66 days; cough: 4 days vs. 7.6 days; Gastrointestinal symptoms: 0.73 days vs. 2.21 days and myalgia: 4.1 days vs. 9.2 days). Also, these results show that the average body temperature before the start of the intervention in the intervention group was 38.32 degrees Celsius and 38.17 degrees Celsius in the control group. This rate 5 day after the start of the study in the intervention group was significantly lower than the control group (37.46 degrees Celsius vs. 37.92). The average oxygen saturation before the intervention was 94.76% in the intervention group and 95.63% in the control group. This amount 5 day after the start of the study in the intervention group was significantly higher than the control group (97.16% vs. 96.1%) (Table 2). to the control group. The results of this study showed that the average number of lymphocytes after the intervention in the intervention group increased significantly compared to the control group (1544.46 in the intervention group and 1132.58 in the control group).

This study showed that daily consumption of Curcumex drug as a supplement along with other routine treatments of COVID-19 disease has a positive effect on the recovery process of the disease shortens the course of clinical symptoms, reduces inflammatory markers by a quarter, and corrects lymphopenia. The duration of clinical symptoms, including shortness of breath, cough, myalgia, and gastrointestinal symptoms in patients with COVID-19 who have been treated with Curcomex has significantly decreased. Furthermore, these results indicated that the recovery of fever and hypoxemia (decreased hemoglobin oxygen saturation) in the intervention group was faster than the placebo group and was significantly less than the group of patients who received a placebo.

Gastro-esophageal reflux disease (GERD) is a very common complaint. It is a major health concern and there is paucity of information about the epidemiology of the disease and its risk factors in Iran, especially Mazandaran province (North of Iran). This study aimed at investigating the prevalence of regurgitation and the factors associated with this condition in Tabari cohort study.

This was a cross-sectional study that analyzed data from Tabari cohort study. Information including the presence and frequency of heartburn and regurgitation, demographic characteristics, socioeconomic status, occupational history, history of chronic illnesses, history of alcohol and cigarette consumption were recorded.

The prevalence of GERD symptoms were 27.6% (20.4% in men, and 32.4% in women, p=0.0001). The frequency of typical symptoms was significantly higher in women than that in men. The risk of developing GERD symptoms were 1.7 times higher in women (p=0.0001). The highest prevalence of GERD symptoms was found in urban areas (41.8%, p=0.0001), in people with low educational levels (48%, p=0.0001), and in participants with history of depression symptoms (36.2%, p=0.0001). The prevalence of GERD symptoms was significantly high in individuals with higher BMI (29.5%, p=0.006), greater waist to hip ratio (29.1%, p=0.0001, p=0.0001), and high waist circumference (31.7%, p=0.0001).

This study showed gender, region of residence, educational level, and depression symptoms as the main risk factors for developing GERD symptoms.

 Celiac disease is an autoimmune disorder resulting from gluten consumption in genetically predisposed individuals. The present study investigated the epidemiological, endoscopic, and clinicopathological features of patients with celiac disease in the southern littoral of the Caspian sea.

140 patients with celiac disease were interviewed and examined regarding demographic characteristics, clinical symptoms, and serologic, endoscopic, and pathological findings.

44 (31.4%) of the patients were male and 68.6% were female. The mean age of the patients at diagnosis was 27.13±13.4 years (ranging from 2 to 60 years). The most common gastrointestinal symptoms were bloating (47.8%), abdominal pain (47.1%) and diarrhea (30.7%), respectively. Also, 17 (12.1%) patients did not complain of any gastrointestinal symptoms.18 (12.8%) patients had aphthous stomatitis, 10.7% had dermatitis herpetiformis, 3.6% suffered from itching without a rash, two (1.4%) mentioned psoriasis and one (0.7%) had lichen planus. 19 (19.7%) of the female patients complained of menstrual bleeding disorders, 4% mentioned infertility, and 2% experienced primary amenorrhea.The most common comorbid condition was hypothyroidism in 16 (11.4%) patients. The most common endoscopic finding was duodenal scalloping (37.25%). In addition, 7.8% of the patients had a normal endoscopic appearance. 43 (30.7%) patients were classified as Marsh IIIC, 25.7% Marsh IIIB, 17.8% Marsh IIIA, 12.8% Marsh II and 12.8% were classified as Marsh I.

 Since celiac disease can present with non-gastrointestinal manifestations and the majority of our patients had Marsh III classification, it seems that celiac disease must be considered as a routine screening test in gastrointestinal clinics, and also, it should be kept in mind as a differential diagnosis in other specialty fields.

It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients.

This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn’s and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes.

From 10 048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn’s disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients (P < 0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P = 0.001), immunomodulators (44.9% vs 25.2%, P < 0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P = 0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, P = 0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P < 0.001), immunomodulators (58.7% vs 41.8%, P = 0.005) and anti-TNF (49.6% vs 35.4%, P = 0.006).

Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use.

Mahboobe Ebrahimi1,
 Hafez tirgar Fakheri2,
Tarang Taghvaei3,
Iradj Maleki2,
Vahid Hosseini3,
 Arash Kazemi Veisari1,
Zohre Bari1,
Hajar Shokri-Afra4,
Sepehr tirgar Fakheri5

1 Assistant Professor, Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
2 Professor, Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
3 Associate Professor, Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
4 PhD in Clinical Biochemistry, Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
5 General Physician, Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

In the article published in volume 32, issue 209, 2022, the affiliation of Iradj Maleki was published incorrectly, which is now corrected.

In the article published in volume 33, issue 222, 2023, the second author’s name was incorrect. It should have been Iradj Maleki, also his affiliation was incorrect, which both are now corrected.

Helicobacter pylori (H. pylori) has infected about 50% of the world’s population and it is the main cause for peptic ulcer, gastric adenocarcinoma and even a major cause for gastric MALT lymphoma.

This study was performed in Mazandaran, Sari, situated in North of Iran. Three-hundred and twenty-eight adult patients with endoscopically approved gastric or duodenal ulcers or erosions and H. pylori infection were randomly divided into 2 groups to receive either 14 days PABT (Pantoprazole 40 mg, Amoxicillin 1 g, Bismuth 425 mg (all twice daily) and Tetracycline 500 mg four times a day) and PACM (Pantoprazole 40 mg, Amoxicillin 1g, Clarithromycin 500 mg, and Metronidazole 500 mg, all twice daily). To evaluate H. pylori eradication, fecal H. pylori antigen test was performed 8 weeks after treatment.

The eradication rates were 94.51% in the PATB and 91.46% in PACM group based on the intention to treat analysis. Moreover, the eradication rates were 95.58% and 92.72% according to per-protocol analysis, respectively. Also, both groups had very low rates of severe side effects.

Regarding the ideal eradication rates achieved by both treatment groups and the low rates of severe side effects, both treatment protocols can be prescribed for H. pylori eradication in North of Iran.

Helicobacter pylori (H. pylori) infection is strongly related to peptic ulcer disease, chronic gastritis, and gastric malignancies. Therefore, H. pylori eradication is necessary in these cases. This study was aimed to compare the efficacy of 14-day reverse hybrid therapy with standard 14-day concomitant regimen for H. pylori eradication in Iran.

Of the 317 patients with dyspepsia and H. pylori infection enrolled in the study, 153 and 164 patients were randomly assigned to reverse hybrid and concomitant groups, respectively. The reverse hybrid regimen containing pantoprazole, amoxicillin, clarithromycin, and metronidazole was taken every 12 hours in the first 7 days, however, Clarithromycin and Metronidazole were discontinued within the next 7 days. Patients in the concomitant group also received the same drugs for 14-day. Eradication confirmation tests were used 8 weeks after the end of treatments.

A crowd of 281 patients continued the trial until the end. H. pylori eradication rates based on intention to treat analysis were 71.2% (109/153) and 83.5% (137/164) in reverse hybrid and concomitant groups, respectively (P = 0.007). By the per-protocol analysis, rates of eradication were 85.8% (109/127) and 89% (137/154), respectively (P = 0.428). Severe side effects were few in both groups. More side effects were observed in concomitant group (p < 0.001), however, the severity of side effects was not statistically different between the two regimens (P = 0.314). Reverse hybrid regimen was better tolerated (98% vs. 91.5%, P= 0.009).

Both 14-day reverse hybrid and concomitant regimens have a fair response rate in Iran.

Leptin is an adipocyte-derived hormone with a critical role in energy balance. As demonstrated by previous investigations, leptin acts as a proliferative and angiogenic factor in cancer cells. However, results regarding its role in colorectal cancer are still inconclusive. We aimed to evaluate serum leptin and tissue expression of leptin receptor (Ob-R) in normal and malignant samples of colorectal.

Serum and tissue samples from pathology-confirmed colorectal cancer patients and normal controls referring to a university hospital of Mazandaran were obtained during 2019-21. ELISA and immunohistochemistry were applied to determine leptin and Ob-R expression respectively.

A total of 90 samples belonging to 46 normal and 44 CRC patients were enrolled. Normal and CRC groups included 32 (69.56%) and 21 (47.72%) female subjects respectively. The average leptin concentration in the normal group was 115.80 and, in the patient, group was 124.47 ng/mL (P=0.897). CRC cases showed an insignificantly higher Ob-R detection rate (P=0.086).

There was no significant difference in leptin and Ob-R expression between CRC patients and normal subjects. Thus, leptin and its receptor may not be useful as a biomarker of CRC.

Immunosuppressive agents used in the treatment of inflammatory bowel diseases (IBDs) could potentially increase the risk of coronavirus disease 2019 (COVID-19). We aimed to compare COVID-19 frequency in patients with IBD with their households and identify the related risk factors.

Firstly, a multi-centered, observational study on 2110 patients with IBD and 2110 age-matched household members was conducted to compare COVID-19 frequency. Secondly, the data of patients with IBD and COVID-19 who had called the COVID-19 hotline were added. Multivariable logistic regression was used to evaluate the effect of age, type and severity of IBD, the number of comorbidities, and medications on the frequency of COVID-19 among the patients with IBD.

The prevalence of COVID-19 in patients with IBD and household groups was similar (34 [1.61%] versus 35 [1.65%]; P = 0.995). The prevalence of COVID-19 increased from 2.1% to 7.1% in those with three or more comorbidities (P = 0.015) and it was significantly higher in those with severe IBD (P = 0.026). The multivariable analysis only showed a significant association with anti-TNF monotherapy (OR: 2.5, CI: 0.97-6.71, P = 0.05), and other medications were not associated with COVID-19.

The prevalence of COVID-19 in patients with IBD was similar to the household members. Only patients with IBD receiving anti-TNF monotherapy had a higher risk of COVID-19 susceptibility. This finding could be attributed to the higher exposure to the virus during administration in health care facilities.

Autoimmune hepatitis is a chronic liver inflammatory disease of unknown etiology that is more common in women. The goal of this study was to investigate the clinical, histopathological, laboratory, and elastography findings and outcome in patients with autoimmune hepatitis and verifying the factors associated with treatment response in Sari, Iran.

This research is a descriptive study in which demographic, clinical, histopathological, laboratory and elastographic information of 136 autoimmune hepatitis patients referred to Imam Khomeini Hospital and specialized gastrointestinal clinics in Sari during the years 2019-2021 was recorded in a pre-designed questionnaire.

In the study of the relationship between demographic, laboratory, histopathological, elastographic, and clinical factors with response to treatment, only prothrombin time (PT) and platelet (PLT) count had a significant relationship with response to treatment (p < 0.05). In fact, thrombocytopenia and high PT led to poor treatment response and high PT was associated with a higher probability of recurrence. There was also a significant relationship between cirrhosis and non-cirrhosis at the time of diagnosis with response to treatment (p < 0.05). People with cirrhosis experienced less response to treatment. None of the factors mentioned were related to the new cirrhosis (p < 0.05). In the study of the relationship between the results of the initial and subsequent liver fibroscan during the follow-up, the reduction of fibrosis following treatment was clearly seen.

Liver elastography is recommended for fibrosis evaluation during treatment and follow-up.

 Most data on the effect of inflammatory bowel disease (IBD) and its treatments on coronavirus disease 2019 (COVID-19) outcomes have not had non-IBD comparators. Hence, we aimed to describe COVID-19 outcomes in IBD compared to non-IBD patients.

 We conducted a prospective cohort study of registered IBD patients with confirmed COVID-19 from six provinces in Iran from February to April 2020. Proven COVID-19 patients were followed up at four weeks and the frequency of outcomes was assessed. Multivariable logistic regression was used to assess associations between demographics, clinical characteristics and COVID-19 outcomes.

 Overall, 2159 IBD patients and 4721 household members were enrolled, with 84 (3.9%) and 49 (1.1%) participants having confirmed COVID-19, respectively. Household spread of COVID-19 was not common in this cohort (1.2%). While hospitalization was significantly more frequent in IBD patients compared with non-IBD household members (27.1% vs. 6.0%, P=0.002), there was no significant difference in the frequency of severe cases. Age and presence of IBD were positively associated with hospitalization in IBD compared with non-IBD household members (OR: 1.06, 95% CI: 1.03-1.10; OR: 5.7, 95% CI: 2.02– 16.07, respectively). Age, presence of new gastrointestinal symptoms, and 5-aminosalicylic acid (5-ASA) use were associated with higher hospitalization rate in IBD patients (OR: 1.13, 95% CI: 1.05–1.23; OR: 6.49, 95% CI: 1.87–22.54; OR: 6.22, 95% CI: 1.90–20.36, respectively). Anti-tumor necrosis factor (TNF) was not associated with more severe outcomes.

 Age, presence of new gastrointestinal symptoms and use of 5-ASA were associated with increased hospitalization rate among IBD patients, while anti-TNF therapy had no statistical association.

The cause of coronavirus disease 2019 (COVID‑19) is a virus which can lead to severe acute respiratory syndrome‑CoV‑2 (SARS‑COV‑2). There are evidences of involvement of immune system in pathogenesis of this disease. We investigated the presence of various vasculitis‑associated autoantibodies and complement levels in patients with COVID‑19.

Patients with severe or critical type of COVID‑19 were evaluated for symptoms, signs, and laboratory tests of vasculitis syndromes including rheumatoid factor (RF), antinuclear antibody (ANA), anti‑double‑stranded DNA, c and p anti‑neutrophilic cytoplasmic antibody (c ANCA and P ANCA), and complement levels.

The study was performed in forty patients with severe or critical illness. The mean age of the participants was 48.5 ± 9.8 years. All patients had pulmonary involvement in lung computed tomography scans. Vasculitis laboratory test results included RF in two patients, ANA in three patients, and ANCA in one patient. Seventeen (42.5%) patients had hypocomplementemia in one or more complement tests. Four patients expired, of whom three had a decrease in complement level.

Decrease in complement levels may predict a critical state of COVID‑19 disease. Therefore, measuring its levels may be of great benefit in making earlier decisions to initiate disease‑suppressing treatments including corticosteroids.

Disease registry of Coronavirus disease 2019 (COVID-19) as an emerging global health threat could create a suitable research context, identify various aspects of the disease from symptoms to laboratory diagnoses, and determine effectiveness of treatment. The present study aimed to design and implement COVID-19 registry in Sari Imam Khomeini Hospital and investigated preliminary results.

At first stage, to design the disease registry, a strategy committee was established consisting of experts involved in COVID-19. Variables determined by members of the registry strategy committee included demographic findings, patients’ vital signs, comorbidity, laboratory findings, diagnostic test results, disease forms, complications, patients’ prognosis, and medical interventions on admission and at the time of discharge. Then, a web based software was designed in Structured Query Language (SQL) to record the information. The study population included all patients attending Sari Imam Khomeini Hospital with clinical and molecular diagnosis of COVID-19.

Out of 1924 registered patients, 829 (43.1%) were female. The mean age of patients was 53.2±17.5 years. The mean ages of men and women were 53.9±16.8 and 52.7±18.1 years, respectively (P= 0.142).

Outbreak of COVID-19 and paucity of information about the disease call for an accurate, complete, and reliable database including timely information which could be achieved by an integrated disease registry.

The present study aimed to compare the complete blood count (CBC) indices between COVID-19 patients and the control group, and assess the relationship of these indices with COVID-19 prognosis given the role of complete blood counts in the COVID-19 prognosis.

COVID-19 patients (confirmed by PCR or CT-Scan) who visited Imam Hospital in Sari were selected in this case-control study. The control group was selected from Tabari cohort population who were matched with the case group in terms of gender and age. CBC, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and outcome of the disease (in the case group) were assessed in this study.

The number of participants in the case and control groups was 527. Of these, 464 (44%) were females. Platelet count, lymphocyte count, and hemoglobin concentration were also higher in the control group (p = 0.000). NLR and PLR were significantly higher in COVID-19 patients compared to the control group (P = 0.000). NLR had a significant relationship with severity of the disease. NLR was two times higher in the patients who died of COVID-19 than those who recovered (P = 0.000). ROC curve analysis for diagnostic values of NLR and PLR showed that the areas under the ROC curves for NLR and PLR were 0.703 (95% CI: 0.64-0.76) and 0.535 (95% CI: 0.46-06) respectively.

NLR can be used as a prognostic marker for COVID-19 given the significant difference of NLR between those died and recovered from COVID-19.

The current study aimed to report a pooled analysis of the association of the circulating levels of liver enzymes and total bilirubin with severe and non-severe COVID-19.

The ongoing coronavirus outbreak is an important threat to health worldwide. Epidemiological data representing greater risk of liver failure in patients infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).

Electronic databases were comprehensively searched using Medline, ISI Web of Science, EMBASE, and the Cochrane Library up to July 2020. Outcomes from each relevant study were pooled using a random-effects model. Heterogeneity was analyzed by Q test and I2 statistics. Sensitivity analysis was also evaluated.

A total of 24 studies were included (4,246 patients) in this study. We found a significant association of COVID-19 severity with increased levels of ALT [SMD: 1.40 U/L; 95% CI (0.93, 1.88); P < 0.05, I2 = 96.5%, PHeterogenity = 0.000 ], AST [SMD: 2.11 U/L; 95% CI (1.40, 2.83); P < 0.05, I2 = 97.9%, PHeterogenity = 0.000], LDH [SMD: 3.88 U/L; 95% CI (2.70, 5); P < 0.05, I2 = 98.7%, PHeterogenity = 0.000] and TBil [SMD: 1.08 mol/L; 95% CI (0.44, 1.72); P = 0.001, I2 = 97.7, PHeterogenity = 0.000], whereas, ALP values [SMD: 0.31; 95% CI (-1.57, 2.20); P = 0.74] was not significant between severe and non-severe COVID-19 patients. Moreover, elevated liver enzymes were found more in males [OR: 1.52, (95% CI 1.26, 1.83), P < 0.05] with severe COVID-19 infection than in females.

The alterations of liver function indexes caused by SARS-CoV-2 infection suggested a potential prognosis biomarker for screening of severe patients at early stages of the disease.

BACKGROUND The COVID-19 pandemic has affected the health care infrastructure dramatically, with abundant resources necessarily being redirected to COVID-19 patients and their care. Also, patients with chronic diseases like inflammatory bowel disease (IBD) may be affected in several ways during this pandemic. METHODS We used the Iranian registry of Crohn’s and colitis (IRCC) infrastructure. We called and sent messages to follow-up and support the care of all registered patients. Besides, we prepared and distributed educational materials for these patients and physicians to reduce the risk of COVID-19 infection. We risk-stratified them and prepared outpatient clinics and hospitalization guidance for IBD patients. RESULTS Of 13165 Iranian patients with IBD, 51 have been diagnosed as having COVID-19. IBD patients made 1920 hotline calls. Among the patients with suspicious presentations, 14 COVID-19 infections were diagnosed. Additionally, 1782 patients with IBD from five provinces actively phone-called among whom 28 definite cases were diagnosed. CONCLUSION IBD patients’ follow-up could help in diagnosing the affected IBD patients with COVID-19. Additionally, the performance of protective actions and preparing the patients and physicians for decisive proceedings are the principles of protection of IBD patients.

The present study aimed at evaluating the demographic, pathological and clinical characteristics of patients with colon cancer and also the survival rate and its related factors.

Cancer is the most important barrier to increasing life expectancy in the world. Furthermore, colon cancer is the fourth leading cause of cancer in Iran.

In this descriptive-analytical study, 219 patients with colon cancer were investigated. Data were analyzed through descriptive and univariate methods using R software. Kaplan-Meier survival analysis and log-rank test were used to evaluate the survival rate of the patients.

In the present study, 25% of patients were below 50 years of age. A family history of cancer was positive in 30% of the patients. According to the clinical symptoms of the patients, rectorrhagia was higher in patients with sigmoid tumor site, abdominal pain was higher in patients with transverse and ascending tumor sites, and anemia was higher in patients with ascending and caecum tumor sites (p< 0.05). The mean life expectancy of the patients was 53.71±2.07 months. Three-year, five-year and seven-year survival rates were 70, 49, and 37 %, respectively.

Half of the patients were diagnosed at advanced stage and the mean survival time at advanced stage was approximately four years. One-third of the patients had local recurrence. It is recommended that patients refer to specialists at specified time intervals for timely diagnosis of the disease and prevention of its recurrence. Providing effective training for people in order for them to acquire more knowledge, and performing screening tests will lead to early diagnosis and lower mortality.

To investigate the possibility that the eradication of H pylori infection is associated with a reduction in the risk of glaucoma.

Sixty-five successive patients with elevated intraocular pressure (IOP) or glaucoma were included in the study. Serum samples from all subjects were analyzed for the presence of H pylori- antibodies using ELISA. Forty patients with positive serologic test were included. Half of the patients enrolled into intervention group and the other half registered as control. Intervention arm was referred to the Gastroenterology Clinic for eradication of H pylori and evaluated for the effect of H pylori regimen eradication on IOP and glaucoma over 2 months of follow-up. The age-matched controls did not receive treatment. Urea breath test was applied to confirm eradication.

There was a significant (p=0.005) reduction in IOP after complete eradication in the intervention group.  This value was not significant in control patients (p=0.08). The mean IOP before treatment of glaucoma in the control group was 23.60±2.37 mmHg and after treatment with anti-glaucoma drugs was 14.25±1.48 mmHg on the onset of study, and 13.55±2.01 mmHg after follow up. The mean IOP before treatment of glaucoma in the intervention group was 24.55±3.6 mmHg and after treatment with anti-glaucoma drugs was 15.15±1.8 mmHg, and 14.3±1.6 mmHg after the eradication of H pylori with a drug regimen. However, after the treatment of glaucoma in all patients, the overall comparison of mean IOP differences showed no statistical difference (P=0.65).

H pylori eradication therapy may have a positive effect on the management of glaucoma.

One of the most critical health issues in the world is the COVID-19 pandemic from the Coronaviridae family. There is a lack of knowledge regarding the disease, and liver involvement is controversial.

We aimed to analyze the laboratory investigations of COVID-19 patients focusing on liver enzymes and association with outcomes.

We enrolled 93 patients with COVID-19 referring to the Mazandaran University of Medical Sciences’ hospitals and 186 people from the normal population of Tabari Cohort. The laboratory tests included CBC, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), direct bilirubin, and total bilirubin. The lengths of hospital stay, critical care transfers, and deaths were the outcome measures investigated with lab results.

The counts of lymphocytes (833.3 ± 564.4 vs. 2465.1 ± 796.6 per mm3, P < 0.001) and platelets (209.4 ± 62.7 vs. 255.2 ± 63.8 per mm3, P < 0.001) were significantly lower in patients than in controls. Also, AST (39.5 ± 34.9 vs. 19.9 ± 7.5 U/L, P < 0.001), ALT (40.4 ± 46.5 vs. 21.6 ± 12.7 U/L, P < 0.001), and ALP (192.6 ± 91.2 vs. 222.2 ± 70.6 U/L, P = 0.004) were higher in patients than in controls. The most common hepatic impairment events were increased direct bilirubin (45.8%), ALT (30.3%), AST (29.2%), ALP (17%), and total bilirubin (10.2%), in sequence. The risk of transfer to intensive and critical care units was strongly associated with elevated levels of AST and direct bilirubin, and AST = 30.5 (U/L) had a sensitivity of 71.4% and specificity of 68.5% for critical and intensive care transfer. The mortality rate significantly increased with increased AST levels (P = 0.023).

Abnormal liver enzymes are frequent in COVID-19 patients. As AST is not specific for liver damage, the systemic inflammation induced by the virus might be responsible for these findings.

A large number of KRAS mutations in codons 12 and 13 exons two have been reported in gastric cancer (GC). This study aimed to investigate the frequency of codon 12 and 13 mutations in the KRAS gene in patients with gastric cancer in northern Iran.

This is a descriptive cross-sectional study that was performed on patients referred for an endoscopy to Imam Khomeini Hospital in Sari, from 2009-2015. The sample size was assumed to be 100 people. Of the 100, 50 were isolated with a healthy tissue sample and placed in a group based on endoscopic results. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to evaluate codons 12 and 13 of KRAS gene located in Exon No. 1 of this gene. Statistical tests were performed using SPSS version 24.

In this study, for both codon 12 and codon 13, in cancerous tissue samples, the results were normal and no mutations in the KRAS gene were found. Also, in the normal samples obtained from the patients, the study of codon 12 and 13 in the KRAS gene did not show any change. No mutations in nucleotide G in KRAS gene were found in patients.

The results of the present study showed that there was no association between codon 12 and 13 mutations in the KRAS gene with GC.