Attenuation of serum laminin concentrations upon treatment of chronic hepatitis

Objectives: The aim of this work was to determine the serum laminin level cutoff point for predicting liver fibrosis highlighting its diagnostic value and determining the effect of treatment on serum laminin concentrations. Methods: Serum laminin concentrations in chronic hepatitis patients (n=62) and controls (n=20) were compared by ELISA and stages of fibrosis were assessed according to the modified Knodell score system. Results: Mean serum laminin concentration in patients (91.9 ± 20.9 ng/ml) was greater than controls (46.2 ± 10.2 ng/ml; p <0.001). Serum concentrations of laminin in all stages of hepatic fibrosis were significantly higher than those of healthy controls (p <0.05). A cutoff point of 52ng laminin/ml of serum was obtained for the discrimination of various stages of liver fibrosis showing a good sensitivity (96.8%) and specificity (80%). After 6 months of treatment, a gradual decrease in serum laminin concentrations were observed, however the level was still higher than that of the healthy group (p<0.05). Conclusions: Our findings suggest that the serum laminin concentration is a useful noninvasive marker of liver fibrosis and shows a strong positive correlation with different stages of the disease

Assessment of Effective Factors In Recurrent Implantation Failure (RIF) Following Assisted Reproductive Technology (ART)

BACKGROUND AND OBJECTIVE: Despite many advances have been made in the assisted reproduction techniques (ART), implantation rate after embryo transfer has not increased significantly. Therefore, this study aims to determine the factors involved in recurrent implantation failure (RIF) following ART. METHODS: In this retrospective study, 80 infertile patients with a history of at least 3 recurrent implantation failure (RIF) following assisted reproductive technology (ART) were referred to Fatemezahra Infertility Center in Babol from March 2006 to March 2013 were selected. The control group also included 80 women who became pregnant following the first IVF. Associated factors of infertility, endocrine disorder and endometriosis were recorded and their effect on RIF was assessed in both groups. FINDINGS: The mean BMI was 26.39±3.63 in the case group and 26.77±4.49 in the control group. Body mass index (BMI) >30 increased the risk of RIF significantly (p=0.001). After adjusting for the effects of other possible confounding factors, the odds ratio of obesity on RIF was 1.09(0.91-1.19) 95% CI which was not significant (p=0.06). There were no significant differences among type and cause of infertility, endocrine abnormalities, uterine malformations, endometriosis and polycystic ovary with RIF. CONCLUSION: According to our findings, BMI, type and cause of infertility, endocrine disorders, uterine abnormalities, endometriosis, and polycystic ovary were not effective on recurrent implantation failure

Investigation of chronic diseases in patients with inflammatory bowel disease: A hospital-based case-control study

Background: Inflammatory bowel disease (IBD) is a broad term that refers to a group of chronic inflammatory disorders that have an unknown origin and might be associated with other diseases. The aim of this study was to determine the frequency of chronic diseases in patients with IBD. Methods: In this case-control study, 280 patients with IBD were compared with 280 healthy individuals, frequency-matched by age, sex, place of residence and marital status. Random sampling was performed in patients that referred to the internal medicine and gastroenterology wards of hospitals affiliated to Babol University of Medical Sciences. Data collection tools included a demographic questionnaire and a checklist for chronic diseases, which were completed through interviews with the case and control groups. Results: Two hundred and twenty-nine (81.78) patients with IBD had at least one chronic disease. Patients with IBD were at increased risks of rheumatoid arthritis (OR= 4.48, 95CI: 1.48, 13.54, P= 0.008), eye diseases (OR= 3.49, 95CI: 1.68, 7.28, P= 0.001), liver diseases (OR= 2.74, 95CI: 1.40, 5.34, P= 0.003), anemia (OR = 2.53, 95CI: 1.56, 4.13, P= 0.000), depression (OR= 2.43, 95CI: 1.58, 3.74, P= 0.000), skin diseases (OR= 2.36, 95CI: 1.18, 4.74, P= 0.015) and hypertension (OR= 1.77, 95CI: 1.06, 2.95, P= 0.028). Conclusion: The frequency of chronic diseases associated with IBD has been high, therefore, physicians and health care professionals should consider the possibility of other chronic diseases when dealing with IBD patients. © The Author(s)

Measurement of serum laminin level during the treatment of chronic hepatitis

Background and Objective: Noninvasive methods have been proposed as surrogate markers for liver biopsy in recent years. It was shown that serum laminin level increases with the development for liver fibrosis The aim of this work was to determine serum laminin level cutoff point for predicting liver fibrosis, highlighting its diagnostic value and determining the effect of treatment on its level. Materials and Methods: In this case-control study during 2008-09, serum laminin levels in chronic hepatitis patients (n=62) and controls (n=20) before the beginning of the treatment and three times in a 2 month's interval i.e. 2.4 and 6 months after the beginning of the treatment- were compared by ELISA and stages of fibrosis were assessed according to the liver biopsy. Results: Mean serum laminin concentration in patients (91.9±20.9 ng/ml) was greater than the control (46.2±10.2 ng/ml, P<0.05). Serum levels of laminin in all stages of hepatic fibrosis were significantly higher than those of the healthy controls (P<0.05). A cutoff point of 52.0 ng/ml of laminin serum was obtained for the discrimination of patients with liver fibrosis than the healthy control showed a good sensitivity (96.8%) and specificity (80%). After 6 months of treatment, a gradual decrease in serum laminin level was observed, however the level was still higher than that of the healthy group (P<0.05). Conclusion: The findings of this study suggest that serum laminin level is a useful non-invasive marker of liver fibrosis due to strong positive correlation between serum laminin level and the degree of liver fibrosis

Interventions for treating hyperemesis gravidarum: a Cochrane systematic review and meta-analysis

<p><b>Introduction:</b> While nausea and vomiting in early pregnancy are very common, affecting approximately 80% of the pregnancies, hyperemesis gravidarum is a severe form affecting 0.3–1.0% of the pregnancies. Although hyperemesis gravidarum is rarely a source of mortality, it is a significant source of morbidity. It is one of the most common indications for hospitalization in pregnancy. Beyond the maternal and fetal consequences of malnutrition, the severity of hyperemesis symptoms causes a major psychosocial burden leading to depression, anxiety, and even pregnancy termination. The aim of this meta-analysis was to examine all randomized controlled trials of interventions specifically for hyperemesis gravidarum and evaluate them based on both subjective and objective measures of efficacy, maternal and fetal/neonatal safety, and economic costs.</p> <p><b>Material and methods:</b> Randomized controlled trials were identified by searching electronic databases. We included all randomized controlled trials for the treatment of hyperemesis gravidarum. The primary outcome was intervention efficacy as defined by severity, reduction, or cessation in nausea/vomiting; number of episodes of emesis; and days of hospital admission. Secondary outcomes included other measures of intervention efficacy, adverse maternal/fetal/neonatal outcomes, quality of life measures, and economic costs.</p> <p><b>Results:</b> Twenty-five trials (2052 women) met the inclusion criteria but the majority of 18 different comparisons described in the review include data from single studies with small numbers of participants. Selected comparisons reported below: No primary outcome data were available when acupuncture was compared with placebo. There was insufficient evidence to identify clear differences between acupuncture and metoclopramide in a study with 81 participants regarding reduction/cessation in nausea or vomiting (risk ratio (RR) 1.40, 95% CI 0.79–2.49 and RR 1.51, 95% CI 0.92–2.48, respectively). Midwife-led outpatient care was associated with fewer hours of hospital admission than routine inpatient admission (mean difference (MD) − 33.20, 95% CI −46.91 to −19.49) with no difference in pregnancy-unique quantification of emesis and nausea (PUQE) score, decision to terminate the pregnancy, miscarriage, small-for-gestational age infants, or time off work when compared with routine care. Women taking vitamin B6 had a slightly longer hospital stay compared with placebo (MD 0.80 days, 95% CI 0.08–1.52). There was insufficient evidence to demonstrate a difference in other outcomes including mean number of episodes of emesis (MD 0.50, 95% CI −0.40–1.40) or side effects. A comparison between metoclopramide and ondansetron identified no clear difference in the severity of nausea or vomiting (MD 1.70, 95% CI −0.15–3.55, and MD −0.10, 95% CI −1.63–1.43; one study, 83 women, respectively). However, more women taking metoclopramide complained of drowsiness and dry mouth (RR 2.40, 95% CI 1.23–4.69, and RR 2.38, 95% CI 1.10–5.11, respectively). There were no clear differences between groups for other side effects. In a single study with 146 participants comparing metoclopramide with promethazine, more women taking promethazine reported drowsiness, dizziness, and dystonia (risk ratio (RR) 0.70, 95% CI 0.56–0.87, RR 0.48, 95% CI 0.34–0.69, and RR 0.31, 95% CI 0.11–0.90, respectively). There were no clear differences between groups for other important outcomes including quality of life and other side effects. In a single trial with 30 women, those receiving ondansetron had no difference in duration of hospital admission compared to those receiving promethazine (mean difference (MD) 0.00, 95% CI −1.39–1.39), although there was increased sedation with promethazine (RR 0.06, 95% CI 0.00–0.94). Regarding corticosteroids, in a study with 110 participants there was no difference in days of hospital admission compared to placebo (MD −0.30, 95% CI −0.70–0.10), but there was a decreased readmission rate (RR 0.69, 95% CI 0.50–0.94; 4 studies, 269 women). For hydrocortisone compared with metoclopramide, no data were available for primary outcomes and there was no difference in the readmission rate (RR 0.08, 95% CI 0.00–1.28; one study, 40 women). In a study with 80 women, compared to promethazine, those receiving prednisolone had increased nausea at 48 h (RR 2.00, 95% CI 1.08–3.72), but not at 17 days (RR 0.81, 95% CI 0.58–1.15). There was no clear difference in the number of episodes of emesis or subjective improvement in nausea/vomiting.</p> <p><b>Conclusions:</b> While there were a wide range of interventions studied, both pharmaceutical and otherwise, there were a limited number of placebo controlled trials. In comparing the efficacy of the commonly used antiemetics, metoclopramide, ondansetron, and promethazine, the results of this review do not support the clear superiority of one over the other in symptomatic relief. Other factors such as side effect profile medication safety and healthcare costs should also be considered when selecting an intervention.</p