The Predictive Role of Parathyroid Hormone for Nonalcoholic Fatty Liver Disease following Bariatric Surgery

Background. Morbid obesity is frequently complicated by chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), and fibrosis. Parathyroid hormone (PTH) is found to be elevated in morbid obesity due to the defective hepatic metabolism of vitamin D. Bariatric surgery is performed to help patients with BMI>40 kg/m2 to effectively lose weight, particularly in patients with obesity who are afflicted with complications such as NAFLD/NASH. Objective. This study aimed to evaluate the PTH level as a predictor of hepatic function in individuals with morbid obesity who have undergone bariatric surgery. Methods. Ninety subjects with morbid obesity referred for Roux en-Y gastric bypass surgery were recruited. After IRB approval, demographic profiles, anthropometric factors, liver biopsy, and laboratory tests were obtained. The two-dimensional shear wave elastography (2D-SWE) technique was applied to assess hepatic stiffness. Results. A significant reduction occurred six months after bariatric surgery in the anthropometric indices p<0.001, hepatic elasticity p=0.002, alanine aminotransferase p<0.001, serum alkaline phosphatase p<0.001, gamma-glutamyl transpeptidase (GGT) p<0.001, and nonalcoholic fatty liver disease fibrosis score (NFS) p<0.001. Serum PTH concentration was not predictive of postsurgical liver fibrosis and steatosis at six months but could predict weight loss success rate. No significant alteration in serum PTH levels was observed between presurgical vs. postsurgical time points. Conclusion. A significant reduction was observed in the anthropometric parameters, liver enzymes, and hepatic elasticity after bariatric surgery. No significant effect was found on PTH levels

A spatial database of colorectal cancer patients and potential nutritional risk factors in an urban area in the Middle East

Objectives Colorectal cancer (CRC) is the third most common cancer across the world that multiple risk factors together contribute to CRC development. There is a limited research report on impact of nutritional risk factors and spatial variation of CRC risk. Geographical information system (GIS) can help researchers and policy makers to link the CRC incidence data with environmental risk factor and further spatial analysis generates new knowledge on spatial variation of CRC risk and explore the potential clusters in the pattern of incidence. This spatial analysis enables policymakers to develop tailored interventions. This study aims to release the datasets, which we have used to conduct a spatial analysis of CRC patients in the city of Mashhad, Iran between 2016 and 2017. Data description These data include five data files. The file CRCcases_Mashhad contains the geographical locations of 695 CRC cancer patients diagnosed between March 2016 and March 2017 in the city of Mashhad. The Mashhad_Neighborhoods file is the digital map of neighborhoods division of the city and their population by age groups. Furthermore, these files include contributor risk factors including average of daily red meat consumption, average of daily fiber intake, and average of body mass index for every of 142 neighborhoods of the city.This study was fnancially supported by Mashhad University of Medical Sci‑ ences (Fund Number: 950920)

Prevalence of Hepatitis E in Iran: A Systematic Review of the Literature

Introduction: Hepatitis E infection is caused by the hepatitis E virus (HEV) and is a self-limiting disease with moderate-to-high prevalence in various regions. Considering that HEV is endemic in Iran, the present study aimed to systematically review the prevalence of HEV in Iran.Methods: This systematic review was performed in May 2016 to investigate the prevalence of Hepatitis E infection in Iran via searching in databases such as PubMed, Scopus, and IranMedex using the following approach: (((Hepatitis E OR HEV)) AND (epidemiology OR frequency OR prevalence)) AND Iran. After collecting the proper documents, the required data were extracted and described.Result: In total, 24 relevant articles with 12,555 study populations were collected in this study. The results of the review indicated that the prevalence of HEV is relatively high in the Iranian population. In the reviewed literature, the prevalence of HEV varied from 2.3% to more than 40%.Conclusion: According to the results, the prevalence of HEV in Iran is similar to the rate reported in the other developing countries. Therefore, it is recommended that routine tests be conducted for the diagnosis of hepatitis E, especially in the suspected cases of acute non-A, non-B, and non-C hepatitis

Spatial Analysis of Colorectal Cancer Incidence in Hamadan Province, Iran: a Retrospective Cross-Sectional Study

Abstract Colorectal Cancer (CRC) is ranked the third most common cancer in women and the fourth in men in Iran. Many factors contribute to CRC occurrence, and most of them are interrelated. The present study aimed to explore the spatial pattern of CRC incidence in Hamadan province, Iran. We collected and analyzed data on patients’ location, gender, age, and date of diagnosis recorded in the CRC registry between 2007 and 2014 in Hamadan province. The Anselin Local Moran’s I statistic was conducted to identify clusters and outliers of CRC distribution. There were 805 recorded CRC cases in Hamadan province during 2007–2014, with an incidence of 45.89 patients per 100,000 people. Three significant clusters of both high and low incidence rate were found in the study area. This research demonstrated significant geographical disparities in CRC incidence in Hamadan province. The spatial analysis of CRC incidence pattern generates new hypothesis on effect of location in disease clusters. These findings may shine light on underlying risk factors in areas where the CRC risk is greater and how contextual factors may play a role in CRC geographic disparity. Keywords Colorectal cancer . Geographical information system . Iran . Spatial analysis . Cluster analysisWe would like to thank Hamadan University of Medical Sciences because of funding this project

Predictive model for survival in patients with gastric cancer

Background and aim: Gastric cancer is one of the most prevalent cancers in the world. Characterized by poor prognosis, it is a frequent cause of cancer in Iran. The aim of the study was to design a predictive model of survival time for patients suffering from gastric cancer. Methods: This was a historical cohort conducted between 2011 and 2016. Study population were 277 patients suffering from gastric cancer. Data were gathered from the Iranian Cancer Registry and the laboratory of Emam Reza Hospital in Mashhad, Iran. Patients or their relatives underwent interviews where it was needed. Missing values were imputed by data mining techniques. Fifteen factors were analyzed. Survival was addressed as a dependent variable. Then, the predictive model was designed by combining both genetic algorithm and logistic regression. Matlab 2014 software was used to combine them. Results: Of the 277 patients, only survival of 80 patients was available whose data were used for designing the predictive model. Mean ± SD of missing values for each patient was 4.43±1.41 combined predictive model achieved 72.57% accuracy. Sex, birth year, age at diagnosis time, age at diagnosis time of patients’ family, family history of gastric cancer, and family history of other gastrointestinal cancers were six parameters associated with patient survival. Conclusion: The study revealed that imputing missing values by data mining techniques have a good accuracy. And it also revealed six parameters extracted by genetic algorithm effect on the survival of patients with gastric cancer. Our combined predictive model, with a good accuracy, is appropriate to forecast the survival of patients suffering from Gastric cancer. So, we suggest policy makers and specialists to apply it for prediction of patients’ survival

The predictive role of parathyroid hormone for non-alcoholic fatty liver disease based on invasive and non-invasive findings in candidates of bariatric surgery

Background: Non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and hepatic fibrosis are the most detrimental hepatic abnormalities associated with increased body weight with devastating clinical outcomes. Therefore, there is a substantial necessity for efficient management strategies, including significant weight reduction. Bariatric surgery has been used as a therapeutic approach in a selected obese patient with NAFLD/NASH and other cardiometabolic comorbidities. Purpose: The study is focused on the predictive role of PTH with the indices of hepatic steatosis/NAFLD and NASH based on liver biopsy, elastography, and sonography in morbidly obese patients. Methods: Ninety patients with BMI between 35 and 40 kg/m with more than two comorbidities who referred to Imam Reza outpatient clinic from December 2016 to September 2017 were recruited and underwent initial assessments, including demographic profiles, psychological assessment, anthropometric measurements, hepatic biopsy, and basic laboratory tests. Liver stiffness was evaluated using two-dimensional shear wave elastography (2D-SWE) at least two weeks before liver biopsy. The histological analysis of the liver was performed using biopsy samples which obtained from left hepatic lobe during bariatric surgery under direct surgeon observation using a 16-gauge Tru-cut needle. The study was approved by the ethical committee (IR.MUMS.fm.REC.1396.312). Results: The level of PTH was significantly high in patients with positive histology for hepatic fibrosis, steatosis, and NASH/NAFLD compared to patients with negative histology (p = 0.005, p = 0.009, and p = 0.013, respectively). Also, patients with liver fibrosis confirmed by elastography had significantly higher serum PTH concentration than patients without fibrosis (p = 0.011). PTH was also positively correlated with hepatic fibrosis, NASH, and steatosis (p = 0.007, p = 0.012, p = 0.023, respectively). Conclusion: High levels of PTH was significantly associated with histological indices of (hepatic fibrosis, steatosis, NAFLD and NASH) and elasticity indices. Therefore, it is imperative to assess for high levels of PTH in the morbidly obese population pre-and post-bariatric surgery. However, for a more robust and comprehensive assessment, a randomized controlled trial is needed. The study was conducted in accordance with the practice guidance in the diagnosis and management of NAFLD from the American association for the study of liver disease (AASLD) 2018. Level III: Evidence obtained from well-designed cohort or case–control analytic studies.

Prevalence of Mismatch Repair-Deficient Colorectal Adenoma/Polyp in Early-Onset, Advanced Cases: a Cross-Sectional Study Based on Iranian Hereditary Colorectal Cancer Registry

Background: Lynch syndrome (LS) increases the risk of many types of cancer, mainly colorectal cancer (CRC). The purpose of this study was to assess the prevalence of mismatch repair (MMR) deficiency in patients under the age of 50 with advanced adenomatous polyps, aiming at an early diagnosis of LS. Methods: This retrospective, cross-sectional study included eligible patients with advanced adenomas diagnosed ≤ 50 years of age registered between April 2014 and February 2017 at three pathology centers in Mashhad. Pathological records were reviewed, and colon tissue specimens were analyzed by immunohistochemistry (IHC) staining to identify proteins which serve as markers for LS as they are related to loss of MMR gene (MLH1, MSH2, MSH6, and PMS2) expression. Results: Of 862 consecutive patients, a total of 50 adenomas (54% males, 46% females of mean age 41.24 ± 6.5) met the eligibility criteria. Of the adenomas examined, 20 (40%) had a tubulovillous component, 34 (68%) had high-grade dysplasia, and 30 (60%) had were larger than 10 mm protrusions. None of the patients had loss of MMR protein expression. Conclusion: No individual with MMR genetic disorder was identified by IHC screening of early-onset advanced colorectal adenomas. This strategy is therefore not an effective strategy for detecting MMR mutation carriers

Diagnostic Value of the Glasgow-Blatchford Scoring System in Patients With Upper Gastrointestinal Bleeding

There are disagreements about the diagnostic value of the current risk stratification systems in patients with acute upper gastrointestinal bleeding (UGIB). The present study aimed to determine the diagnostic value of the Glasgow-Blatchford score in UGIB patients. This study was conducted on 182 patients with UGIB who underwent endoscopy in the Emergency Department of Imam Reza Hospital, Mashhad, Iran. Glasgow-Blatchford Score (GBS) of each patient was estimated by using the clinical and laboratory parameters. The relationship between Blatchford score and endoscopic findings was assessed. Additionally, the sensitivity and specificity of GBS were measured based on high- and low-risk patients. According to the results, GBS had a high sensitivity (90.9%), specificity (79%), as well as positive (76%), and negative predictive values (92.2%). However, no significant relationship was observed between the Glasgow-Blatchford score and re-bleeding. As the findings of the present study indicated, Glasgow-Blatchford was a good predictive method for the determination of the high-risk and low-risk patients with UGIB. Nevertheless, this method showed poor performance in the prediction of re-bleeding

Effect of vitamin D supplementation on chronic liver disease: systematic literature review

Introduction: It is long known that vitamin D deficiency was common in patients with liver disease, but little is known on the therapeutic effects of vitamin D, especially in patients with chronic liver disease. In this study, we aimed to systematically review the literatures and study the evidences in which the effects of vitamin D supplementation had been investigated on the severity of chronic liver disease or liver cirrhosis.Methods: A systematic literature search was performed by using the following key terms “vitamin D supplementation” and “chronic liver disease” in the PubMed, Scopus and Google scholar to find relevant articles. After collecting the eligible documents, data were extracted and described based on the purpose of this review.Result: Of total 196 articles found, only 7 relevant documents with 518 studied patients were included. The results of this study showed that the levels of 25(OH) D were considerably lower in patients with chronic liver disease. Findings showed that vitamin D supplementation can rise up the mean serum level of 25(OH) D in patients with severe vitamin D deficiency, especially patients with liver cirrhosis.Conclusion:The results of this review showed that vitamin D deficiency is associated with the severity of liver disease and may have prognostic value in the assessment of liver disease. Also, it was shown that vitamin D supplementation may be helpful for the treatment of liver disease at least in certain groups of patients