Publications by authors named "Anahita Sadeghi"

36 Publications

Changes in liver fibrosis in patients with chronic hepatitis C after successful direct-acting antiviral therapy.

Int J Clin Pract 2021 Mar 11:e14145. Epub 2021 Mar 11.

Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Introduction And Objectives: After successful treatment of hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs), the stage of liver fibrosis decreases over time. Here, we aimed to assess the changes in the liver fibrosis stage using transient elastography (TE) after successful DAA therapy in HCV-infected cirrhotic patients who were referred to Shariati hospital from 2016 to 2017.

Material And Methods: In this observational cohort, all HCV-infected cirrhotic patients who were treated with a combination of sofosbuvir/daclatasvir, had sustained virologic response (SVR), and had undergone pre- and post-treatment TE, were enrolled. The primary outcome was the changes in TE parameters six months after the end of treatment compared with baseline.

Results: A total of 442 eligible subjects received DAA therapy. Overall, the SVR rate was 96.6%. Of these, 149 patients had completed the protocol and were enrolled. The mean age of patients was 56.1 ± 10.3 years and the predominant sex was male (77.9%). The median (Q -Q ) liver stiffness (LS) value at baseline was 26.3 kPa (18.1-38 kPa), which significantly decreased to 20.9 kPa (12-29.7 kPa) [z = -8.45, P-value < .001]. Also, the liver steatosis of patients with baseline CAP ≥ 220 dB/m had a significant response to treatment [z = -2.3, P-value = .023]. Based on multivariate analysis, a higher baseline liver fibrosis stage was the only determinant of LS values improvement in our study.

Conclusion: Successful HCV eradication in patients with liver fibrosis results in significant improvement in LS, even in cirrhotic patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijcp.14145DOI Listing
March 2021

A Supporting System for Management of Patients with Inflammatory Bowel Disease during COVID-19 Outbreak: Iranian Experience-Study Protocol.

Middle East J Dig Dis 2020 Oct;12(4):238-245

Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/mejdd.2020.188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859612PMC
October 2020

Existing antiviral options against SARS-CoV-2 replication in COVID-19 patients.

Future Microbiol 2020 12 6;15:1747-1758. Epub 2021 Jan 6.

Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 28081, USA.

COVID-19 caused by SARS-CoV-2, is an international concern. This infection requires urgent efforts to develop new antiviral compounds. To date, no specific drug in controlling this disease has been identified. Developing the new treatment is usually time consuming, therefore using the repurposing broad-spectrum antiviral drugs could be an effective strategy to respond immediately. In this review, a number of broad-spectrum antivirals with potential efficacy to inhibit the virus replication via targeting the virus spike protein (S protein), RNA-dependent RNA polymerase (RdRp), 3-chymotrypsin-like protease (3CLpro) and papain-like protease (PLpro) that are critical in the pathogenesis and life cycle of coronavirus, have been evaluated as possible treatment options against SARS-CoV-2 in COVID-19 patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2217/fmb-2020-0120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789744PMC
December 2020

SARS-CoV-2 antibody seroprevalence in the general population and high-risk occupational groups across 18 cities in Iran: a population-based cross-sectional study.

Lancet Infect Dis 2021 04 15;21(4):473-481. Epub 2020 Dec 15.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Rapid increases in cases of COVID-19 were observed in multiple cities in Iran towards the start of the pandemic. However, the true infection rate remains unknown. We aimed to assess the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 18 cities of Iran as an indicator of the infection rate.

Methods: In this population-based cross-sectional study, we randomly selected and invited study participants from the general population (from lists of people registered with the Iranian electronic health record system or health-care centres) and a high-risk population of individuals likely to have close social contact with SARS-CoV-2-infected individuals through their occupation (from employee lists provided by relevant agencies or companies, such as supermarket chains) across 18 cities in 17 Iranian provinces. Participants were asked questions on their demographic characteristics, medical history, recent COVID-19-related symptoms, and COVID-19-related exposures. Iran Food and Drug Administration-approved Pishtaz Teb SARS-CoV-2 ELISA kits were used to detect SARS-CoV-2-specific IgG and IgM antibodies in blood samples from participants. Seroprevalence was estimated on the basis of ELISA test results and adjusted for population weighting (by age, sex, and city population size) and test performance (according to our independent validation of sensitivity and specificity).

Findings: From 9181 individuals who were initially contacted between April 17 and June 2, 2020, 243 individuals refused to provide blood samples and 36 did not provide demographic information and were excluded from the analysis. Among the 8902 individuals included in the analysis, 5372 had occupations with a high risk of exposure to SARS-CoV-2 and 3530 were recruited from the general population. The overall population weight-adjusted and test performance-adjusted prevalence of antibody seropositivity in the general population was 17·1% (95% CI 14·6-19·5), implying that 4 265 542 (95% CI 3 659 043-4 887 078) individuals from the 18 cities included were infected by the end of April, 2020. The adjusted seroprevalence of SARS-CoV-2-specific antibodies varied greatly by city, with the highest estimates found in Rasht (72·6% [53·9-92·8]) and Qom (58·5% [37·2-83·9]). The overall population weight-adjusted and test performance-adjusted seroprevalence in the high-risk population was 20·0% (18·5-21·7) and showed little variation between the occupations included.

Interpretations: Seroprevalence is likely to be much higher than the reported prevalence of COVID-19 based on confirmed COVID-19 cases in Iran. Despite high seroprevalence in a few cities, a large proportion of the population is still uninfected. The potential shortcomings of current public health policies should therefore be identified to prevent future epidemic waves in Iran.

Funding: Iranian Ministry of Health and Medical Education.

Translation: For the Farsi translation of the abstract see Supplementary Materials section.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1473-3099(20)30858-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833828PMC
April 2021

Sofosbuvir/daclatasvir regimens for the treatment of COVID-19: an individual patient data meta-analysis.

J Antimicrob Chemother 2021 01;76(2):286-291

Department of Translational Medicine, University of Liverpool, UK.

Background: The combination of sofosbuvir and daclatasvir has a well-established safety profile and improves clinical outcomes in HCV patients. In silico and in vitro studies suggest that sofosbuvir/daclatasvir may show antiviral activity against SARS-CoV-2.

Methods: Three clinical trials comparing sofosbuvir/daclatasvir-based regimens with a comparator in hospitalized COVID-19 patients were combined in a meta-analysis. The primary outcomes measured were clinical recovery within 14 days of randomization, time to clinical recovery and all-cause mortality. A two-step approach was used to analyse individual-level patient data. The individual trial statistics were pooled using the random-effects inverse-variance model.

Results: Our search identified eight studies of which three met the inclusion criteria (n = 176 patients); two studies were randomized and one was non-randomized. Baseline characteristics were similar across treatment arms. Clinical recovery within 14 days of randomization was higher in the sofosbuvir/daclatasvir arms compared with control arms [risk ratio = 1.34 (95% CI = 1.05-1.71), P = 0.020]. Sofosbuvir/daclatasvir improves time to clinical recovery [HR = 2.04 (95% CI = 1.25-3.32), P = 0.004]. The pooled risk of all-cause mortality was significantly lower in the sofosbuvir/daclatasvir arms compared with control arms [risk ratio = 0.31 (95% CI = 0.12-0.78), P = 0.013].

Conclusions: Available evidence suggests that sofosbuvir/daclatasvir improves survival and clinical recovery in patients with moderate to severe COVID-19. However, the sample size for analysis was relatively small, one of the trials was not randomized and the designs were not standardized. These results need to be confirmed in larger randomized controlled trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jac/dkaa418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665526PMC
January 2021

Endoscopy during COVID-19 Pandemic.

Middle East J Dig Dis 2020 Jul;12(3):217-219

Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/mejdd.2020.186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548085PMC
July 2020

Personal Protective Equipment for Endoscopy in Low-Resource Settings During the COVID-19 Pandemic: Guidance From the World Gastroenterology Organisation.

J Clin Gastroenterol 2020 Nov/Dec;54(10):833-840

Department of Medicine, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.

Performance of endoscopic procedures is associated with a risk of infection from COVID-19. This risk can be reduced by the use of personal protective equipment (PPE). However, shortage of PPE has emerged as an important issue in managing the pandemic in both traditionally high and low-resource areas. A group of clinicians and researchers from thirteen countries representing low, middle, and high-income areas has developed recommendations for optimal utilization of PPE before, during, and after gastrointestinal endoscopy with particular reference to low-resource situations. We determined that there is limited flexibility with regard to the utilization of PPE between ideal and low-resource settings. Some compromises are possible, especially with regard to PPE use, during endoscopic procedures. We have, therefore, also stressed the need to prevent transmission of COVID-19 by measures other than PPE and to conserve PPE by reduction of patient volume, limiting procedures to urgent or emergent, and reducing the number of staff and trainees involved in procedures. This guidance aims to optimize utilization of PPE and protection of health care providers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MCG.0000000000001411DOI Listing
October 2020

The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19.

J Antimicrob Chemother 2020 11;75(11):3366-3372

Abadan Faculty of Medical Sciences, Abadan, Iran.

Objectives: Sofosbuvir and daclatasvir are direct-acting antivirals highly effective against hepatitis C virus. There is some in silico and in vitro evidence that suggests these agents may also be effective against SARS-CoV-2. This trial evaluated the effectiveness of sofosbuvir in combination with daclatasvir in treating patients with COVID-19.

Methods: Patients with a positive nasopharyngeal swab for SARS-CoV-2 on RT-PCR or bilateral multi-lobar ground-glass opacity on their chest CT and signs of severe COVID-19 were included. Subjects were divided into two arms with one arm receiving ribavirin and the other receiving sofosbuvir/daclatasvir. All participants also received the recommended national standard treatment which, at that time, was lopinavir/ritonavir and single-dose hydroxychloroquine. The primary endpoint was time from starting the medication until discharge from hospital with secondary endpoints of duration of ICU stay and mortality.

Results: Sixty-two subjects met the inclusion criteria, with 35 enrolled in the sofosbuvir/daclatasvir arm and 27 in the ribavirin arm. The median duration of stay was 5 days for the sofosbuvir/daclatasvir group and 9 days for the ribavirin group. The mortality in the sofosbuvir/daclatasvir group was 2/35 (6%) and 9/27 (33%) for the ribavirin group. The relative risk of death for patients treated with sofosbuvir/daclatasvir was 0.17 (95% CI 0.04-0.73, P = 0.02) and the number needed to treat for benefit was 3.6 (95% CI 2.1-12.1, P < 0.01).

Conclusions: Given these encouraging initial results, and the current lack of treatments proven to decrease mortality in COVID-19, further investigation in larger-scale trials seems warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jac/dkaa331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529105PMC
November 2020

Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial.

J Antimicrob Chemother 2020 11;75(11):3379-3385

Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19.

Methods: This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2.

Results: Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4-8)] than the control group [8 days (IQR 5-13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray's P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported.

Conclusions: The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jac/dkaa334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454592PMC
November 2020

Knowledge of Laboratory Medicine in Medical Students: Is It Sufficient?

Iran J Pathol 2020 1;15(2):61-65. Epub 2020 Apr 1.

Digestive Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background & Objective: Appropriate use of laboratory testing is essential for achieving safe and effective care to patient. Insufficient knowledge could lead to poor case management and increase the health care costs. It is believed that education on laboratory testing for undergraduate medical student is inadequate. This study was designed to evaluate the level of knowledge of 5 and 6 year undergraduate medical students in field of laboratory medicine.

Methods: Totally, 59 questions including 8 basic questions concerning individual assessment of their knowledge and 51 objective questions focusing on various stages of test ordering and interpretation were asked.

Results: Thirty seven undergraduate medical students at the level of internship participated. On average, 47.9% of students evaluated themselves as "weak" in 8 self-assessment questions. There was no significant difference between responders assessment on their own knowledge in various aspects of laboratory testing (=0.184). In the objective questions regarding various stages of test ordering including pre-analytic, analytic and post analytic phases,45.6%,51.9% and 50% correct answers were reported ,respectively. Comparison of the level of the knowledge of the students regarding various stages of pathology testing did not show significant difference (=0.638).

Conclusion: Prioritizing an effective teaching method of laboratory medicine to medical students on appropriate time should be considered in medical school curriculum for better clinical decision making and optimal modern medical care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.30699/ijp.2020.94221.1916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081764PMC
April 2020

Efficacy of Anti-TNF Therapy for the Treatment of Patients with Moderate-to-Severe Inflammatory Bowel Disease; a First Iranian Report.

Middle East J Dig Dis 2020 Jan;12(1):12-18

Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

BACKGROUND The anti-TNF drugs are shown to be highly effective in treatment of patients with moderate-tosevere inflammatory bowel disease (IBD). Here, we aimed to assess the efficacy and safety of antiTNF therapy at the national level. METHODS IBD patients aged 15 > years who received Infliximab and/or CinnoRA® between 2013 to July 2018 were identified. The data extracted from medical dossier and telephonic interview. The efficacy of therapy was defined as time to drug discontinuation or need for IBD-related surgery. The safety was assessed based on patient's reported adverse events. RESULTS We included 315 patients. The mean age of patients was 37.2 years and 62.2% of them developed the disease before age 30 years. Involvement of masculoskeletal system was reported in 7.3% of patients. Partial and complete response to Anti-TNF therapy was seen in 67% of patients. About 16% of patients did not respond to induction therapy and 16.9% of patients lost their response to Anti-TNF during one year. No serious adverse events, serious opportunistic infection, tuberculosis and malignancies reported by patients. Two patients reported pneumonia. CONCLUSION This study for the first time in our country, provides the evidences for efficacy of anti-TNF therapy in moderate to severe IBD patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2020.158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023648PMC
January 2020

Multiple Raised White Plaques in the Right Colon.

Middle East J Dig Dis 2019 Oct 5;11(4):234-236. Epub 2019 Nov 5.

Liver and pancreatobilliary Disease Research Center, Digestive Disease Research Institute, Tehran university of Medical sciences, Tehran, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2019.155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895851PMC
October 2019

Celiac Crisis in a Young Woman: Raising Awareness of a Life-Threatening Condition.

Middle East J Dig Dis 2019 Oct 5;11(4):230-233. Epub 2019 Nov 5.

Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.

Celiac crisis is a rare, acute, and life-threatening presentation of celiac disease. Its clinical presentations consist of severe watery non-bloody diarrhea, electrolyte disturbances (i.e. hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, and metabolic acidosis), hypoproteinemia, and dehydration. Here we present a 33-year-old woman who referred with profuse diarrhea, weight loss, hemodynamic instability, hypokalemia, hypoproteinemia, ascites, pancytopenia, and iron deficiency anemia. She used herbal medicines for constipation and had severe weakness after her childbirth. The patient was diagnosed as having celiac disease through pathological and serological evaluations 10 months earlier. Diagnosis of celiac crisis after ruling out the other causes of resistant celiac was made and she was treated with steroids.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2019.154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895852PMC
October 2019

Combination of different clinical reasoning tests in a national exam.

J Adv Med Educ Prof 2019 Oct;7(4):230-234

Medical School, University of Montreal, Montreal, Canada.

Introduction: Clinical reasoning as a critical and high level of clinical competency should be acquired during medical education, and medical educators should attempt to assess this ability in medical students. Nowadays, there are several ways to evaluate medical students' clinical reasoning ability in different countries worldwide. There are some well-known clinical reasoning tests such as Key Feature (KF), Clinical Reasoning Problem (CRP), Script Concordance Test (SCT), and Comprehensive Integrative Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this study, we evaluated the reliability of combination of clinical reasoning tests SCT, KF, CIP, and CRP in one national exam and the correlation between the subtest scores of these tests together with the total score of the exam.

Methods: In this cross sectional study, a total number of 339 high ranked medical students from 60 medical schools in Iran participated in a national exam named "Medical Olympiad". The ninth Medical Olympiad was held in Shahid Beheshti University of Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry of Health and Medical Education in summer 2017. The expert group designed a combination of four types of clinical reasoning tests to assess both analytical and non-analytical clinical reasoning. Mean scores of SCT, CRP, KF, and CIP were measured using descriptive statistics. Reliability was calculated for each test and the combination of tests using Cronbach's alpha. Spearman's correlation coefficient was used to evaluate the correlation between the score of each subtest and the total score. SPSS version 21 was used for data analysis and the level of significance was considered <0.05.

Results: The reliability of the combination of tests was 0.815. The reliability of KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The mean total score was 169.921±41.54 from 240. All correlations between each clinical reasoning test and total score were significant (P<0.001). The highest correlation (0.887) was seen between CIP score and total score.

Conclusion: The study showed that combining different clinical reasoning tests can be a reliable way of measuring this ability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.30476/jamp.2019.83101.1083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820014PMC
October 2019

Solitary Rectal Ulcer Syndrome: A Narrative Review.

Middle East J Dig Dis 2019 Jul 28;11(3):129-134. Epub 2019 Jun 28.

Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Solitary rectal ulcer syndrome is a multifactorial pathology, which entails a variety of clinical, histologic and endoscopic aspects that needs step-wise logical approach for management especially in relapsing refractory cases. Apart from the diagnostic dilemma that may be faced due to similarities of presentation with inflammatory bowel diseases or colorectal neoplastic lesions, the syndrome also overlaps with dyssynergic defecation syndrome, health anxiety disorder, obsessive compulsive disorder, and latent mucosal rectal prolapse, a systematic composite treatment modality including psychological, pharmacological, physiological and possibly surgical interventions are sometimes essential. Selecting appropriate treatment in this condition not only affects clinical outcome but also patients' experience and further stigma of SRUS life-long. In this review, we will discuss the detailed pathophysiology, diagnostic and therapeutic approaches in dealing with solitary rectal ulcer syndrome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2019.138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819965PMC
July 2019

Pharmacological prophylaxis versus pancreatic duct stenting plus pharmacological prophylaxis for prevention of post-ERCP pancreatitis in high risk patients: a randomized trial.

Endoscopy 2019 10 27;51(10):915-921. Epub 2019 Aug 27.

Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this noninferiority study was to evaluate the effectiveness of pancreatic duct (PD) stenting plus pharmacological prophylaxis vs. pharmacological prophylaxis alone in the prevention of post-ERCP pancreatitis (PEP) in high risk patients.

Methods: In this randomized, controlled, double-blind, noninferiority trial, patients at high risk of developing PEP were randomly allocated to pharmacological prophylaxis (rectal indomethacin, sublingual isosorbide dinitrate, and intravenous hydration with Ringer's lactate) plus PD stenting (group A) or pharmacological prophylaxis alone (group B). The rate and severity of PEP, serum amylase levels, and length of hospital stay after ERCP were assessed.

Results: During 21 months, a total of 414 patients (mean age 55.5 ± 17.0 years; 60.2 % female) were enrolled (207 in each group). PEP occurred in 59 patients (14.3 %, 95 % confidence interval [CI] 11.1 % - 17.9 %: 26 patients [12.6 %, 95 %CI 8.6 % - 17.6 %] in group A and 33 [15.9 %, 95 %CI 11.4 % - 21.4 %] in group B). There was no significant difference between the two groups in PEP severity ( = 0.59), amylase levels after 2 hours ( = 0.31) or 24 hours ( = 0.08), and length of hospital stay ( = 0.07).

Conclusions: The study failed to demonstrate noninferiority or inferiority of pharmacological prophylaxis alone compared with PD stenting plus pharmacological prophylaxis in the prevention of PEP in high risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-0977-3119DOI Listing
October 2019

Post-infectious Irritable Bowel Syndrome: A Narrative Review.

Middle East J Dig Dis 2019 Apr 25;11(2):69-75. Epub 2019 Mar 25.

Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

The Irritable bowel syndrome (IBS) is a functional disorder of alimentary system, which may be caused by infectious gastroenteritis determined as post infectious irritable bowel syndrome (PI-IBS). The prevalence of PI-IBS is reported to be 4-36% in patients with infectious gastroenteritis. The exact mechanism leading to PI-IBS is not fully understood and some factors pertaining to infectious agent and host response may have a role. Rome IV diagnostic criteria provided new definition for PI-IBS. Though it is now considered a well-defined functional disorder of gastrointestinal system, no specific treatment is yet available for PI-IBS. This article reviews the latest issues on these heading about PI-IBS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2019.130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663289PMC
April 2019

Iranian Registry of Crohn's and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East.

Intest Res 2019 Jul 24;17(3):330-339. Epub 2019 Apr 24.

Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background/aims: A recent study revealed increasing incidence and prevalence of inflammatory bowel disease (IBD) in Iran. The Iranian Registry of Crohn's and Colitis (IRCC) was designed recently to answer the needs. We reported the design, methods of data collection, and aims of IRCC in this paper.

Methods: IRCC is a multicenter prospective registry, which is established with collaboration of more than 100 gastroenterologists from different provinces of Iran. Minimum data set for IRCC was defined according to an international consensus on standard set of outcomes for IBD. A pilot feasibility study was performed on 553 IBD patients with a web-based questionnaire. The reliability of questionnaire evaluated by Cronbach's α.

Results: All sections of questionnaire had Cronbach's α of more than 0.6. In pilot study, 312 of participants (56.4%) were male and mean age was 38 years (standard deviation=12.8) and 378 patients (68.35%) had ulcerative colitis, 303 subjects (54,7%) had college education and 358 patients (64.74%) were of Fars ethnicity. We found that 68 (12.3%), 44 (7.9%), 13 (2.3%) of participants were smokers, hookah and opium users, respectively. History of appendectomy was reported in 58 of patients (10.48%). The most common medication was 5-aminosalicylate (94.39%).

Conclusions: To the best of our knowledge, IRCC is the first national IBD registry in the Middle East and could become a reliable infrastructure for national and international research on IBD. IRCC will improve the quality of care of IBD patients and provide national information for policy makers to better plan for controlling IBD in Iran.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5217/ir.2018.00157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667360PMC
July 2019

Esophageal Aperistalsis in a Patient with Lipoid Proteinosis.

Middle East J Dig Dis 2018 Jan 14;10(1):55-58. Epub 2018 Jan 14.

Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Lipoid proteinosis is a rare disorder with autosomal recessive inheritance, characterized by progressive deposition of hyaline material in the skin, mucous membrane, and different organs of the body, resulting in a multitude of clinical manifestations. A 34-year-old woman presented with hoarseness, dysphagia, eyelid beeding, and acneiform scars on the facial skin and extremities. The patient was diagnosed clinically as having lipoid proteinosis, which was confirmed by laryngeal biopsy. The objective of the present report is to describe this rare entity. This case report also illustrates that lipoid proteinosis may show protean clinical features and yet may remain undiagnosed for many years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2017.92DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903930PMC
January 2018

Non-parasitic Splenic Cyst.

Middle East J Dig Dis 2017 Oct;9(4):242-243

Associate Professor of Anatomical and Clinical Pathology, Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2017.81DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726339PMC
October 2017

Ulcerative Colitis Following Orthotopic Cardiac Transplantation.

Middle East J Dig Dis 2017 Oct;9(4):235-238

Liver and Pancreatobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Inflammatory bowel disease following a solid organ transplantation while the patient is receiving immunosuppressive therapy is a rare phenomenon. Here we present a 48-year-old man who underwent cardiac transplantation 9 years earlier and was receiving cyclosporine as immunosuppressive therapy since then, presenting with complaints of rectorrhagia and diarrhea. In follow-up, he was diagnosed as having ulcerative colitis. We also reviewed the literature for similar cases, which yielded very few similar ones.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2017.79DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726337PMC
October 2017

An Interprofessional Collaboration between Medicine and Pharmacy Schools: Designing and Evaluating a Teaching Program on Practical Prescribing.

J Res Pharm Pract 2017 Jul-Sep;6(3):178-181

Department of Clinical Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objective: Medical students need proper education in drug prescription. The aim of the present study is to introduce a course that improves the students' prescribing skills and also promotes an interprofessional collaboration between medicine and pharmacy schools.

Methods: This study was done in a skill laboratory at the pharmacotherapy department of Tehran University of Medical Sciences, Tehran, Iran. The course was an 18-h interactive workshop in 3 days under the supervision of clinical pharmacists. A total of 18 medical students participated in these classes before their internship. Before and after each class, they were given tests and paired -test was done to compare the marks.

Findings: A total of 18 medical students participated in this study. The results showed that the knowledge of the students on pharmacotherapy, drug information, and prescribing skills has been significantly improved at the end of the course.

Conclusion: Using clinical pharmacists to the present pharmacotherapy course could be an effective model for medical students to obtain better prescribing skills.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jrpp.JRPP_17_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632939PMC
October 2017

Inappropriate Packed RBC Transfusion in a Tertiary Care Center.

Arch Iran Med 2017 Feb;20(2):83-85

Associate Professor of Medicine, Pharmacology and Experimental Therapeutics; Director, Hematology and Medical Oncology Fellowship, University of Maryland School of Medicine, Marlene and Stewart Greenebaum.

Introduction: Transfusion of packed red blood cells (pRBC) with appropriate indications is not only important for patient safety and well-being but is also crucial for proper utilization of resources and health care-related cost reduction. We aimed to investigate the clinical appropriateness of blood transfusion in Shariati Hospital, one of the largest academic medical centers in Tehran.

Methods: In this prospective observational study, 1000 transfusions of allogenic pRBCs from April 1st to October 31st, 2015 were included. The patients' characteristics, reason for hospitalization, indications for pRBC transfusions and ordering wards were collected.

Results: The mean level of hemoglobin before transfusion was 7.4 ± 2.3 g/dL in the emergency department, 7.5 ± 1.0 g/dL in medical wards, 10.4 ± 2.6 g/dL in surgical wards, and 9.1 ± 2.2 g/dL in the intensive care unit. The baseline hemoglobin levels differed significantly between the departments (P < 0.001). Approximately 22% (219 patients) with hemoglobin level ≥ 10 g/dL received pRBC, which appeared to be unnecessary and inappropriate.

Conclusion: Despite current international guidelines emphasizing the importance of restricted transfusion policy, the transfusion of pRBC with insufficient indications occurred frequently in Shariati Hospital, particularly in surgical wards.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/0172002/AIM.004DOI Listing
February 2017

Quality of Life in Medical Students With Internet Addiction.

Acta Med Iran 2016 Oct;54(10):662-666

Department of E-Learning in Medical Education, Center of Excellence for E-Learning in Medical Education, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Medical Education, Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

The widespread use of internet has caused new psychological, social, and educational problems for the students. The aim of this study was to examine the quality of life in medical students who suffer from internet addiction. This cross-sectional survey was carried out in Tehran University of Medical Sciences, and a total of 174 fourth-to seventh-year undergraduate medical students were enrolled. The quality of life was assessed by WHOQOL-BREF questionnaire which covers four domains of physical health, psychological, social relationships, and the environment. For assessing internet addiction, we used Internet Addiction Test (IAT) of Young. The students with IAT score higher than 50 were considered as addicted. For evaluating academic performance, the students were requested to report their grade point average (GPA). The mean IA score (±SD) was 34.13±12.76. Twenty-eight students (16.90%) had IAT score above 50. The mean quality of life score in internet addicted group was 54.97±11.38 versus 61.65±11.21 in normal group (P=0.005). Furthermore, there was a negative correlation between IA score and physical domain (r=-0.18, P=0.02); psychological domain (r=-0.35, P=0.000); and social relation domain (r=-0.26, P=0.001). Mean GPA was significantly lower in the addicted group. It seems that quality of life is lower in the internet addicted medical students; moreover, such students academically perform poorer in comparison with non-addicts. Since internet addiction is increasing at a rapid pace which may provoke considerable academic, psychological and social implications; as a result, it may require screening programs to the immediate finding of such problem to give consultations to prevent unwanted complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2016

Clinical Clerkship Education Improves With Implementing a System of Internal Program Evaluation Using Medical Students' Feedbacks.

Acta Med Iran 2016 Aug;54(8):530-535

Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Quality of clinical education for medical students has always been a concern in academic medicine. This concern has increased in today's time-squeeze while faculty members have to fulfill their complementary roles as a teacher, researcher, and practitioner. One of the strategies for program evaluation is obtaining trainees' feedbacks since they are the main customers of educational programs; however, there are debates about the efficacy of student feedback as a reliable source for reforms. We gathered Likert scores on a 16-item questionnaire from 2,771 medical students participating in all clerkship programs in a multidisciplinary teaching hospital. An expert panel consisting of 8 attending physicians established content validity of the questionnaire while a high Cronbach's Alpha (0.93) proved its reliability. Summary reports of these feedbacks were presented to heads of departments, clerkship program directors, and hospital administrators, at the end of each semester. Analysis of variance was used for comparing hospital scores across different time periods and different departments. Significant changes (P<0.001) were observed in mean scores between different semesters (partial η2=0.090), different departments (partial η2=0.149) as well as the interaction term between departments and semesters (partial η2=0.111). A significant improvement in mean clinical education score is noticeable after three semesters from the beginning of the survey. Periodic, systematic trainee's feedback to program directors can lead to an improved educational performance in teaching hospitals.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2016

Medical Journal Club as a New Method of Education: Modifications for Improvement.

Arch Iran Med 2016 Aug;19(8):556-60

Associate Professor of Endocrinology, Endocrinology and Metabolism Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: The emerging goals of journal clubs are now considered to be teaching critical appraisal skills and how to use evidence based medicine in practice. Although journal clubs are well accredited, designing the right format to keep members stimulated and educated remains a great challenge.

Methods: We conducted journal club structure modifications in internal medicine residency program of a university affiliated hospital. Initially, group-based sessions identified feasible changes and baseline data concerning residents` knowledge of evidence based medicine (EBM) was collected using a questionnaire. Modifications were implemented and a second set of group discussions and data collection took place after 12 months.

Results: A total of 78 (86.7%) internal medicine residents participated. The most important identified changes were schedule adjustments and setting new goals regarding EBM, medical statistics and critical appraisal teaching. Group discussion showed increased satisfaction and questionnaire assessments showed significant improvement in residents' knowledge of EBM.

Conclusions: Redesigning journal clubs with emphasis on regularity and setting new horizons basically improves their effectiveness. Assigning entire sessions to augment participants` skills in new areas of knowledge is a unique way to fit journal clubs as a novel and innovative teaching practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/0161908/AIM.007DOI Listing
August 2016

Leech Induced Pyoderma Gangrenosum in an Ulcerative Colitis Patient: A Case Report.

Middle East J Dig Dis 2016 Jan;8(1):63-6

Department of Internal Medicine, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran.

Pyoderma gangrenosum (PG) is a painful skin lesion that results from excessive inflammatory response to a host of traumatic, inflammatory, or neoplastic processes in susceptible individuals. A clear pathogenetic mechanism as well as an exhaustive list of potential triggers for PG is yet to be fully characterized. This case documents the occurrence of pyoderma gangrenosum following leech-therapy in a patient who is a known case of ulcerative colitis and it deserves attention because leeches have been part of medical armamentarium since ancient times and have re-emerged in the last century relying on their ancient charm and modern research revealing potential benefits of several bioactive substances in their saliva.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15171/mejdd.2016.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773086PMC
January 2016

A seemingly insignificant lesion.

Indian Dermatol Online J 2015 Nov-Dec;6(6):467-8

Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/2229-5178.169723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4693378PMC
January 2016

Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis.

Gastrointest Endosc 2016 Feb 28;83(2):290-8.e1. Epub 2015 Sep 28.

Anniston Digestive Health, Anniston, Alabama, USA.

Background And Aims: EUS-guided FNA (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary strictures. The aim of this study was to determine the diagnostic yield of EUS-FNA in malignant biliary strictures.

Methods: A comprehensive literature review was carried out by 2 reviewers for studies evaluating the accuracy of EUS-FNA in biliary stricture. A meta-analysis was performed to determine the pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for EUS-FNA of extrahepatic biliary stricture. A Quality Assessment of Diagnostic Accuracy Studies questionnaire was used to assess the quality of the selected studies. Several sensitivity analyses were performed to assess the effect of the quality of the studies on the accuracy of the final results of the meta-analysis.

Results: Twenty studies involving 957 patients met inclusion criteria and were included in the meta-analysis. The pooled sensitivity and specificity of EUS-FNA for diagnosis of malignant biliary stricture were 80% (95% confidence interval [CI], 74%-86%), and 97% (95% CI, 94%-99%), respectively. The pooled positive likelihood ratio was 12.35 (95% CI, 7.37-20.72), and the negative likelihood ratio was 0.26 (95% CI, 0.18-0.38). The pooled diagnostic odds ratio for diagnosing a malignant biliary stricture was 70.53 (95% CI, 38.62-128.82). The area under the receiver-operating characteristic curve was 0.97. Sensitivity analyses showed that the quality of the included studies did not affect the accuracy of the final results of the meta-analysis.

Conclusion: This meta-analysis demonstrates that EUS-FNA is sensitive and highly specific for diagnosing malignancy in biliary strictures. Further studies are needed to compare EUS--FNA with emerging methods including cholangioscopy-guided biopsy and laser endomicroscopy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gie.2015.09.024DOI Listing
February 2016