Publications by authors named "Jamshid Vafaeimanesh"

45 Publications

Function of circular RNAs in the pathogenesis of colorectal cancer.

Biomed Pharmacother 2021 Aug 17;140:111721. Epub 2021 May 17.

Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Circular RNAs (circRNAs) comprise a group of noncoding RNAs with a circular conformation being constructed by either classic spliceosome-mediated or lariat-kind of splicing. They have tissue and temporal specificity and are involved in different biological functions. A vast body of literature has demonstrated critical roles of circRNAs in the formation or progression of neoplasms. Hsa_circ_0066631, hsa_circ_0082096, ciRS-7, circMAT2B, circ_052666, circMBOAT2, circPACRGL and circ_0128846 are among up-regulated circRNAs in CRC. Instead, expression levels of circTADA2A, circ_022743, circ_004452, circ-FBXW7, circ0106714, circFNDC3B and circ_cse1 have been decreased in CRC samples. Finally, expression levels of circRNA-100876, hsa_circ_0002320, circNOL10, circ_0056618, circ_0060745, circ-0004277, hsa_circRNA_102958, circPPP1R12A, hsa_circ_0007534, circ_0079993 and hsa_circ_0005075 can be used for prediction of clinical outcome of patients CRC.
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http://dx.doi.org/10.1016/j.biopha.2021.111721DOI Listing
August 2021

Plasmapheresis with corticosteroids and antiviral: a life-saving treatment for severe cases of Covid 19.

Caspian J Intern Med 2020 ;11(Suppl 1):572-576

Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran.

Background: COVID-19 pandemic is a global concern. Unfortunately, there is no exclusive treatment for critical patients to survive. In this study, we suggest using a novel three-dimensional treatment mainly based upon immune system modulation to fix the virus chaos, through cytokine storm as the main character of COVID-19 infection scenario.

Case Presentation: A young man infected by SARS-CoV-2 who suffered from respiratory arrest and loss of consciousness, underwent cardiopulmonary resuscitation and endotracheal intubation. Following ICU administration and confirmed diagnosis of COVID-19, considering critical condition of the young patient, plasmapheresis was performed once on a daily basis, three doses of interferon beta(IFN-β-1b) was injected subcutaneously every other day and dexamethasone was given at a dose of 4 mg every 8 hours along with common antiviral regimen. After 2 days, the patient was extubated and transferred from the ICU to the ward where plasmapheresis was performed 4 times daily for 4 days. Finally, after 7 days of hospitalization, the patient was discharged with a good general condition.

Conclusion: We modulated the immune system through plasmapheresis to sweep out the released cytokines. Also, corticosteroid along with interferon was added to common antiviral treatments. Our data suggest that this combined method is effective for critically ill COVID-19 patients.
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http://dx.doi.org/10.22088/cjim.11.0.572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780874PMC
January 2020

Prevalence of coronavirus disease 2019 in rheumatic patients and evaluation of the effect of disease-modifying anti-rheumatic drugs.

Intern Emerg Med 2021 06 31;16(4):919-923. Epub 2020 Oct 31.

Tehran University of Medical Sciences, Tehran, Iran.

One of the most controversial issues among rheumatologists is the best approach to managing a rheumatic patient (RP) with coronavirus disease 2019 (COVID-19). This study aims to evaluate the prevalence of COVID-19 in RPs compared to the general population and to relatively assess the potential role of RPs' treatment regimen against COVID-19. In a cross-sectional study, all RPs with an updated medical record between December 1, 2019, and February 29, 2020, at the rheumatology clinic of Shahid Beheshti Hospital, Qom, Iran were included (as the case group), and the prevalence of COVID-19 was compared to the paired control group-individuals without RDs, randomly selected from the Qom Health Network's database. Qom was the first city in Iran in which COVID-19 was identified and spread rapidly. Both groups were paired regarding sex, age, and underlying severe conditions. The prevalence of COVID-19 was lower in RPs than the control group (p = 0.028). Moreover, patients who were under treatment with disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents seemed to possess a lower risk for COVID-19. Two RPs died from COVID-19, both of whom had granulomatosis and polyangiitis (GPA). The prevalence of COVID-19 in the RPs was lower than the control group, which could be associated with more adherence to the quarantine and social distancing rules by RPs and stricter routine follow-ups than the general population. Besides, taking DMARDs, such as leflunomide, might possess a protective effect against severe COVID-19, probably as a result of preventing cytokine storm.
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http://dx.doi.org/10.1007/s11739-020-02535-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599976PMC
June 2021

Effect of gastric lavage with hemostasis powder on upper gastrointestinal bleeding (Conversion of emergency endoscopy to elective endoscopy).

Caspian J Intern Med 2020 May;11(3):304-309

Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.

Background: From many years ago, gastric lavage has been one of the main pillars of the classic treatment for upper gastrointestinal bleeding (UGIB). The present study investigated the effect of gastric lavage with hemostatic powder on the UGIB complications.

Methods: This clinical trial study was performed on 54 patients who referred to the emergency department during 2017-2018. The subjects were divided into two groups (n=27 per group). Gastric lavage with saline and hemostasis powder was performed in the control and experimental groups, respectively. The patients' information was collected and analyzed using SPSS software Version. 18. The significance level was set to p<0.05%.

Results: In this study,59.2% and 18.5% of the patients in the gastric lavage with Hemostasis Powder® and saline required no treatment during the early endoscopy, respectively (=0.002). The duration of endoscopy was shorter in the experimental group (p=0.001), (4.83±8.04 hours vs.6.73±14.12 hours, respectively) (=0.001). Moreover, the gastric lavage with Hemostasis Powder significantly improved the quality of endoscopy .There was no difference between the two groups in terms of their need for blood transfusion (=0.4).

Conclusion: Gastric lavage with hemostasis powder is a useful measure in the primary treatment of patients with UGIB and can convert emergency therapeutic endoscopy to diagnostic elective endoscopy with higher quality.
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http://dx.doi.org/10.22088/cjim.11.3.304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442465PMC
May 2020

Resistance-associated substitutions (RASs) to HCV direct-acting antivirals (DAAs) at baseline of treatment in thalassemia patients: a referral center study.

Arch Virol 2020 Oct 8;165(10):2193-2203. Epub 2020 Jul 8.

Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.

Patients with thalassemia major are at high risk of hepatitis C through blood transfusion from donors infected by hepatitis C virus (HCV). The use of direct-acting antiviral (DAA) therapy against such HCV infections has increased in different populations. However, resistant viral variants can affect treatment outcomes, and therefore improved surveillance strategies are needed. Accordingly, we aimed to evaluate resistance-associated substitutions (RASs) to HCV DAAs at the baseline of treatment in thalassemia patients in a referral center. Out of 89 thalassemia patients who suffered from HCV infection and were referred to our center between 2016 and 2017, 43 underwent further analysis of the HCV nonstructural proteins NS5A and NS5B using polymerase chain reaction (PCR) sequencing methods. Unique primers were designed using bioinformatics software for separate detection of HCV subtypes 1a, 3a, and 1b. Detection of RASs was performed based on previously published literature. Statistical analysis was carried out using SPSS version 19. The participants, 60.4% (26/43) of whom were male, had a mean age ± standard deviation (SD) of 33.0 ± 5.0 years. HCV subtype 1a was found in 27 cases, 3a in 13, and 1b in three. In HCV subtype 1a there were 163 mutations in NS5A and 212 mutations in NS5B. The frequency of RASs was 20.9% (8 RASs in 9 patients), including M28V and H58P in subtype 1a, L28M, R30Q, C316N, and C316S in subtype 1b, and S24F in subtype 3a. Statistically, the subtype 1b and a higher mutation rate in NS5A were associated with RASs (p-value < 0.05). The emergence of natural RASs to HCV DAAs serves as a warning of the risk of drug resistance in response to the broad usage of antivirals. However, relapses in these DAA-treated HCV-infected thalassemia patients are rarely reported. Our findings indicate that the prevalence of RASs prevalence at baseline was 20.9% in these patients, and this calls for extrapolation to a larger population study, as highlighted in other studies, with larger sample sizes, high-throughput methods, and follow-up in order to fully evaluate treatment outcomes in RASs-detected individuals. Optimized therapeutic strategies, particularly in complex, difficult-to-cure patients, can effectively prevent DAA treatment failure as a result of selection for RASs.
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http://dx.doi.org/10.1007/s00705-020-04728-xDOI Listing
October 2020

An Interesting Finding in Upper Gastrointestinal Endoscopy.

Middle East J Dig Dis 2020 Apr;12(2):130-132

Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Ira.

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http://dx.doi.org/10.34172/mejdd.2020.174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320992PMC
April 2020

Therapeutic plasma exchange as a rescue therapy in patients with coronavirus disease 2019: a case series.

Pol Arch Intern Med 2020 05 7;130(5):455-458. Epub 2020 May 7.

Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran; Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran.

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http://dx.doi.org/10.20452/pamw.15340DOI Listing
May 2020

Esophageal Polyp Lesion in a Patient with Globus Pharyngeus Compliant.

Middle East J Dig Dis 2020 Jan;12(1):52-54

Clinical Research Development Center, Qom University of Medical Sciences, Qom, Islamic Republic of Iran.

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http://dx.doi.org/10.15171/mejdd.2020.165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023646PMC
January 2020

Evaluating the effect of a herb on the control of blood glucose and insulin-resistance in patients with advanced type 2 diabetes (a double-blind clinical trial).

Caspian J Intern Med 2020 ;11(1):12-20

Gastroenterology & Hepatology Disease Research Center, Qom University of Medical Science, Qom, Iran.

Background: Different benefits of various herbal medicines in decreasing blood sugar have been reported in different clinical trials so far. Considering the growing tendency toward these combinations and the booming market, inappropriate advice is growing accordingly. Hence, it is necessary to evaluate the effects and possible complications of such combinations on health status and blood glucose control.

Methods: Two 38-subject groups were formed and a 12-week treatment program was administered for both groups. The inclusion criteria were failure to control blood glucose with two oral medicines, unwillingness to inject insulin. The medicine was prepared in capsules by Booali Company. Each capsule weighed 750 mg and contained nettle leaf 20% (w/w), berry leaf 10% (w/w), onion and garlic 20% (w/w), fenugreek seed 20% (w/w), walnut leaf 20% (w/w), and cinnamon bark 10% (w/w) all in powder.

Results: At the beginning of the study, there was no significant difference between the subjects regarding the evaluated parameters, but after the intervention, the level of glucose was significantly lower in fasting (P=0.0001) and 2-hour postprandial (P=0.002) levels. The level of glycated hemoglobin A1c (HbA1c) (P=0.0001) also decreased from 0.33±9.72 % to 0.20±8.39 %. Finally, the level of insulin resistance reduced from 1.9±4.1 to 1.4±2.6 (P=0.001) after consuming herbal medicine.

Conclusion: According to the results of the current study, the herbal combination was effective in controlling blood sugar, and considering the reduction of HbA1c by 1.31 %, it seems that the herbal combination is an effective medicine to treat diabetes.
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http://dx.doi.org/10.22088/cjim.11.1.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992722PMC
January 2020

Squamous cell carcinoma of the lung and pulmonary metastasis of papillary thyroid carcinoma: a case report.

J Med Case Rep 2019 Aug 19;13(1):259. Epub 2019 Aug 19.

Endocrinology & Metabolism Research Center, Endocrinology & Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Dr. Shariati Hospital, Jalal Al Ahmad Highway, Tehran, 1411713137, Iran.

Background: The coexistence of malignancies in a patient may be explained by the tumor-to-tumor metastasis phenomenon or multiple primary malignant tumors, both of which are not common findings. Here, we are going to present a case with coexistent papillary thyroid carcinoma and primary squamous cell carcinoma of the lung.

Case Presentation: A 36-year-old Iranian man presented to our clinic for evaluation of constitutional symptoms. His past medical history was significant for papillary thyroid carcinoma due to which he had undergone total thyroidectomy, cervical lymph node dissection, and radioactive iodine therapy 14 years ago. Six months prior to admission, he received radioactive iodine therapy due to the metastatic involvement of both lungs with papillary thyroid carcinoma in another center with consequent improvement in symptoms. Diffuse nodular lesions in both lungs, a lesion in the lower lobe of his left lung, not present 6 months ago, peritoneal carcinomatosis, and several para-aortic lymphadenopathies were detected by imaging studies. A radioactive iodine uptake scan, positron emission tomography/computed tomography scan, and transbronchial biopsy of the lesion in the lung revealed concurrent squamous cell carcinoma of the lung and pulmonary metastasis of papillary thyroid carcinoma. After consultation with an oncologist, our patient received 6 months of chemotherapy; however, he died 8 months after presentation.

Conclusions: Physicians should be aware of the possibility of the emergence of primary malignancies in patients with a history of papillary thyroid carcinoma, especially lung cancer as it is a common site of papillary thyroid carcinoma metastases. Using appropriate diagnostic evaluations in order to choose the best therapeutic option is of utmost importance.
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http://dx.doi.org/10.1186/s13256-019-2177-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699065PMC
August 2019

The Effect of Hemostasis Powder® on Treatment of Bleeding from Benign Ulcers of Upper Gastrointestinal Tract; A Pilot Study.

Middle East J Dig Dis 2019 Apr 14;11(2):84-89. Epub 2019 Feb 14.

Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

BACKGROUND Gastrointestinal (GI) bleeding is one of the most prevalent internal medical emergencies. Despite using several methods of treatment, effective treatment cannot be achieved in some patients. Hemostasis powder® is a mineral-herbal product. This emulsion was able to coagulate blood in, in vitro studies and also was effective in the treatment of mucosal and cutaneous bleeding in animal studies, without any toxicity. We decided to compare its effect on the treatment of human GI bleeding with the other common method for treatment of GI bleeding "argon plasma coagulation plus epinephrine injection" in a pilot randomized clinical trial. METHODS The patients with GI bleeding who were admitted to the emergency wards of Ghaem and Imam-Reza Hospitals in Mashhad were randomized to treatment with Hemostasis powder® or "argon plasma coagulation plus epinephrine injection" method, with randomized doctors, after complete testimonial sheet. The patients underwent re-endoscopy to evaluate the ulcers 3 days later, and were under observation for 3 months. After achieving the number of patients that was planned (20 patients), all data were entered to SPSS software version 20 and were analyzed with parametric and non-parametric tests. RESULTS The treatment success was 95% in both groups. There was no complication after treatment of GI bleeding in the two groups after 3 months. No rebreeding was reported in Hemostasis powder® group but 10 % was reported in "argon plasma coagulation plus epinephrine injection" group. CONCLUSION It seems that if the successful results occur in the future complimentary studies, Hemostasis powder® can be used as a new, effective, available, and inexpensive measure in the treatment of GI bleeding and also in the GI bleedings that cannot be treated with common available methods.
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http://dx.doi.org/10.15171/mejdd.2018.132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663293PMC
April 2019

Levofloxacin-containing triple therapy versus bismuth-based quadruple therapy as regimens for second line anti- Helicobacter pylori.

Caspian J Intern Med 2019 ;10(2):211-216

Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran.

Background: Although the prevalence of infection decreased following the hygiene promotion and application of proper anti- H.pylori treatments, unfortunately gradual increase is reported in treatment failure; hence, application of a proper treatment regimen as a second-line therapy is of great importance.

Methods: In the current randomized, clinical trial, a total of 120 patients with peptic ulcers who failed to respond to treatment were enrolled. In the OLA group, a regimen of omeprazole 40 mg/day, levofloxacin 1 g/day, and amoxicillin 2 g/ day was prescribed; however, a regimen of omeprazole 40 mg/day, bismuth sub-citrate 480 mg/day, furazolidone 400 mg/day, and amoxicillin 2 g/day was administered to the OFAB group. Both groups were treated for 2 weeks, and 6 weeks after the treatment, the urea breath test (UBT) was performed in the subjects. Collected data were analyzed with SPSS Version 18. At the end, 58 patients in group OLA and 57 patients in the OFAB group were analyzed.

Results: According to the results of the current study, 96.7% of the subjects in the OLA and 95% in the OFAB groups completed the treatment course and the eradication rates were 86.7% and 78.3% in the OLA and OFAB groups, respectively (P=0.23). Treatment side effects were observed in 51.7% and 11.7% of the subjects in the OLA and OFAB groups, respectively (P<0.01).

Conclusion: Both regimens were applicable as the second-line therapy due to insignificant difference between the results of the 2 groups; however, OLA regimen was superior to OFAB, due to lower side effects.
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http://dx.doi.org/10.22088/cjim.10.2.211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619475PMC
January 2019

Collagenous Gastritis, a Rare Cause of Dyspepsia Resistant to Treatment; A Case Report.

Middle East J Dig Dis 2018 Oct 10;10(4):263-266. Epub 2018 Sep 10.

Associate Professor, Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran.

Collagenous gastritis is hardly ever found in children and adults. Based on the extent of collagenous changes in the bowel, various symptoms may develop including iron deficiency, anemia, and abdominal pain in most of the patients. We present a 30-year-old man with persistent abdominal pain and anemia due to collagenous gastritis.
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http://dx.doi.org/10.15171/mejdd.2018.121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488506PMC
October 2018

Coexistence of medullary thyroid carcinoma and recurrent non-functional pituitary adenoma: a case report.

J Med Case Rep 2018 Aug 15;12(1):220. Epub 2018 Aug 15.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Medullary thyroid carcinoma and pituitary adenoma are neuroendocrine tumors and their coexistence has not been reported in the literature, previously. Medullary thyroid carcinoma is a neoplasm of the thyroid gland arising from parafollicular c-cells producing calcitonin, and pituitary adenoma is a benign hyperplasia of the cells of the pituitary gland. Coexistence of these neoplasms can be explained by being affected by simultaneous primary neoplasms or tumor-to-tumor metastasis phenomenon.

Case Presentation: We present the case of a 60-year-old Persian man who presented to the clinic with a chief complaint of headache for the last 2 months. His past medical history was significant for non-functional pituitary macroadenoma and medullary thyroid carcinoma and he had received a total thyroidectomy and a transsphenoidal surgery several years ago. Diagnostic evaluations revealed that the pituitary adenoma has recurred. He was well and symptom-free after the second transsphenoidal surgery for resection of the adenoma. Noticeably, investigations were negative for any form of multiple endocrine neoplasia syndromes; however, we could not rule them out definitively.

Conclusions: To the best of our knowledge, it is the first case reported in the literature of a patient who has been affected by recurrent non-functional pituitary adenoma and medullary thyroid carcinoma, concomitantly. Although this association can be accidental, it emphasizes the fact that patients with a history of a neoplasm should be monitored regularly in order to diagnose and treat possible second primary cancers in a timely manner. Of note, this consideration is of great importance in patients whose first neoplasms have better prognosis and survival rates, which provide them more time to develop second primary cancers, for example, pituitary adenoma.
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http://dx.doi.org/10.1186/s13256-018-1745-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092822PMC
August 2018

The effectiveness of sofosbuvir and daclatasvir in the treatment of hepatitis C in thalassaemia major patients and their effect on haematological factors.

Indian J Med Microbiol 2018 Apr-Jun;36(2):224-229

Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran; Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran.

Context: Patients with thalassaemia are at risk of infections such as hepatitis C virus (HCV) due to their repeated blood transfusions; meanwhile, the treatment of thalassaemia patients who had developed HCV infection is a controversial issue.

Aims: Although the effectiveness of direct-acting antivirals on HCV infection has been confirmed, their side-effects as well as effects on haematological factors due to the resultant need for blood transfusion remain to be further understood.

Materials And Methods: In this study, 61 patients with major beta thalassaemia and HCV infection, and who had a history of interferon treatment failure were examined. The patients underwent a 24-week treatment with sofosbuvir (SOF) and daclatasvir (DAC). Sustained virological response 12 was used to assess response to treatment. At the end of the study, the need for blood transfusion and serum ferritin was evaluated.

Results: About 98.4% of the patients responded to the treatment, and only one patient with genotype 1b did not respond positively. No significant complications necessitating treatment cessation were observed, and all the patients tolerated the treatment well. The level of liver enzymes showed a significant reduction 12 weeks after the treatment. The need for blood transfusions in patients before treatment was averagely 1.595 ± 0.65 bag per month, in which 1.593 ± 0.64 bags were received after treatment (P = 0.9). This regimen did not affect the amount of anaemia in patients and did not differentiate the need for blood transfusions. The rate of haemoglobin before treatment was 9.5 ± 1.42 g/dl, which reached 9.6 ± 1.6 g/dl after treatment (P = 0.54). Ferritin levels decreased significantly (from 1948.08 ± 1539.54 to 1315.73 ± 1207.67 ng/ml) (P = 0.001) in the patients after the treatment.

Conclusion: Combination of SOF and DAC is an effective and tolerable treatment regimen without affect on the amount of anaemia in patients and did not differentiate the need for blood transfusions.
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http://dx.doi.org/10.4103/ijmm.IJMM_18_90DOI Listing
December 2018

Obstructive Jaundice in a Patient with Polycystic Liver.

Middle East J Dig Dis 2018 Apr 6;10(2):117-120. Epub 2018 Mar 6.

Gastroenterology and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.15171/mejdd.2018.101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040926PMC
April 2018

Effect of Infection on Serum Lipid Profile.

J Lipids 2018 3;2018:6734809. Epub 2018 Jun 3.

Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran.

Background: Some studies suggest a significant relationship between infection and atherogenesis; but the mechanism of the relationship is almost unknown. The current study aimed at evaluating the relationship between infection and serum lipid profile.

Patients And Methods: The current study was conducted on 2573 patients, from 2008 to 2015. The serum anti- antibody titer and serum lipid profile were assessed in the study population; data were statistically analyzed by SPSS version 16. values < 0.05 were considered significant.

Results: In the current study, 66.5% of the cases were serologically positive for . Among male cases, the level of low density lipoprotein (LDL) was higher in patients with infection, compared with that of the ones without the infection ( = 0.03); although level of triglyceride (TG) was higher and the level of high density lipoprotein (HDL) was lower in the cases with infection; there was no statistically significant difference between the cases with and without infection regarding the level of HDL and TG. Among female cases, the level of TG was significantly lower in patients with infection, compared with that of the ones without the infection ( = 0.001); but there was no significant difference between the cases with and without infection regarding the level of LDL and HDL. The mean fasting blood sugar (FBS) in the cases with infection was significantly higher than that of the ones without the infection ( = 0.04).

Conclusion: According to the results of the current study, the levels of LDL and FBS were high among the male cases with infection. However, in females with infection the level of TG was low; hence, it seems that the atherogenicity of affected the level of blood sugar more.
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http://dx.doi.org/10.1155/2018/6734809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008870PMC
June 2018

Insulin resistance and coronary artery disease in non-diabetic patients: Is there any correlation?

Caspian J Intern Med 2018 ;9(2):121-126

Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.

Background: Cardiovascular diseases are the most common causes of death in the world and type 2 diabetes is one of them because it is highly prevalent and doubles heart disease risk. Some studies suggest that insulin resistance is associated with coronary artery disease in non-diabetics. The aim of this study was to evaluate the association of insulin resistance (IR) and coronary artery disease (CAD) in non-diabetic patients.

Methods: In this cross-sectional study, from September 2014 to July 2015, 120 patients referring to Shahid Beheshti Hospital of Qom were evaluated. Their medical history, baseline laboratory studies, BMI and GFR were recorded. After 8 hours of fasting, blood samples were taken from the patients at 8 am, including fasting glucose and insulin level. We estimated insulin resistance using the homeostatic model assessment index of IR (HOMA-IR). Finally, we evaluated the association between IR and CAD.

Results: Totally, 120 patients were assigned to participate in this study, among them, 50 patients without CAD and 70 with coronary artery stenosis. Insulin resistance (HOMA-IR> 2.5) was positive in 59 (49.3%) patients and negative in 61 (50.7%) patients. Hence, the correlation between IR and CAD was not statistically significant (P=0.9).

Conclusions: In this study, although the correlation was not found between insulin resistance and coronary heart disease, among men, we found a significant association between coronary heart disease and insulin resistance.
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http://dx.doi.org/10.22088/cjim.9.2.121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912218PMC
January 2018

Comparison of eradication regimens in patients with end stage renal disease.

Gastroenterol Hepatol Bed Bench 2018 ;11(1):15-19

Gastroenterology &Hepatology Research Center. Qom Univercity of Medical Séances, Qom, Iran.

Aim: The aim of this study was to compare the (HP) eradication regimens in patients with end stage renal disease.

Background: In patients undergoing hemodialysis, the pathologic changes seen in the stomach may be the result of high serum levels of gastrin, delayed gastric emptying or HP infection.

Methods: Our study was a randomized clinical trial in which 120 patients with ESRD (Patients who undergo hemodialysis) confirmed HP infection, were divided to four groups having 2-week eradication regimens; Group I: LCA (lansoprazole 30 mg-BD,clarithromycin 250 mg-BD, amoxicillin 500 mg-BD), Group II: LCM (lansoprazole 30 mg-BD,clarithromycin 250 mg-BD, metronidazole 500 mg-BD), Group III: LCAM (lansoprazole 30 mg-BD,clarithromycin 250 mg-BD,amoxicillin 500 mg-BD, metronidazole 500 mg-BD) and Group IV: Sequential (lansoprazole 30 mg-BDfor two weeks; first week: amoxicillin 500 mg-BD and second week: clarithromycin 250 mg-BD, metronidazole 500 mg-BD).6 weeks after treatment, Urea Breath Test (UBT) was performed for all patients.

Results: The mean age of patients was 43.1±11.2 years. 55.8% of patients were male. The success rates of HP eradication in 4 groups were76.7%, 70%, 90% and 90%, respectively. HP eradication rates were not statistically different among the regimens (p=0.11). There were not significant differences among the groups regarding demographic and anthropometric variables.

Conclusion: The results showed there was no significant difference between the success rates of HP eradication regimens for ESRD patients. According to approved regimen for 90% eradication rate, with a lower number of medications and given the less risk of side effects and drug interactions, the sequential regimen is the best.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849113PMC
January 2018

Neurobrucellosis in systemic lupus erythematosus.

Caspian J Intern Med 2017 ;8(2):119-122

Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.

Background: Brucellosis is a zoonotic infection which is endemic in many countries. It is a multisystem disease which may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is an uncommon complication of brucellosis.

Case Presentation: A 25-year-old woman with a history of lupus for 5 months referred to the emergency ward of Shahid Beheshti Hospital of Qom due to vertigo, drop attack and a convulsion episode from the previous day. She was unable to move at initial evaluation, and her upper and lower extremities were spastic. She had blurred vision one day after admission. Based on her past history and suspecting neurological pulmonary presentations, treatment with immunosuppressive drugs was started and brain MRI was performed. According to the MRI mode and endemic area, neurobrucellosis was suspected and 2ME and Wright tests were performed. Wight test was 1.5120 while 2ME test was 1.640 which were strongly positive. So, with neurobrucellosis diagnosis, the patient was treated but unfortunately 4 days later, after respiratory apnea, she was pronounced dead.

Conclusion: In endemic areas for brucellosis, neurobrucellosis should always be kept in mind in the differential diagnosis of neurological and psychiatric cases that are encountered.
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http://dx.doi.org/10.22088/cjim.8.2.119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494048PMC
January 2017

Effect of on metabolic syndrome parameters in diabetic patients.

Gastroenterol Hepatol Bed Bench 2016 Dec;9(Suppl1):S36-S41

Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of medical sciences, Tehran, Iran.

Aim: The aim of this study is to survey the effect of Helicobacter Pylori on metabolic syndrome parameters in diabetic patients.

Background: Helicobacter pylori () infection is the most common infection in developing countries. Some studies showed the association between infection and insulin resistance. Insulin resistance is a major mechanism in the development of metabolic syndrome (MetS) and it is said that MetS is more prevalent among HP infected subjects. Also, some studies have shown that MetS is common among patients with type 2 diabetes mellitus. In this study, we aimed to investigate the prevalence of MetS in diabetic patients and its association with .

Methods: This cross-sectional study was carried out from May to December 2014 on 211 diabetic patients. For each patient, the following data were collected: age, gender, diabetes duration, weight, body mass index (BMI), waist circumference, blood pressure (BP), HDL, cholesterol, triglyceride (TG), total cholesterol, and HbA1c. The lipid profile was performed on fasting samples. Anti- HP IgG antibody was measured and serum titer >30AU/mL was considered positive. MetS was diagnosed by The National Cholesterol Education Program's Adult Treatment Panel III report (NCEP-ATPIII) and IDF criteria.

Results: Totally 139 patients (65.9%) were HP+ and 72 patients (34.1%) were HP-. Age, gender and diabetes duration were not significantly different in both groups. BMI was significantly lower in HP+ women (29.05±5.26 vs. 31.45±4.8, p=0.02). Although the waist circumference of men was not different between the two groups but it was significantly lower in HP+ women (102.04±12.37 vs. 97.3±10, p=0.03). Although BP and TG levels were not statistically different in HP+ and HP- patients, but HP+ patients had lower HDL level (p=0.037) which was due to lower HDL in men (58.2±26.6 vs. 72.48±28.1, p=0.012). The prevalence of MetS according to the IDF criteria among HP+ and HP- patients was 76.6% vs. 69.8% (p=0.27). Also, the prevalence of MetS according to NCEP-ATP III criteria among HP+ and HP- patients was 90.4% vs. 87.2% (p=0.5). Duration of diabetes did not affect the prevalence of metabolic syndrome among HP+ and HP- patients.

Conclusion: It seems that HP infection increases the prevalence of metabolic syndrome through an increase in insulin resistance. According to NCEP-ATPIII criteria, the increase in the prevalence of metabolic syndrome in HP+ patients is almost significant, however more complete studies is recommended to investigate this relationship.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310798PMC
December 2016

Subclavian artery-esophageal fistula after placement of a self-expanding metal stent in a patient with esophagogastric anastomosis stenosis.

Caspian J Intern Med 2016 ;7(4):297-299

Clinical Research Development Center, Department of Internal Medicine, Qom University of Medical Sciences, Qom, Iran.

Background: There have been reports on stent-related vascular erosions about patients with benign or malignant stenosis of the esophagus who received endoscopic stent insertion for palliative intention for oral intake.

Case Presentation: A 61-year-old woman with esophageal cancer located in the middle part of esophagus was treated with esophagectomy. Two years following the surgery, malignant stenosis recurred in the esophagogastric anastomosis. A non-covered self-expanding metal stent (10 cm length with a diameter of 18 mm at expanded state) was inserted. Three months later, a massive hematemesis with subsequent hemorrhagic shock developed from the proximal end of the stent which resulted in the final diagnosis of arterioesophageal fistula on the left subclavian artery. An endovascular repair using a stent graft for the left subclavian artery via the right common iliac artery was performed and the patient remained well until discharge.

Conclusion: Increase in the treatment of esophageal strictures by stent insertion increases the risk of stent-related vascular fistula. These complications should be considered in any patients with massive upper gastrointestinal bleeding.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153524PMC
January 2016

Addition of cranberry to proton pump inhibitor-based triple therapy for eradication.

J Res Pharm Pract 2016 Oct-Dec;5(4):248-251

Qom Gastroenterology and Hepatology Research Center, Qom University of Medical Sciences, Qom, Iran; Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.

Objective: Proton pump inhibitor-based triple therapy with two antibiotics for eradication is widely accepted, but this combination fails in a considerable number of cases. Some studies have shown that cranberry inhibits the adhesion of a wide range of microbial pathogens, including . The aim of this study was to assess the effect of cranberry on eradication with a standard therapy including lansoprazole, clarithromycin, and amoxicillin (LCA) in patients with peptic ulcer disease (PUD).

Methods: In this study, -positive patients with PUD were randomized into two groups: Group A: A 14-day LCA triple therapy with 30 mg lansoprazole bid, 1000 mg amoxicillin bid, and 500 mg clarithromycin bid; Group B: A 14-day 500 mg cranberry capsules bid plus LCA triple therapy. A C-urea breath test was performed for eradication assessment 6 weeks after the completion of the treatment.

Findings: Two hundred patients (53.5% males, between 23 and 77 years, mean age ± standard deviation: 50.29 ± 17.79 years) continued treatment protocols and underwent C-urea breath testing. eradication was achieved in 74% in Group A (LCA without cranberry) and 89% in Group B (LCA with cranberry) ( = 0.042).

Conclusion: The addition of cranberry to LCA triple therapy for has a higher rate of eradication than the standard regimen alone (up to 89% and significant).
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http://dx.doi.org/10.4103/2279-042X.192462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084481PMC
November 2016

Addition of clidinium-C to the 14-day proton-pump inhibitor-based triple therapy for Helicobacter pylori eradication.

Caspian J Intern Med 2016 ;7(2):78-81

Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.

Background: Triple therapy with a proton pump inhibitor and two antibiotics in Helicobacter pylori (HP) eradication is widely accepted, but this combination fails in a considerable number of cases. The aim of this study was to assess the effect of clidinium-C addition on HP eradication and to investigate the efficacy and safety of clidinium-C in prevention of drugs' side effects.

Methods: A total of 200 histopathologically confirmed HP positive peptic ulcer enrolled in this study which were randomly assigned to two treatment groups: OAC (20 mg omeprazole bid, 1000 mg amoxicillin bid and 500 mg clarithromycin bid) and OAC + clidinium-C. The effect of treatment and adverse effects were compared 6 weeks after completion of treatment. A13C-urea breath test was performed to confirm HP eradication.

Results: A total of 184 patients (90 in group A and 94 in group B) completed the treatment protocols. HP eradication was achieved in 71.1% in OAC versus 72.3% in OCA+clidinium-C, (P=0.73). The frequencies of abdominal pain and stool abnormality, among the side effects recorded during the therapy period, were significantly lower in group B (OCA+clidinium-C) (P=0.01 and P=0.001, respectively).

Conclusion: Addition of clidinium-C to OCA triple therapy decreases abdominal pain and frequency of stool abnormalities without affecting HP eradication rate. Based on these findings addition of clidinium-C may increase patient's compliance.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913708PMC
July 2016

Impact of creatinine clearance on Helicobacter pylori eradication rate in patients with peptic ulcer disease.

Iran J Kidney Dis 2015 Nov;9(6):427-32

Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.

Introduction: Gastrointestinal complaints are common in patients with kidney failure. The aim of this study was to investigate the effect of creatinine clearance on Helicobacter pylori (HP) eradication rate in patients with peptic ulcer disease.

Materials And Methods: In this clinical trial, 132 patients with a range of kidney function (normal to end-stage renal disease) and peptic ulcer disease with HP infection were enrolled and divided into 5 groups by their creatinine clearance. For all patients, a 14-day standard regimen of triple therapy for peptic ulcer was started with omeprazole, 20 mg; clarithromycin, 500 mg; and amoxicillin, 1 g; twice per day. After 6 weeks, HP eradication rate were evaluated and compared between the groups with urea breath test.

Results: The mean age of the participants was 44.84 ± 12.20 years and 68 (51.5%) were women. The five groups were not significantly different in terms of age, sex distribution, or body mass index. The results of urea breath test at 6 weeks were positive in 23 patients (17.4%). There was no significant difference in HP eradication rate (negative urea breath test) between the five groups.

Conclusions: This study showed no association between the success rate of eradication of HP infection and kidney function.
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November 2015

Helicobacter pylori infection prevalence: Is it different in diabetics and nondiabetics?

Indian J Endocrinol Metab 2015 May-Jun;19(3):364-8

Department of Internal Medicine, Clinical Research Development Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Shahid Beheshti Boulevard, Qom, Iran.

Background: Helicobacter pylori (HP) infection plays a significant role in the development of gastrointestinal complications and has a significant role in systemic inflammation. It has some extragastrointestinal manifestations like endocrine diseases. In this study, we aimed to compare the prevalence of HP infection in diabetic and nondiabetic individuals.

Materials And Methods: In this cross-sectional study, 218 nondiabetic and 211 diabetic patients referring to Shahid Beheshti Hospital of Qom between March 2013 and 2014 were studied. The patients were divided into two HP(+) and HP(-) groups based on serological immunoglobulin G antibody against HP and the association between diabetes, and HP infection was evaluated. Data were analyzed using independent t-tests, Chi-square, Fisher's exact and Mann-Whitney tests.

Results: The prevalence of HP seropositive was 65.9% versus 50.5% in diabetic and nondiabetics, respectively, and the difference was statistically significant (P = 0.001).

Conclusions: This study showed a higher prevalence of HP infection in diabetic patients.
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http://dx.doi.org/10.4103/2230-8210.152773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366774PMC
May 2015

Plasmapheresis: Lifesaving treatment in severe cases of HELLP syndrome.

Caspian J Intern Med 2014 ;5(4):243-7

Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.

Background: HELLP syndrome is an important complications in pregnancy which increases maternal and fetal mortality. This disease usually remits with supportive treatment which includes prescription of corticosteroid, magnesium sulfate, stabilization of mother and pregnancy termination. Plasmapheresis is a treatment of choice which improves clinical outcomes in complicated cases.

Case Presentation: A 22-year-old woman with coagulopathy and respiratory distress and 33-year-old woman with a history of cerebellar medulloblastoma at 32-weeks' gestation developed thrombocytopenia due to HELLP syndrome were treated with plasmapheresis were described.

Conclusion: Plasmapheresis can significantly improve the outcome of patients with HELLP syndrome who are unresponsive to conservative therapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247490PMC
December 2014

Helicobacter pylori infection and insulin resistance in diabetic and nondiabetic population.

ScientificWorldJournal 2014 23;2014:391250. Epub 2014 Oct 23.

Clinical Research Development Center, Department of Internal Medicine, Qom University of Medical Sciences, Qom, Iran.

Helicobacter pylori (HP) is a common worldwide infection with known gastrointestinal and nongastrointestinal complications. One of the gastrointestinal side effects posed for this organism is its role in diabetes and increased insulin resistance. The aim of this study was to evaluate the association between HP and insulin resistance in type 2 diabetic patients and nondiabetics. This cross-sectional study was carried out from May to December 2013 on 211 diabetic patients referred to diabetes clinic of Shahid Beheshti Hospital of Qom and 218 patients without diabetes. HP was evaluated using serology method and insulin resistance was calculated using HOMA-IR. The prevalence of H. pylori infection was 55.8% and 44.2% in diabetics and nondiabetics (P = 0.001). The study population was divided into two HP positive and negative groups. Among nondiabetics, insulin resistance degree was 3.01 ± 2.12 and 2.74 ± 2.18 in HP+ and HP- patients, respectively (P = 0.704). Oppositely, insulin resistance was significantly higher in diabetic HP+ patients rather than seronegative ones (4.484 ± 2.781 versus 3.160 ± 2.327, P = 0.013). In diabetic patients, in addition to higher prevalence of HP, it causes a higher degree of insulin resistance.
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http://dx.doi.org/10.1155/2014/391250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227459PMC
November 2015

Effects of pistachio nut supplementation on blood glucose in patients with type 2 diabetes: a randomized crossover trial.

Rev Diabet Stud 2014 10;11(2):190-6. Epub 2014 Aug 10.

Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.

Background: Diabetes is a chronic, potentially debilitating, and often fatal disease. Dietary strategies to reduce postprandial glycemia are important in the prevention and treatment of diabetes. Nuts are rich in mono- and polyunsaturated fatty acids, which may reduce hyperglycemia and improve metabolism.

Objectives: To evaluate the effectiveness of pistachio nut supplementation on glycemic and inflammatory measures in patients with type 2 diabetes.

Methods: In this double-blind, randomized, placebo-controlled, crossover trial, 48 diabetic patients were equally assigned to groups A and B. Patients in group A received a snack of 25 g pistachio nuts twice a day for 12 weeks and group B received a control meal without nuts. After 12 weeks of intervention, the patients had an 8-week washout. Then the groups were displaced, and group B received the same amount of pistachios for 12 weeks.

Results: With respect to the total change in variables over both phases, there was a marked decrease in HbA1c (-0.4%) and fasting blood glucose (FBG) concentrations (-16 mg/dl) in the pistachio group compared with the control group (p ≤ 0.001 for both). There was no overall significant change in BMI, blood pressure, HOMA-IR, and C-reactive protein (CRP) concentrations. Analysis of the two phases separately showed a decrease in FBG by 14 mg/dl and in HbA1c by 0.45% in the treatment group (A) after 12 weeks, while no significant differences were seen in group B (control group). In the second phase, FBG decreased from 151.36 ± 39.22 to 137.28 ± 28.65 mg/dl (-14 mg/dl) and HbA1c decreased from 7.42 ± 0.97 to 7.15 ± 0.68 mg/dl (-0.28%, p = 0.013 and p = 0.033, respectively) in the pistachio group (B). Pistachio consumption reduced systolic blood pressure (p = 0.007), BMI (p = 0.011), and CRP (p = 0.002) in patients from the treatment groups, but not insulin resistance.

Conclusions: Dietary consumption of pistachio nuts as a snack has beneficial effects on glycemic control, blood pressure, obesity, and inflammation markers in diabetic patients.
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http://dx.doi.org/10.1900/RDS.2014.11.190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310069PMC
July 2015