Digestive Disease Research Institute

Tehrān, Iran

Digestive Disease Research Institute

Tehrān, Iran
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PubMed | Harvard University, Hematology Oncology and Stem Cell Transplantation Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences and 5 more.
Type: Journal Article | Journal: Allergologia et immunopathologia | Year: 2016

The aim was to describe the clinical manifestations, complications and long-term outcome of a cohort of Iranian patients with primary immune deficiency (PID).We retrospectively studied the demographic, clinical and immunological characteristics of the PID patients in a single tertiary centre, from January 1989 to July 2014. The patients were classified according to the International Union of Immunological Societies Expert Committee on PID.98 patients were diagnosed with and followed-up for 15 disorders. The mean age at onset and diagnosis and the diagnostic delay were 810, 14.213.1 and 6.17 years, respectively. Parental consanguinity rate was 57%. Predominantly Antibody Deficiency was the most common diagnosis (n=63), followed by congenital defects of phagocytes (n=16), combined immunodeficiencies (n=12), well defined syndromes (n=4) and defects in innate immunity (n=3). Recurrent sinopulmonary infection was the most common presentation. Active infections were treated appropriately, in addition to prophylactic therapy with IVIG and antimicrobials. Not all the patients were compliant with prophylactic regimens due to cost and unavailability. One SCID patient underwent successful bone marrow transplantation. The total mortality rate was 19% during the follow-up period (7.87.6 years). The mean age of living patients at the time of study was 2311.7 years.Physicians awareness of PID has been rising dramatically in Iran, ensuring an increasing number of patients being diagnosed and treated. More effective treatment services, including health insurance coverage and drug availability are needed to improve the outcome of PID patients.


Nabavi M.,Tehran University of Medical Sciences | Arshi S.,Tehran University of Medical Sciences | Bemanian M.H.,Tehran University of Medical Sciences | Aghamohammadi A.,Tehran University of Medical Sciences | And 24 more authors.
Allergologia et Immunopathologia | Year: 2016

Purpose: The aim was to describe the clinical manifestations, complications and long-term outcome of a cohort of Iranian patients with primary immune deficiency (PID). Method: We retrospectively studied the demographic, clinical and immunological characteristics of the PID patients in a single tertiary centre, from January 1989 to July 2014. The patients were classified according to the International Union of Immunological Societies Expert Committee on PID. Results: 98 patients were diagnosed with and followed-up for 15 disorders. The mean age at onset and diagnosis and the diagnostic delay were 8. ±. 10, 14.2. ±. 13.1 and 6.1. ±. 7 years, respectively. Parental consanguinity rate was 57%. Predominantly Antibody Deficiency was the most common diagnosis (n = 63), followed by congenital defects of phagocytes (n = 16), combined immunodeficiencies (n = 12), well defined syndromes (n = 4) and defects in innate immunity (n = 3). Recurrent sinopulmonary infection was the most common presentation. Active infections were treated appropriately, in addition to prophylactic therapy with IVIG and antimicrobials. Not all the patients were compliant with prophylactic regimens due to cost and unavailability. One SCID patient underwent successful bone marrow transplantation. The total mortality rate was 19% during the follow-up period (7.8. ±. 7.6 years). The mean age of living patients at the time of study was 23. ±. 11.7 years. Conclusions: Physicians awareness of PID has been rising dramatically in Iran, ensuring an increasing number of patients being diagnosed and treated. More effective treatment services, including health insurance coverage and drug availability are needed to improve the outcome of PID patients. © 2016.


Jalili M.,Norwegian University of Science and Technology | Hekmatdoost A.,Shahid Beheshti University of Medical Sciences | Vahedi H.,Digestive Disease Research Institute | Poustchi H.,Digestive Disease Research Institute | And 4 more authors.
PLoS ONE | Year: 2016

Background and Aims The substantial characteristics of Irritable Bowel Syndrome (IBS) are associated with estrogens in women. Both soy isoflavones and vitamin D can modulate estrogen receptors in the colonic smooth muscles. The aim of this study was to investigate the effects of soy isoflavones, vitamin D and their probable interactions in women with IBS. Methods In a factorial blinded randomized clinical trial, 100 women with IBS (age:18-75yr, were randomly assigned in 4 arms to receive either placebo of vitamin D and placebo of soy isoflavones (P+P), or placebo of vitamin D and soy isoflavones (P+S), or vitamin D and placebo of soy isoflavones (D+P), or vitamin D and soy isoflavones (D+S) for 6 weeks. Dosage of soy isoflavone was 2 capsules of 20 mg soy isoflavones per day, and dosage of vitamin D was one pearl of 50'000 IU biweekly. The clinical outcomes were IBS symptoms severity scores (IBS-SSS), disease- specific quality of life (IBS-QOL) and total score (IBS-TS) that evaluated at weeks 0, 6, and 10, and compared to each other. Results IBS-TS improved significantly in both S+P and D+P groups (p- value = 0.004, 0.015). The interaction effect of soy isoflavones and vitamin D on IBS-TS was significant (p<0.05). The interaction effect of soy isoflavones with vitamin D and the main effect of vitamin D on IBS-SSS were not statistically significant, whereas IBS-SSS decreased significantly in S+P and D+P groups (p-value = 0.001, 0.047 respectively). Conclusion Our results indicate that co-administration of soy isoflavones with vitamin D did not improve the IBS- SSS and IBS- QOL; however, it improved the IBS-TS. Trial Registration Clinical Trials.gov NCT02026518. © 2016 Jalili et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | Tehran University of Medical Sciences, Digestive Disease Research Institute, Tabriz University of Medical Sciences, Shahid Beheshti University of Medical Sciences and Norwegian University of Science and Technology
Type: Journal Article | Journal: PloS one | Year: 2016

The substantial characteristics of Irritable Bowel Syndrome (IBS) are associated with estrogens in women. Both soy isoflavones and vitamin D can modulate estrogen receptors in the colonic smooth muscles. The aim of this study was to investigate the effects of soy isoflavones, vitamin D and their probable interactions in women with IBS.In a factorial blinded randomized clinical trial, 100 women with IBS (age:18-75yr, were randomly assigned in 4 arms to receive either placebo of vitamin D and placebo of soy isoflavones (P+P), or placebo of vitamin D and soy isoflavones (P+S), or vitamin D and placebo of soy isoflavones (D+P), or vitamin D and soy isoflavones (D+S) for 6 weeks. Dosage of soy isoflavone was 2 capsules of 20 mg soy isoflavones per day, and dosage of vitamin D was one pearl of 50000 IU biweekly. The clinical outcomes were IBS symptoms severity scores (IBS-SSS), disease- specific quality of life (IBS-QOL) and total score (IBS-TS) that evaluated at weeks 0, 6, and 10, and compared to each other.IBS-TS improved significantly in both S+P and D+P groups (p- value = 0.004, 0.015). The interaction effect of soy isoflavones and vitamin D on IBS-TS was significant (p<0.05). The interaction effect of soy isoflavones with vitamin D and the main effect of vitamin D on IBS-SSS were not statistically significant, whereas IBS-SSS decreased significantly in S+P and D+P groups (p-value = 0.001, 0.047 respectively).Our results indicate that co-administration of soy isoflavones with vitamin D did not improve the IBS- SSS and IBS- QOL; however, it improved the IBS-TS.Clinical Trials.gov NCT02026518.


Jamali R.,Digestive Disease Research Institute | Arj A.,Shahid Beheshti Hospital | Razavizade M.,Shahid Beheshti Hospital | Aarabi M.H.,Kashan University of Medical Sciences
Medicine (United States) | Year: 2016

Considering limitations of liver biopsy for diagnosis of nonalcoholic liver disease (NAFLD), biomarkers' panels were proposed. The aims of this study were to establish models based on serum adipokines for discriminating NAFLD from healthy individuals and nonalcoholic steatohepatitis (NASH) from simple steatosis. This case-control study was conducted in patients with persistent elevated serum aminotransferase levels and fatty liver on ultrasound. Individuals with evidence of alcohol consumption, hepatotoxic medication, viral hepatitis, and known liver disease were excluded. Liver biopsy was performed in the remaining patients to distinguish NAFLD/NASH. Histologic findings were interpreted using "nonalcoholic fatty liver activity score." Control group consisted of healthy volunteers with normal physical examination, liver function tests, and liver ultrasound. Binary logistic regression analysis was applied to ascertain the effects of independent variables on the likelihood that participants have NAFLD/NASH. Decreased serum adiponectin and elevated serum visfatin, IL-6, TNF-A were associated with an increased likelihood of exhibiting NAFLD. NAFLD discriminant score was developed as the following: [(-0.298∗adiponectin) \+ (0.022∗TNF-a) \+ (1.021∗Log visfatin) \+ (0.709∗Log IL-6) \+ 1.154]. In NAFLD discriminant score, 86.4% of original grouped cases were correctly classified. Discriminant score threshold value of (-0.29) yielded a sensitivity and specificity of 91% and 83% respectively, for discriminating NAFLD from healthy controls. Decreased serum adiponectin and elevated serum visfatin, IL-8, TNF-A were correlated with an increased probability of NASH. NASH discriminant score was proposed as the following: [(-0.091∗adiponectin) \+ (0.044∗TNF-a) \+ (1.017∗Log visfatin) \+ (0.028∗Log IL-8)-1.787] In NASH model, 84% of original cases were correctly classified. Discriminant score threshold value of (-0.22) yielded a sensitivity and specificity of 90% and 66% respectively, for separating NASH from simple steatosis. New discriminant scores were introduced for differentiating NAFLD/NASH patients with a high accuracy. If verified by future studies, application of suggested models for screening of NAFLD/NASH seems reasonable. © 2016 Wolters kluwer Health, Inc. All rights reserved.


PubMed | Digestive Disease Research Institute and Tehran University of Medical Sciences
Type: Journal Article | Journal: Endoscopic ultrasound | Year: 2015

Pancreatobiliary abnormalities in patients with opium addiction have not been widely evaluated by endoscopic ultrasonography before.Patients without any pancreatobiliary disease or symptom during 10 months were enrolled in this study. Common bile duct (CBD), pancreatic duct (PD) and portal vein (PV) diameters, gallbladder wall thickness and surface area of the papilla and abnormalities were evaluated in both groups by endosonography.In total, 199 patients were evaluated. 36 (18.1%) cases were addicted to opium. Mean age of the patients was 56.0 14.2 years. Opium users had a statistically significant higher (all P < 0.001) mean diameters of distal CBD (4.6 1.9 vs. 3.1 1.0 mm), middle part of CBD (7.5 3.1 vs. 4.6 1.6 mm), PD in head (3.3 1.3 vs. 2.3 0.7 mm) and PV (10.3 2.3 vs. 8.9 2.1 mm). However, the difference in the diameters of PD in the body of pancreas and gallbladder wall thickness did not reach statistical significance. The size of the papilla as measured by the surface area of the papilla of Vater was also significantly larger in opium users (40.6 17.1 vs. 29.9 13.5, P < 0.001).Opium addicted persons have larger diameters of CBD, PV and a larger surface area of the papilla of Vater. Dilated PD only in the head of the pancreas might be an important clue to differentiate opium-induced CBD dilation from periampullary tumors and chronic pancreatitis. The clinical significance of these findings warrants further investigation.


PubMed | Digestive Disease Research Institute
Type: Journal Article | Journal: Endoscopic ultrasound | Year: 2015

Occasionally, common bile duct (CBD) dilatation is discovered while working up patients for various causes. Not infrequently, the usual imaging modalities fail to identify the cause and endoscopic ultrasonography (EUS) becomes necessary. The aim of this study is to assess the value of EUS in identifying the cause of CBD dilatation undiagnosed by transabdominal ultrasonography.During 1 year, 152 consecutive patients who were referred for evaluation of dilated CBD (diameter 7 mm) discovered incidentally during transabdominal ultrasonography were included. Final diagnoses were confirmed by endoscopic retrograde cholangiopancreatography, EUS-guided fine-needle aspiration, surgical exploration, or clinical follow-up of at least 10 months.One hundred and fifty two patients (54% female) with dilated CBD were included. Mean age of patients was 60 17 years. The final diagnoses was choledocholithiasis in 32 (21.1%), passed CBD stone in 35 (23%), opium-induced CBD dilation in 14 (9.2%), post-cholecystectomy states in 20 (13.1%), ampullary neoplasia in 15 (15.8%), cholangiocarcinoma in 14 (9.2%) and pancreatic head cancer in 9 (5.9%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS for patients with abnormal EUS was 89.5%, 100.0%, 100.0%, 91.2%, and 90.9%, respectively.After diagnosis of CBD dilation by transabdominal ultrasonography, EUS may be a reasonable next choice for determining the etiology of dilated CBD.

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