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Nemati A.,Isfahan University of Medical Sciences | Rahmatabadi Z.K.,Poursina Hakim Research Institute | Fatemi A.,Isfahan University of Medical Sciences | Emami M.H.,Isfahan University of Medical Sciences
Journal of Research in Medical Sciences | Year: 2012

BACKGROUND: There is a lack of data on familial aggregation of colorectal cancer (CRC) in Iran. We aimed to determine the frequency of hereditary nonpolyposis colorectal cancer (HNPCC) and familial colorectal cancer (FCC) and to determine the frequency of extracolonic cancers in these families in Isfahan. METHODS: We reviewed documents of all patients with a pathologically confirmed diagnosis of CRC admitted to Isfahan referral hospitals between 1995 and 2006. We also studied our CRC registry at Poursina Hakim Research Institute from 2003 to 2008. We found HNPCC and FCC families based on the Amsterdam II criteria and interviewed them for family history of CRC and extracolonic tumors. The family history was taken at least up to the second-degree relatives. RESULTS: During 1996 to 2008, a total of 2580 CRC cases have been diagnosed. We found 14 HNPCC and 53 FCC families. Mean age of CRC at diagnosis was 48.0 ± 14.6 and 49.0 ± 13.9 years in the HNPCC and FCC families, respectively (p > 0.05). The total numbers of observed extracolonic tumors were 70 (21.6%; mean age = 53.6 ± 11.0 years) and 157 (13.8%; mean age = 54.8 ± 18.0 years) in HNPCC and FCC families, respectively (p > 0.05). CRC was respectively found in 52 and 76 members of the HNPCC and FCC families, revealing the frequency of HNPCC and FCC as 2.0% (52/2580) and 2.9% (76/2580), respectively. CONCLUSIONS: We found a relative high frequency of HNPCC (2.0%) and FCC (2.9%) among CRC cases in our society and high incidence of extracolonic tumors in their families. Further studies focusing on molecular basis in this field and designing a specific screening and national cancer registry program for HNPCC and FCC families should be conducted.


Solouki R.,Isfahan University of Medical Sciences | Solouki R.,Poursina Hakim Research Institute | Emami M.H.,Isfahan University of Medical Sciences
Journal of Research in Medical Sciences | Year: 2014

Background: Magnetic resonance cholangiography (MRC) has gained popularity for diagnosing primary sclerosing cholangitis (PSC). We determined the accuracy of MRC compared with endoscopic retrograde cholangiography (ERC) for diagnosing PSC. Materials and Methods: This retrospective case-control study was conducted on patients referred to an outpatient gastroenterology clinic from 2001 to 2013. Patients with established diagnosis of PSC who had undergone MRC and ERC within a 6-month interval were included. Controls were selected from patients who had undergone imaging for reasons other than PSC evaluation. Disease outcome at the study time and liver biochemistry data at diagnosis and 1-year thereafter were retrieved. Diagnostic accuracy of MRC in comparison with ERC was evaluated. Results: A total of 46 definite PSC patients (age at diagnosis = 36.8 ± 11.6 years, 33 male) were found. Diagnostic imaging for PSC was ERC alone in 12, MRC alone in 23, and ERC plus MRC in 11 patients. Controls were 89 patients mostly with bile stones. The sensitivity, specificity, and positive and negative likelihood ratios of MRC was 90.9%, 95.5%, 20.23, and 0.10, respectively. Early PSC was found more frequently by MRC compared with ERC (30.4% vs. 8.3%, P = 0.146). No significant difference was found between imaging modalities with regards to patients’ outcome (P = 0.786) or liver biochemistry at diagnosis or 1-year thereafter (P >0.05). Conclusion: Starting diagnostic imaging for PSC with MRC seems better and may provide diagnosis of PSC at its earlier phase. Further studies with larger sample of patients and longer follow-ups are warranted. © 2014, Isfahan University of Medical Sciences(IUMS). All rights reserved.


Roohafza H.,Isfahan University of Medical Sciences | Pourmoghaddas Z.,Isfahan University of Medical Sciences | Saneian H.,Isfahan University of Medical Sciences | Gholamrezaei A.,Poursina Hakim Research Institute
Neurogastroenterology and Motility | Year: 2014

Background: Antidepressants are effective in adults with pain-related functional gastrointestinal disorders. We investigated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP). Methods: Children with FAP, based on the Rome III criteria (n=115, aged 6-18years), were randomized to receive either citalopram 20mg/day or placebo for 4weeks. Treatment response was defined as ≥2 point reduction in the 6-point Faces pain rating scale or 'no pain'. Depression, anxiety, somatization, and physician-rated global severity and improvement were also evaluated. Patients were followed up for 8weeks after medication period. Key Results: Eighty-six patients completed the medication (43 in each group). Response rate in the citalopram and placebo groups based on per-protocol (intention-to-treat) analysis was 55.8% (40.6%) and 39.5% (30.3%) at week 4 (p=0.097 [0.169]) and 72.0% (52.5%) and 53.4% (41.0%) at week 12 (p=0.059 [0.148]), respectively. In per-protocol analysis, more reduction was observed in pain (F=3.84, p=0.024) and global severity scores (F=4.12, p=0.021) in the citalopram group compared with the placebo group over the study period. Such differences were not present in the intention-to-treat analysis. No difference was found between the two groups regarding change in depression, anxiety, or somatization score over the study. Conclusions & Inferences: Overall, we found a trend toward the effectiveness of citalopram in the treatment of children with FAP. Trials with longer treatment duration in larger samples of patients are required in this regard. © 2014 John Wiley & Sons Ltd.


Shahidi S.,Isfahan University of Medical Sciences | Moeinzadeh F.,Isfahan University of Medical Sciences | Mohammadi M.,Isfahan University of Medical Sciences | Gholamrezaei A.,Poursina Hakim Research Institute
Iranian Journal of Kidney Diseases | Year: 2011

Dermatological complications, especially skin infections, are very common following organ transplantation, and result in a lot of distress in the recipient. Herpes zoster, herpes simplex, and human papillomavirus infections are common infections in kidney transplant recipients, and therapeutic management is usually disappointing in immunosuppression state. We report here 2 cases of kidney transplant recipients who developed diffuse human papillomavirus-induced cutaneous warts with no response to conventional treatments. According to similar reports in organ transplant recipients, we modified the immunosuppressive regimen by converting to sirolimus, which led to a rapid relief from cutaneous warts in both patients. This evidence along with other case reports suggest that conversion to sirolimus may be considered as an effective strategy in cases of giant or multiple viral warts in kidney and perhaps other transplant recipients.


Sajjadi M.,Tehran University of Medical Sciences | Gholamrezaei A.,Poursina Hakim Research Institute | Daryani N.E.,Tehran University of Medical Sciences
Digestive Diseases and Sciences | Year: 2015

Background: Adenosine deaminase activity is proposed as a marker of inflammation in some inflammatory conditions. Aims: To investigate the association of serum adenosine deaminase activity and disease activity in Crohn’s disease patients. Methods: In a cross-sectional study, 30 consecutive known cases of Crohn’s disease (15 with active disease and 15 in remission) referring to a university hospital in Tehran (Iran) and 15 age- and gender-matched healthy controls were studied. Disease activity was assessed using the Crohn’s disease activity index (cutoff >150). Total serum adenosine deaminase activity, C-reactive protein, erythrocyte sedimentation rate, and fecal calprotectin were evaluated in patients. Serum adenosine deaminase activity was measured in controls. Results: Mean age of the patients was 36.8 ± 12.6 years, and 56.7 % were male. Serum adenosine deaminase activity in patients with active disease, patients in remission, and controls was 12.3 ± 5.9, 14.6 ± 6.2, and 11.9 ± 6.4 U/L, respectively (P = 0.458). Compared with patients in remission, those with active disease had higher erythrocyte sedimentation rate (40.4 ± 30.6 vs. 16.9 ± 16.0 mm/h, P = 0.014) and higher frequency of positive C-reactive protein (66.6 vs. 13.3 %, P = 0.004) and positive fecal calprotectin tests (86.6 vs. 33.3 %, P = 0.004). Serum adenosine deaminase activity was not correlated with erythrocyte sedimentation rate (r = 0.05, P = 0.761) and was not different between patients with positive and negative C-reactive protein (12.2 ± 5.4 vs. 14.2 ± 6.5 U/L, P = 0.393) and fecal calprotectin tests (11.7 ± 5.3 vs. 16.0 ± 6.5 U/L, P = 0.063). Conclusions: In patients with Crohn’s disease, serum adenosine deaminase activity is not associated with clinical disease activity or with other inflammation markers and cannot be suggested as an inflammation marker. © 2015, Springer Science+Business Media New York.


Heidari R.,Isfahan University of Medical Sciences | Sadeghi M.,Isfahan University of Medical Sciences | Talaei M.,Poursina Hakim Research Institute | Rabiei K.,Isfahan University of Medical Sciences | And 2 more authors.
Diabetology and Metabolic Syndrome | Year: 2010

Introduction. There is a remarkable increase in cardiovascular disease after menopause. On the other hand, metabolic syndrome as a collection of risk factors has a known effect on cardiovascular diseases. Hormone changes are considered as one of the main relevant factor regarding cardiovascular disease as well as some recognized relationship with metabolic syndrome's components. This study was carried out in order to search for prevalence of metabolic syndrome during menopausal transition. Method. In a cross sectional study in urban and rural areas of Isfahan, Najafabad and Arak cities, 1596 women aged more than 45 years were investigated using Isfahan Healthy Heart Program's (IHHP) samples. Participants were categorized into three groups of pre-menopause, menopause and post-menopause. Leisure time physical activity and global dietary index were included as life style factors. The association of metabolic syndrome and its components with menopausal transition considering other factors such as age and life style was analyzed. Results. there were 303, 233 and 987 women in premenopausal, early menopausal and postmenopausal groups respectively. Metabolic syndrome was found in 136(44.9%) premenopausal participants and significantly increased to 135(57.9%) and 634(64.3%) in early menopausal and postmenopausal participants respectively, when age was considered (P = 0.010). Except for hypertension and hypertriglyceridemia, there was no significant difference between three groups of menopausal transition when metabolic syndrome's components were considered. Conclusion. In contrary to the claims regarding the role of waist circumference and blood glucose in increasing of metabolic syndrome during the menopausal transition, this study showed this phenomenon could be independence of them. © 2010 Heidari et al; licensee BioMed Central Ltd.


Saneian H.,Isfahan University of Medical Sciences | Tavakkol K.,Azad University | Adhamian P.,Poursina Hakim Research Institute | Gholamrezaei A.,Poursina Hakim Research Institute
Journal of Research in Medical Sciences | Year: 2013

Background: Functional constipation is one of the most prevalent childhood gastrointestinal disorders. We evaluated effects of adding a probiotic to mineral oil in the treatment of functional constipation in children. Materials and Methods: This controlled trial was conducted on 60 children (2 to 14 years old) with functional constipation (Rome III criteria). Children were allocated to receive the synbiotic (Lactol®, composed of Lactobacillus Sporogenes, 1 Tab/20 kg/d) plus mineral oil (Paraffin 1 ml/kg/d) or the mineral oil alone for two months. Symptoms of constipation including defecation frequency, stool form, strain and pain at defecation, incomplete evacuation and soiling were assessed and compared before and after the intervention. After the treatment period, the two groups were also compared with regards to subjective global assessment of improvement. Results: After the treatment, stool frequency increased in both groups (P < 0.001), with greater increase in synbiotic + mineral oil group (P = 0.001). Frequency of hard/very hard stool and frequency of painful defecation decreased similarly in both groups (P < 0.001). Straining at defecation, incomplete evacuation, and soiling decreased in both groups (P < 0.001), but more decrease was seen in the synbiotic + mineral oil group (P < 0.05). Finally, there was a better global improvement in the synbiotic + mineral oil group (P < 0.05). No severe side-effects were observed in any group. Conclusion: Adding the synbiotic Lactol® (containing Lactobacillus Sporogenes) to mineral oil can increase the improvement in the constipation symptoms of children without specific side-effects.


Pourmoghaddas Z.,Isfahan University of Medical Sciences | Saneian H.,Isfahan University of Medical Sciences | Roohafza H.,Isfahan University of Medical Sciences | Gholamrezaei A.,Poursina Hakim Research Institute
BioMed Research International | Year: 2014

We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP). Children with FAP (n = 115, aged 6-18 years) received mebeverine (135 mg, twice daily) or placebo for 4 weeks. Response was defined as ≥2 point reduction in the 6-point pain scale or "no pain." Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine). Per-protocol and intention-to-treat (ITT) analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol [ITT] analysis was 54.5% [40.6%] and 39.5% [30.3%] at week 4 (P = 0.117 [0.469]) and 72.7% [54.2%] and 53.4% [41.0] at week 12, respectively (P = 0.0503 [0.416]). There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks (P = 0.723) or after 12 weeks (P = 0.870) in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted. © 2014 Zahra Pourmoghaddas et al.


Saneian H.,Isfahan University of Medical Sciences | Pourmoghaddas Z.,Isfahan University of Medical Sciences | Roohafza H.,Isfahan University of Medical Sciences | Gholamrezaei A.,Poursina Hakim Research Institute
Gastroenterology and Hepatology from Bed to Bench | Year: 2015

Aim: We evaluated the effectiveness of a synbiotic in the treatment of childhood functional abdominal pain (FAP). Background: Probiotics are effective in the treatment of functional gastrointestinal disorders in adult patients, but there is lack of information in children. Patients and methods: Children with FAP, based on the Rome III criteria (n = 115, aged 6-18 years), were randomized to receive either synbiotic (Bacillus coagulans, Unique IS-2, 150 million spore plus FOS, 100 mg) twice daily or placebo for four weeks. Treatment response was defined as ≥ 2-point reduction in the 6-point self-rated pain scale or "no pain". Physician-rated global severity and improvement were also evaluated. Patients were followed for a total of 12 weeks. Results: Eighty-eight patients completed the trial (45 with synbiotic). Response rate was higher with synbiotic than placebo after medication (60% vs. 39.5%, P = 0.044), but was not different between the two groups at week 12 (64.4% vs. 53.4%, P = 0.204). Difference between the two groups regarding the physician-rated global severity over the study period was not statistically significant (z = -1.87, P = 0.062). There was no significant difference between the two groups in physician-rated global improvement (week 4, P = 0.437; week 12, P = 0.111). Receiving synbiotic (OR 2.608, 95% CI: 1.01-6.68) and baseline pain score (OR 2.21, 95% CI: 1.19-4.10) were predictors of treatment response after medication. Conclusion: The synbiotic containing Bacillus coagulans and FOS seems to be effective in the treatment of childhood FAP. Further trials are recommended in this regard. © 2015 RIGLD, Research Institute for Gastroenterology and Liver Diseases.


Bonakdar Z.S.,Isfahan University of Medical Sciences | Jahanshahifar L.,Isfahan University of Medical Sciences | Jahanshahifar F.,Isfahan University of Medical Sciences | Gholamrezaei A.,Poursina Hakim Research Institute
Lupus | Year: 2011

Evidence has shown a relationship between vitamin D deficiency and systemic lupus erythematosus (SLE). We evaluated the frequency of vitamin D deficiency and its association with disease activity in new cases of SLE. Women with newly diagnosed SLE, based on the American College of Rheumatology (ACR) criteria, were enrolled consecutively. Those receiving vitamin D supplements and postmenopausal women were not included. Disease activity was measured by the BILAG index (2004) and serum concentration of 25-hydroxyvitamin D (25[OH]D) was measured by radioimmunoassay method. Forty SLE patients with mean age of 25.3 ± 4.2 years were studied. Severe, moderate, and mild vitamin D deficiency, corresponding to serum 25[OH]D concentrations of <12.5, 12.5-24.9, and 25-39.9 nmol/l, were found in 12.5%, 62.5%, and 17.5% of the patients, respectively. Serum 25[OH]D concentration was inversely correlated with the British Isles Lupus Assessment Group (BILAG) index score (r = -0.486, p = 0.001). Those with a more severe vitamin D deficiency had also higher concentrations of liver enzymes (p < 0.05), lower serum albumin and hemoglobin concentrations (p < 0.05), and higher titers of antibodies to double-stranded DNA (ds-DNA) (p < 0.001). This study showed that most of the SLE patients in our society have vitamin D deficiency at the time of diagnosis that is associated with a higher disease activity. Routine screening for vitamin D deficiency and its prompt treatment in patients with newly diagnosed SLE is recommended. © The Author(s), 2011.

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