مقالات رزومه دکتر نجمه سادات آل طه

Infiltration of IgG4 positive plasma cells has been detected in the colonic mucosa of patients with ulcerative colitis (UC). The aim of the study was to investigate the association between colonic mucosal infiltration of IgG4 plasma cells and the presence, activity, extension, and duration of UC.

In this case-control study (2009-2014), 102 subjects (84 with UC/18 controls) were enrolled. Clinical records and rectosigmoid biopsies of UC patients were selected, and biopsies were stained with IgG4 monoclonal antibodies. IgG4 positive plasma cells were counted by a single pathologist.

Amongst 84 patients with UC, 73.8% had UC without primary sclerosing cholangitis (PSC), and 26.2% had UC with PSC. IgG4 plasma cells were seen in 35 (41.7%) patients with UC and 0% of controls (p = 0.001). The mean amount of IgG4 containing plasma cells was significantly different between active and inactive patients with UC, although it was not significantly different between UC patients with and without PSC. The presence of IgG4 infiltration was significantly associated with the extension and duration of the disease. Furthermore, IgG4 count had a sensitivity/specificity of 78.6%/83.3% for the diagnosis of UC.

Our study revealed the diagnostic role of IgG4 plasma cells in the colonic mucosa of patients with UC and its association with activity, extension, and duration of disease.

From mid-December of 2019 a newly diagnosed Corona virus with a highly human to human transmission rate was discovered in china which rapidly involved many countries and became pandemic. Although most infected cases are mild but this virus can cause severe lung injury which lead to severe mortality and morbidity. The mortality rate of this virus is high in immunosuppressed patient or with previous medical disorder. Many Inflammatory bowel disease patient are using immunosuppressive or immunomodulating agents which has raised the concern of severe disease in these patients.

Long non-coding RNAs (lncRNAs) associated with various cancers, including colorectal cancer (CRC), could be collected from body fluids easily. Our aims were to determine the expression level of HOTTIP lncRNA in plasma samples of healthy individuals and CRC patients as well as their relationship with clinico-pathological characteristics of patients. First, total RNA was extracted from the plasma samples of 100 subjects including 50 patients and 50 age and sex matched healthy persons. Then, gene expression was measured using real-time PCR technique. The sensitivity and specificity of HOTTIP dysregulation in CRC and healthy individual’s plasma was measured by receiver operating characteristic (ROC) analysis. As compared with healthy controls, HOTTIP lncRNA was over expressed in a statistically significant manner in plasma samples of patients (P = 0.001). Significant relationship between HOTTIP expression and positive family history of CRC was observed, too (P = 0.04). The ROC curve analysis showed an AUC value of 0.775, a specificity of 82%, a sensitivity of 76%, with a cut off value equal to 2.40 (P = 0.001). HOTTIP transcript can be proposed as a new biomarker for early diagnosis due to the increased expression in plasma samples of patients with CRC and the relatively high sensitivity and specificity.

Patients with a stoma have a 5% developing parastomal varices chance, which tend to repetitive massive and life-threatening hemorrhages. Treatment of choice in parastomal varices have not been established, and Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been revealed as the most successful measure.We report a hemodynamically unstable patient with the history of Ulcerative Colitis (UC) & Primary Sclerosing Cholangitis (PSC) with colostomy, because of colon cancer who presented with massive parastomal bleeding. Non-operative treatments and TIPS was failed to control the symptoms. Color Doppler ultrasound showed a hepato-fugal flow. The direct antegrade technique, using Sodium Tetradecyl Sulfate (STS 1%) and glue-Lipiodol, was applied under ultrasonography guidance, and complete stoppage of bleeding was achieved. No immediate or late complication or follow-up recurrence were noted after 2 month.In case of hepatofugal flow, direct percutaneous mesenteric parastomal venous access, and sclerotherapy is a rapid and relatively safe procedure for parastomal variceal bleeding.

Polycythemia vera (PV) is classified as a myeloproliferative disorder (MPD). Such patients are prone to both thrombotic and hemorrhagic events. Although gastrointestinal (GI) bleeding is not a prominent manifestation of PV, it would be life threatening and necessitating hospital admission and blood transfusion if it occurs. GI hemorrhage in these patients may be due to Aspirin usage, peptic ulcer disease (PUD), acquired VonWillbrand disease, Dieulafoy lesion (DL), Mallory Weiss tear, and esophageal and gastric varices. DL is an enlarged, thick-walled artery in the muscularis mucosa with a small submucosal defect. In this case report, we describe a 65-year-old man with history of PV presented with a massive upper GI bleeding. After a therapeutic endoscopic hemostasis failure and reoccurrence of bleeding during hospital admission, an abdominal computed tomography (CT) was ordered, which revealed an aberrant artery originated from aorta directly into the stomach. An angiographic embolization was considered for the patient, which was successfully performed. Our patient was complicated by splenic infarction due to splenic collateral arteries embolization and the overwhelming thrombotic tendency of the patient himself due to the history of PV. Fortunately, our patient’s signs and symptoms responded to supportive therapies and eventually he discharged well.

A dramatic rise in the rate of clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has been reported in recent years.   In this observational case control study, 65 patients were included and were divided into two groups of IBD+CDI as case group and IBD without CDI as control group.   35 patients who had positive test for clostridium difficile were assigned to the case group. The control group consisted of 30 patients with negative test for clostridium difficile. Pancolitis was seen in the cases more statistically significant than the controls and proctitis was seen more among the controls than the cases (p =0.001). The cases were on immunosuppressive (p=0.001) and antibiotic (p =0.02) therapy more than the controls. Colonoscopic findings revealed more severe and extensive inflammation among the cases versus milder inflammation among the controls, but these differences were not statistically significant (p =0.2). Colectomy was seen in 10% of controls and none of the cases and this difference was statistically significant (p value=0.05). More fecal calprotectin were seen among the cases than the controls and this difference was statistically significant (p <0.05)   This study showed more clostridium difficile infection among the patients on antibiotic or immunosuppressive therapy. Pathological investigation revealed more severe and extensive inflammation among the cases than the controls. Cases had clinically more severe signs and symptoms with higher mayo scores than the controls. ESR(erythrocyte sedimentation rate) and fecal calprotectin were higher in patients with positive clostridium difficile infection and serum albumin was lower in such patients.

This letter was written because of the high incidence of acute hepatitis A in our hospital in this period of time. In December 2016 and January 2017, eight patients with acute hepatitis A were admitted to Gastroenterology Ward of Imam Hospital. Some of them had acute liver failure and fulminant hepatitis.

Biliary papillomatosis is a disorder characterized by numerous adenomatous polyps of variable distribution and extent in intrahepatic bile ducts. It should be considered as a premalignant condition because a high proportion of the lesions undergo malignant transformation. In this report, we present a patient with abdominal pain and jaundice.
According to his presenting signs and symptoms, ERCP was done for him and multiple biopsies were taken from the common bile duct. Due to high grade dysplasia in the pathological report, Whipple surgery was performed and specimens were sent for microscopic evaluation. Histological examination showed intraductal biliary papillomatosis.

Improvements in imaging techniques has led to an increase in the number of diagnosed pancreatic cysts. Although most of the detected cases are benign, a significant percentage of them are malignant or are potentially malignant. Currently, endosonography, and analysis of cyst morphology, fine needle aspiration (FNA) of the cyst contents, and measurement of the amylase and carcinoembryonic antigen (CEA) levels of the aspirated fluid are the common methods used for evaluating such lesions (80% accuracy in the final diagnosis). We have used these same techniques to analyze cystic lesions of the pancreas, in two referring centers in Iran.
This is a descriptive case series study. In addition to demographic information and findings of the cystic morphology, we determined the cytology of the centrifuged sediments of cystic fluid aspirations, and the amylase and CEA levels of the fluid.
Sixty eight patients were included in the study with an average age of 51 years. 68% of the participants were female (n=46). Analysis of the lesions was performed based on the cytology findings as well as the other results (CEA, amylase, cyst morphology, and history of pancreatitis). The patients who were diagnosed as having pseudocysts were the youngest group, with an average age of 41 years, and those with cystic adenocarcinoma were the oldest group, with an average age of 62 years. The most common types of lesions were pseudocysts (n=18, 26.5%), mucinous cystic neoplasms (n=11, 16%), serous cyst adenomas (n=10, 14.7%), intraductal papillary mucinous neoplasms (n=9, 13.2%), and cystic adenocarcinoma (n=9, 13.2%). The most common location of cysts was the head of pancreas (n=25, 35.2%). Excluding the neuroendocrine tumors, all other types of lesions were more common in women than men. Septation in the cysts was observed in cystic adenocarcinomas, serous cystadenomas, and intraductal papillary mucinous neoplasms (IPMNs). Lesions smaller than 2 cm were found most frequently in IPMNs, endocrine tumors, and simple tumors whilst pseudocysts were all greater than 2 cm in maximum diameter.
47% of the patients in this study had malignant or premalignant lesions, which despite being asymptomatic, they needed follow-up imaging or surgery. Endosonography played an important role in the diagnosis of the cystic tumors of the pancreas. Diagnosis of premalignant lesions and providing appropriate treatment increase patients’ life expectancy. Diagnosis of benign cysts, leads to fewer unnecessary surgeries.

Annular pancreas (AP) is a rare congenital abnormality in which pancreatic tissue completely surround the duodenum. Presentation of AP in adulthood is very rare and obstructive jaundice is one of the uncommon manifestations of AP in adults. Herein; we reported a 47 years old woman who presented with icterus, mid common bile duct stricture and annular pancreas. She was diagnosed as pancreas cancer three months after surgery. Although AP presenting with jaundice is rare but is indicative of significant relationship with periampullary malignancies and requires a complete investigation of these cancers and close follow up.

the aim of this study was to investigate the necessity of screening for celiac disease in idiopathic osteoporotic patients. Osteopenia and osteoporosis are well-known and prevalent complications of celiac disease. However, the relative prevalence of celiac disease among osteoporotic populations is not known, and the benefit of screening for celiac disease among the osteoporotic population remains controversial.Patients and We evaluated a total of 560 individuals, 460 with osteoporosis and 100 healthy subjects, from the rheumatology clinic in Imam Khomeini and Shariati hospital by IgA anti-tissue transglutaminase (anti-tTG) for celiac disease. Then individuals with positive serologic test underwent upper GI Endoscopy & 2nd part duodenum biopsies. The clinical findings were evaluated in both groups and were compared with each other. Five (1.08%) of 460 patients with osteoporosis and 1 (1%) of 100 subjects without osteoporosis had celiac disease by positive serologic & pathology results. Three patients with positive serology & pathology results were female. All patients in osteoporotic group had at least one other symptom of celiac disease. Two of them had anemia and others had chronic abdominal pain, recurrent oral aphtous lesion & chronic bloating. In the present study, the prevalence of celiac disease in osteoporotic patients is not high enough to justify recommendation for serologic screening of celiac disease in all patients with idiopathic osteoporosis; but in osteoporotic patients with other celiac or gastrointestinal symptoms and signs, for example iron deficiency anemia, chronic dyspepsia and bloating, constipation or diarrhea and recurrent aphtous lesions, it is necessary to evaluate for celiac disease.

Currently, non-invasive methods for screening atrophic gastritis and gastric cancer are lacking. The purpose of this study was to evaluate the value of serological parameters including serum pepsinogen I (PGI), pepsinogen II (PGII) and pepsinogen I: II ratio for the screening atrophic gastritis and gastric cancer. The study population consisted of 132 dyspeptic patients who had undergone upper endoscopy with biopsy. Blood samples for ELISA assays of serum PGI, PGII and IgG antibodies against Helicobacter pylori were drawn. Comparison between the two groups was done by Student’s t- test, and Mann Whitney test. Cut-off points were calculated using receiver operating curves (ROC). Mean (±SD) age of the study population was 51.4 (±15.5) years. Values of PGI and PG ratio decreased significantly in the atrophic gastritis as compared with the control group (p<0.05). Values of PG and PG ratio didn’t show any significant difference between the gastric cancer and control group (p>0.05). For patients with atrophic gastritis, the area under the ROC for PGI was 0.639 (95% CI:0.538-0.741, p=0.008) in which the best cut-off value was 40μg/L (sensitivity 90%, specificity 67%, accuracy 69%, negative predictive value 92%, YI: 0.429). The area under the ROC for PG ratio was 0.711 (95% CI: 0.617–0.806, p 0.0001) and the best cutoff value was 8 (sensitivity 71%, specificity 71%, accuracy 71%, negative predictive value 86%,YI: 0.431). It seems that PGI, PGI: PGII ratio is potential biomarkers for screening atrophic gastritis with high sensitivity, specificity, accuracy and negative predictive value. Serology could be used as a screening method for the detection of precancerous states due to its convenience, relative low cost and safety.

Polycystic ovarian syndrome (PCOS) is a condition associated with chronic anovulation, insulin resistance and androgen excess. Women with this syndrome are at increased risk of metabolic syndrome. The aim of the present study was to determine the prevalence of metabolic syndrome (MBS) in women with PCOS referred to Arash Hospital in different ages and body mass index (BMI). A cross-sectional study was conducted in Gynecologic Clinic at Arash Hospital affiliated with Tehran University. A total of 282 women with PCOS ages between 15-40 years were included. The prevalence of Metabolic Syndrome and its components in this population were the main outcomes. Height, weight, waist circumference, blood pressure and laboratory tests (FBS, TSH, HDL-C, serum prolactin, triglycerides and total cholesterol) were measured in this population. The prevalence of MBS in PCOS women was 22.7% (64 cases). The rate of central obesity, FBS more than 110 mg/dl, triglycerides more than 150 mg/dl, high-density lipoprotein cholesterol levels (HDL-C) less than 50 mg/dl, and blood pressure? 130/85 mmHg in PCOS women was 31% (87), 3.2% (9), 33% (93), 68.8% (194), and 10.6% (30), respectively. The risk of MBS was increased in older and the obese women (BMI? 30 kg/m2). The present sample showed women with PCOS have a high prevalence of MBS and its individual components, particularly decreased HDL-C.