ali akbar hajiaghamohammadi

 Currently, no therapeutic or surgical treatment for non-alcoholic fatty liver disease (NAFLD) has been officially approved. This is a serious void in the medical field given the increasing prevalence of NAFLD cases in developing countries. Our study compared the therapeutic effect of metformin, melatonin and vitamin E on serum parameters that are associated with NAFLD pathogenesis.

 This randomized clinical trial was performed on 140 patients with NAFLD who were referred to the central hospital of Qazvin. Patients were assigned randomly into four groups. The first group received metformin (500mg daily) with two placebos, the second group received melatonin (10mg daily) with two placebos, the third group received daily 800 IU vitamin E with two placebos and the fourth group received three placebos daily. All four groups were placed on the same diet regimen and had the same lifestyle changes to increase their daily activity time. Ultrasonography was used for the evaluation of the appearance of liver. Weight, BMI, AST, ALT, lipid profile and FBS were measured at baseline, 3 months and 6 months later.

 All of the therapeutic agents caused a decrease in aminotransferases but metformin was also more potent in improving lipid profiles. A significant difference in LDL was obtained by melatonin (mean change in the control vs. melatonin 15.9; P=0.032) and AST (mean change in control vs. melatonin -18.3; P<0.001). Metformin improved liver appearance in ultrasonography imaging better than the other treatments (P=0.043).

 Metformin can be considered an effective medication but melatonin may accelerate the healing process in NAFLD patients.

There is no current and broad consensus about the eradication of Helicobacter pylori (HP) infection in gastric ulcer and indigestion diseases.

This study aimed to compare three regimens based on clarithromycin, furazolidone, and levofloxacin in patients with HP infection.

This study was a randomized clinical trial examining 102 patients with gastrointestinal diseases. They were randomly assigned to three equal groups. In the first group, basic medication (i.e., a combination of esomeprazole 40 mg and amoxicillin 1000 mg) with clarithromycin 1000 mg was prescribed. The second group was treated with basic medication regimen along with furazolidone 400 mg. And the third group was given the basic medication with levofloxacin 500 mg. Eradication rates of the HP infection and incidence rates of drug side- effects in the three groups were compared after two-week and the obtained data were analyzed using appropriate statistical methods.

According to our study results, the HP infection eradication rates revealed by the per- protocol (PP) and intention-to-treat (ITT) analyses for the levofloxacin group were 91.2% and 93.8%, respectively, which were significantly different from those found for the furazolidone group by PP analysis and for the clarithromycin group by PP and ITT analyses ( P < 0.05). Moreover, there were no significant differences among the three groups regarding the side effects (P > 0.05).

It was concluded that two-week regimen of levofloxacin together with a single-dose of esomeprazole and amoxicillin was desirable (90%-95%) and more effective than furazolidone and clarithromycin in eradicating

Irritable Bowel Syndrome (IBS) is a type of intestinal dysfunction. Oxidative stress plays a significant pathological role in this disease. Ellagic acid (EA) as a dietary polyphenol is known to have antioxidant effects. This study was designed to investigate the effect of ellagic acid supplementation on quality of life in patients with IBS.

A randomized double blind placebo-controlled clinical trial was carried out in 44 patients with IBS in Qazvin University of Medical Sciences, Iran 2019. The participants were randomly allocated to receive either a capsule containing 180 mg EA per day (n=22) or placebo, a capsule containing 180 mg wheat flour, (n=22) for 8 weeks. At the beginning and end of the study, demographic characteristics and frequency of physical activity were recorded, and 24-hour dietary recall index and the Irritable Bowel Syndrome Quality of Life (IBS-QOL-34) questionnaire were completed. Data analysis was performed in SPSS V20.

At the beginning and end of the study, there were no significant differences between the two groups in anthropometric indices, food intake, and physical activity (P>0.05). At the end of the study, EA consumption significantly decreased the mean IBS-QOL total score compared to baseline and significantly increased quality of life (P<0.05). The study showed no significant change in the quality of life in the placebo group (P>0.05).

According to this study, dietary polyphenols such as ellagic acid improve bowel function, possibly by reducing oxidative stress, thereby improving the quality of life in patients with IBS. (Clinical Trials Registry Number: IRCT20141025019669N11)

The purpose of this study was to evaluate the effects of probiotic and alpha-lipoic acid (ALA) supplements, on appetite in overweight people.

This study included two phases of weight loss (8 weeks) and weight maintenance (16 weeks). Eighty-eight overweight people were randomly divided into 4 groups: Isocaloric diet with probiotic (500mg), isocaloric diet with ALA (600mg) and probiotic, isocaloric diet with ALA and isocaloric diet with placebo groups. In the second phase, the participants received normal diet with the above - mentioned supplements. At the beginning and end of the first phase and at the end of the second phase, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), body fat percentage, C-reactive protein (CRP), and appetite were evalauted. We used SPSS software for statistical analysis. Independent sample t-test and ANOVA were used to compare the alterations in the mean values among the groups.

At the end of the first phase, the level of anthropometric changes, inflammatory factor and appetite were significant in the intervention groups, but these changes were higher in the probiotic + ALA group than in the other groups (P <0.05). At the end of the second phase we found significant changes only in the probiotic + ALA group (P<0.05).

Addition of probiotic and ALA supplements to the normal diet can be effective in appetite and weight management and also maintainance of weight loss which may be due to decreased inflammation.

Inflammatory bowel disease (IBD) as a chronic and debilitating disease is affected by sleep disturbance which increases the risk of malignancy. Sleep disturbance is more common in irritable bowel syndrome (IBS) and few reported studies have assessed its role in IBD. We evaluated the effect of IBS on sleep quality and quality of life (QOL) of IBD patients in clinical remission. In a cross‑sectional study, 115 IBD patients in clinical remission aged from 14 to 70 years referred to gastroenterology outpatient departments and private gastroenterology offces from 2007 to 2016. Patients considered in four groups (with/without IBS). The Revised “Rome III criteria” used for diagnosing IBS. Pittsburgh Sleep Quality Index questionnaire and the health‑related QOL questionnaire used for evaluating sleep quality and QOL. About 85 (73.9%) cases had ulcerative colitis (UC) and 30 (26.1%) cases had Crohn’s disease (CD). Forty (34.8%) cases had IBD + IBS. Poor sleep quality in UC + IBS (OR: 0.018, P = 0.003) and UC (OR: 0.016, P = 0.002) was less than CD. Diseases extent in left side colitis (OR: 0.064, P = 0.016) were less than with pancolitis. Sleep quality affected by quality of life (IBDQ) (P = 0.048). Mean quality of life (IBDQ) in patients who had poor sleep was 11% less than those with good sleep. The syndrome of IBS affects the sleep quality of IBD in clinical remission, especially in CD. Its additive effect with IBD may worsen symptoms that correlated with sleep disturbance, such as pain, psychological and physical condition, and QOL.

Cirrhosis as the final stage of progressive fibrosis of liver can affect other organs such as lungs, kidneys and heart. "Cirrhotic cardiomyopathy" involves the electrophysiological abnormalities such as QT interval prolongation. We assessed correlation between corrected QT interval prolongation and severity of cirrhosis based on Child Classification in each ECG lead.
In this case-control study, the patients attending the outpatient clinic and inpatient department of internal medicine of Velayat Hospital in Qazvin were enrolled from September 2014 to July 2015. Total samples were 74 patients, half of which were used as controls. Cirrhosis severity was determined as per Child Classification. Both groups had Ca2, Mg2, K tested and 12- lead ECG was obtained. The QT interval was corrected by two different formulas: (1) QTc=QT/√RR (QTc1); (2) QTc=QT.75 (heart rate-60) (QTc2). To analyze the data, the software SPSS Version 16 and Mann-Whitney, Pearson’s chisquare test-Kruskal-Wallis, and t-tests were used.
The mean of QTc1 and QTc2 was longer in cirrhotics than the control group. There was a significant correlation between Child score and length of QTc1 in leads: III (p=0.032), AVL (p=0.041), V2 (p=0.049), V6 (p=0.015). There were significant differences in length of QTc1 in leads: V3 (p=0.031) and V6 (p=0.021); and QTc2 in lead V3 (p=0.039) between Child Classification.
Cirrhosis can induce QTc interval prolongation. Lead V3 has statistically significant correlation with the severity of cirrhosis based on child classification. We propose that QT interval prolongation be added as a criterion for prioritizing liver transplantation.

Helicobacter pylori (H.pylori) infection causes multiple upper gastrointestinal diseases but optimal therapeutic regimen which can eradicate infection in all the cases has not yet been defined. This study was designed to evaluate the efficacy of triple levofloxacin-based versus clarithromycin-based therapy.
In this open-label randomized clinical trial study 120 patients who had esophagogastroduodenoscopy (EGD) with positive rapid urease test (RUT) were enrolled and divided into 2 groups. Case group was treated with levofloxacin (500 mg daily) plus amoxicillin (1 gr twice a day) plus omeprazole (20 mg daily) for 2 weeks. Control group was treated with clarithromycin (500 mg twice a day) plus omeprazole (20 mg daily) for 2 weeks. After the main course of treatment, they received maintenance treatment with omeprazole for 4 weeks. Stool antigen test was performed on them after two weeks of not having any medicine.
H.pylori eradication (intention to treat analysis) was successful in 75% of case group and 51.7% of control group showing a significant difference (P=0.008). H.p infection eradication (per-protocol analysis) was successful in 80.4% in case group and 57.4%% in control group showing significant difference (P=0.009). Drugs adverse effects causing discontinuation treatment were seen in 5% of case group and 3.3% of control group which have not shown a significant difference between the two groups (P=0.648).
Triple therapy with levofloxacin-based regimen has better efficacy than clarithromycin-based regimen and as safe as it is.

Ezetimibe inhibits the resorption of dietary and biliary cholesterol in the small intestine and decreases insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD). Acarbose has been used in type 2 diabetes mellitus and metabolic syndrome. This study aims to compare the therapeutic effects of ezetimibe and acarbosein decreasing liver transaminase levels in patients with NAFLD. This was a single center, double-blind, parallel-group study conducted at Bu-Ali Sina Hospital, Qazvin, Iran. In this trial, we enrolled, by simple randomization, a total of 62 patients diagnosed with NASH. There were 29 patients treated with ezetimibe and 33 who were treated with acarbose over a ten-week period. Ezetimibe treatment significantly reduced ALT, AST, triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-sensitivity C-reactive protein (hsCRP), and serum insulin levels and the insulin resistance homeostasis model assessment (HOMA-IR) index compared to patients treated with acarbose (p)Both ezetimibe and acarbose improved metabolic and biochemical abnormalities in patients with NASH, however these effects were more prominent with ezetimibe.