amir sadeghi

Predicting capital market behavior has always been one of the challenges for market participants. Over the years, trends forecasting methods have evolved and knowledge of predicting behavior and stock prices is still evolving. It is important to analyze the past behavior of stock prices based on technical methods. The technical method is often focused on price changes, moving averages and trading volume. In this research, we have tried to study the trading ratios based on table reading and analyze the past behavior and movements of real traders in the form of Lasso linear regression.Over the years, trends forecasting methods have evolved and knowledge of predicting behavior and stock prices is still evolving. It is important to analyze the past behavior of stock prices based on technical methods. The technical method is often focused on price changes, moving averages and trading volume. In this research, we have tried to study the trading ratios based on table reading and analyze the past behavior and movements of real traders in the form of Lasso linear regression.

Appropriate and practical indicators are crucial for evaluating NGO performance. NGOs can understand strengths and weaknesses by determining indicators. They can measure performance conformity and take effective steps for improvement. There was no tool to measure NGO performance in Iran's health system. The present study aims to identify and confirm evaluation indicators. The study will use expert and university manager opinions in 2022.

A cross-sectional study conducted in 2022 on 1000 health NGOs. We designed the model and determined its content validity using the Delphi technique. The Delphi technique involved 3 rounds and the participation of 20 experts. Factor analysis measured the structural validity of the model. It involved exploratory and confirmatory analysis. Cronbach's alpha coefficient determined the reliability of the validation model. Data analysis done with Excel2013, Spss26 and Lisrel8.80 software.

The initial questions of the model confirmed to have content validity based on the CVI = 0.775 index. The exploratory factor analysis results revealed a model with 7 dimensions. These dimensions were “International relations, Communication, Volunteering, Education, Successful models, Transparency and accountability, and Financial”. The model also includes 56 items. Based on the goodness of fit, the obtained model was reliable to measure the performance of NGOs (RMSEA=0.029).

The validation model is reliable. It measures NGOs performance in Iran.

LARG supply chain methods consist of lean, agile, resilient and green methods, which are among the most widely used supply chain management approaches in today's world. These methods are used in order to improve performance and increase the efficiency and effectiveness of an organization. Therefore, the purpose of this research is to present a LARG supply chain model in defense organizations.

This research is applied in terms of purpose and exploratory in terms of qualitative method. The information sources of the research are the published scientific articles and documents, as well as interviews with experts of defense organizations, which have been analyzed using the database method (Glaser's Emerging Approach) and with the help of MAXQDA software. The statistical population of the research in the interview phase was 􀀔􀀘 individuals among experts in Logistics and Support Deputy who were selected purposefully and judiciously using the snowball method.

From the analysis of related articles, documents and interviews, 􀀕􀀕􀀖 primary codes were extracted, which were identified in a multi-step process of coding, indicators, components and model dimensions.

The most important factors of the lean, agile, resilient and green supply chain are managerial factors, human resources, resources and equipment, process factors, organizational factors, technical and technological capabilities, in order of priority.

This study aimed to investigate whether transdiagnostic treatment as well as acceptance and commitment therapy (ACT) could improve treatment adherence and alleviate gastrointestinal symptoms plus perceived stress in patients suffering from irritable bowel syndrome.

Research has shown that people with chronic diseases often have negative attitudes toward medications, especially when they also have psychiatric disorders. This, along with the complex dosing requirements and inadequate knowledge about medication adherence among irritable bowel syndrome patients, can affect the treatment efficacy.

A randomized clinical trial was conducted using a pre-test-post-test design. The statistical population included patients with irritable bowel syndrome referring to Taleghani Hospital in Tehran between winter 2021 and spring 2022. Convenience sampling was used to select 30 individuals, with 15 people assigned to each group. Two types of psychotherapy were provided online and individually to the participants. The desired treatments were given to the transdiagnostic treatment and ACT groups in eight weekly sessions of 45-60 minutes.

There was no significant difference between the transdiagnostic treatment pre-test and ACT regarding perceived stress, medication adherence, and gastrointestinal symptoms (P>0.05). There was no significant difference either between the transdiagnostic treatment and ACT post-test. However, there was a significant difference between the pre-test and post-test phases of ACT regarding adherence, gastrointestinal symptoms, plus perceived stress (P<0.05) and transdiagnostic treatment regarding gastrointestinal symptoms (P<0.05).

Specialists may use transdiagnostic treatment and ACT as effective psychological treatments to alleviate gastrointestinal symptoms and perceived stress, thereby increasing treatment adherence in patients with irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal (GI) tract disorder. Although the main reason for IBS is unclear, the interaction between intestinal microorganisms and the gut barrier seems to play an important role in the pathogenesis of IBS. The current study aimed to investigate the effect of Blastocystis on the Firmicutes/ Bacteroidetes ratio of IBS patients compared to healthy subjects.

This is a case- control study. Stool samples were collected from 80 participants, including 40 samples from each IBS and healthy group. Upon DNA extraction from stool samples, barcoding region and quantitative real- time polymerase chain reaction (PCR) were analyzed to investigate Blastocystis and the Firmicutes/ Bacteroidetes ratio, respectively. Student T-test, Shapiro- Wilk, Mann- Whitney, and Wilcoxon were employed to analyze data.

The value of Firmicutes was increased in IBS patients (14.52 ± 3.04) compared to healthy controls (12.83 ± 2.19). Regarding Blastocystis, Firmicutes were higher than other groups (14.238 ± 3.836). The value of Bacteroidetes in IBS patients (8.11 ± 1.69) was higher than healthy controls (7.62 ± 1.62). Regarding Blastocystis, the changes in IBS patients with Blastocystis were higher than other groups (8.27 ± 1.79). The changes in the Firmicutes/ Bacteroidetes ratio were not significant in different groups.

The present study revealed that the changes in bacteria were not significant between IBS and healthy controls. In addition, Blastocystis does not change the abundance of bacteria in IBS and healthy subjects. More studies are needed to clear the effect of Blastocystis on gut microbiota.

The current systematic review and meta-analysis aimed to assess the association between Gastrointestinal (GI) cancers and opium use.

GImalignancies are a global public health issue and are associated with many risk factors including genetic and lifestyle factors.

PubMed, Web of Science, Embase and Scopus and the Google Scholar search engine in addition to Persian databases including Magiran and SID were searched using relevant keywords. The associations of opium use, long duration of opium use, high daily amount opium use and high cumulative opium use and GI cancer and various subtypes of GI cancers were estimated and pooled in format of odds ratios (OR) and their corresponding 95% confidence intervals (CI) with a random effects model.

22 articles that were published between 1983 and 2022 entered the analyses. There were significant relationships between opium use based on crude effect sizes (OR: 2.53, 1.95-3.29) and adjusted effect sizes (OR: 2.64, 1.99-3.51), high daily opium use (or: 3.41, 1.92-6.06), long duration of opium use (OR: 3.03, 1.90-4.84) and high cumulative opium use (OR: 3.88, 2.35-6.41), all compared to never opium use, and GI cancer. The results were not sensitive to sensitivity analyses and no influential publication biases were found in these analyses.

Our meta-analysis showed that opium use could be associated with increased risk of overall and some particular GI cancers including oropharyngeal, gastric, pancreatic and colorectal cancers. Opium use as a potentially modifiable factor, therefore,should be more emphasized.

Rapid transportation and delivery large volumes of equipment to combat operational and support units, especially in recent wars, clearly shows the necessity of using all transportation capacities in the country. In addition to speed, safety and reliability and other criteria affect the modes of transport. This study analyzes the rail transport selection decisions in the logistics of a defense organization by gathering the opinions of experts through the Analytical Hierarchy Process (AHP) and attempts to analyze the items and criteria for the transport of each of them through rail transport. Therefore, it is applied in terms of purpose and exploratory in terms of nature and method. The innovations of this research include analyzing the application of rail transport in defense organizations, the use of the Analytical Hierarchy Process and the presentation of the same prepared classes between military and civilian organizations. According to the findings, transportation safety was the most important criterion and dangerous items among the movable items in the five categories, according to the transportation safety criterion was extracted as the first option. The results of the research can be used in the logistics policy of defense organizations.

One of the most prevalent gastrointestinal tract ailments is gallstone disease (GD). Diet has been acknowledged as a modifiable GD risk factor. The Healthy Eating Index (HEI) is a scale for evaluating the quality of diets; therefore, this study aimed to determine whether the HEI-2015 score was associated with serum metabolic parameters in women with GD.

This case-control study was conducted on a sample of 75 women diagnosed with GD and 75 healthy women at the Gastroenterology and Hepatology Clinic of Shahid Beheshti University of Medical Science in Tehran, Iran. Standard laboratory methods were employed to measure the biochemical parameters. The participants' habitual dietary intake was assessed using a validated food frequency questionnaire (FFQ). The HEI-2015 score was computed for all participants. The study employed multivariate logistic regression to identify the optimal predictor of GD. The Pearson Correlation was employed to determine the correlation between the HEI-2015 and serum metabolic parameters.

The study found a significant negative association between the risk of GD and serum HDL-c (OR: 0.84; 95% CI: 0.76–0.95, P=0.008). Moreover, a significant positive association was detected between HOMA-IR (OR: 3.27; 95% CI: 1.16-9.19, P=0.025), and the risk of GD. The study did not find a statistically significant correlation between the HEI-2015 and serum parameters.

While an association was discovered between certain serum metabolic parameters and the risk of GD, the results do not provide a significant association between serum metabolic parameters and HEI-2015 score.

Medical mistakes cause injury to patients and raise the expenses of treatment and hospital stays. The current study aimed to identify medical errors in the field of gastroenterology and propose a prevention strategy.The study was carried out through a mixed method (quantitative, qualitative) in a sequential manner. In the first stage (quantitative), common errors in the department were identified. In the second stage (qualitative stage), data gathering was done by interviewing nurses and doctors. The collected data was analyzed using content analysis method and error prevention strategies were identified.The mean (standard deviation) score of patients in the departments were 66.28 (98.7), and the mean number of nurses was 4.83 (26.3). It was found that the most medical errors were not serious, and the most errors in drug registration were drug card registration (42.9%), drug preparation (38.1%), and drug prescription (33.3%). Medical errors resulting in severe complications due to incorrect patient identification accounted for 2% of the total errors. The suggested prevention strategies included: adjusting department supervision processes, ensuring proper training, enhancing patient education, and developing a culture of error reporting.The study's findings revealed a high frequency of errors that were largely benign and identified before they occurred. Nevertheless, given their potential to inflict harm, it is essential to implement effective error detection and reporting system.

Considering the importance of the supply chain in gaining a competitive advantage, it is said that the competition between organizations has been replaced by the competition between their supply chains. Therefore, the effective management of the supply chain is considered a fundamental factor in the success of organizations. The role of emerging approaches in improving deterrence against military threats shows the importance and necessity of using these approaches in defense industry supply chain management. This research has focused on monitoring and prioritizing the most important new approaches of defense supply chains. The research is fundamental in terms of its purpose, mixed (qualitative-quantitative) in terms of the nature of the data, and descriptive-survey in terms of the data collection method. In this research, first, the literature and background of the subject were reviewed and the most important emerging approaches in the supply chain were identified. After identifying the approaches using experts' opinions and the technology acceptance model, the technology acceptance criteria in defense organizations were localized and finally, prioritization was done using the Electra decision-making method. Among the most important results of the research, we can mention the determination of electronic, flexible, agile and intelligent supply chain as the most important approaches in defense organizations.

Colon cancer ranks third among the most common cancers. In Iran, this disease ranks fourth in men and second in women. The incidence and mortality caused by this cancer are different in different geographical areas. It is known to reduce the incidence of colon cancer by performing screening methods because most cases originate from polyps that can be seen and removed in colonoscopy before they become malignant. Also, screening methods are able to detect cancer in its early stages and reduce the death rate caused by this disease. However, the implementation of screening programs worldwide, including in Iran, has always faced problems such as the cost of diagnostic equipment, insurance coverage, health infrastructure, human resources, and, most importantly, acceptance by the people. Today, different methods are used for colon cancer screening in different countries, and the choice of these methods depends on several factors, including the prevalence and incidence of this disease, economic resources, and health infrastructure in each region. The purpose of this study was to investigate the common methods for colon cancer screening so that, according to the current situation and considering the screening facilities available in Iran, the best method can be suggested to cover more and more people who need screening.

Subepithelial lesions formerly known as subepithelial tumors are incidentally discovered protrusions throughout the gastrointestinal tract with normal overlying mucosa. Studies related to the diagnosis and methods of therapy are limited due to the low incidence and low malignant potential of these lesions. They are commonly originating from the second, third and fourth layers (muscularis mucosa, submucosa and muscularis propria) of gastrointestinal wall. They are reported to be more prevalent in stomach and esophagus than small intestine and colon. Subepithelial lesions located in the stomach and duodenum are more prone to malignancy than the lesions in the esophagus. Despite the presence of different strategies in the management of subepithelial lesions based on their size and location, there is still not a unique consensus on the issue. In this review we have attempted to introduce the most practical approach to the management of gastrointestinal subepithelial lesions based on current guidelines.

Because gastric ulcer is a psychosomatic disease in which many psychological factors are involved, this study aimed to investigate the effectiveness of emotion regulation training on pain intensity and quality of life in patients with peptic ulcer disease.

The research method was semi-experimental and based on the pretest-posttest control group design, with follow-up after three months. The sample included 46 participants who were selected by a purposeful sampling method and placed randomly in the experimental and control groups. At first, at the same time, and in the same conditions, all the participants responded to the Chronic Pain Grade questionnaire (CPG) and Quality of life Questionnaire (SF-12). The emotion regulation training was performed for the experimental group. In the end, both groups were evaluated by posttests, and then they were tracked after an interval of three months. In order to analyze data, ANCOVA test was applied through SPSS 22.

Findings showed that emotion regulation training was meaningfully effective in decreasing pain intensity and increasing life quality (p<0.01) and after three months, no significant changes were found in the results.

Due to the positive changes in the criteria of this protocol effectiveness, it is concluded that emotion regulation training has been successful in reducing the symptoms of pain intensity in PUD patients and increasing life quality, this treatment can be added to other treatments for PUD patients.

ASGE predictive model for the detection of choledocholithiasis is a reasonable approach for the management of patients with cholelithiasis. Surgeons do not pursue cholecystectomy without evaluation of the biliary system when laboratory tests and diagnostic imaging evidence show biliary duct involvement. Literature revisions reveal that the prediction of choledocholithiasis based on ASGE criteria suffers from poor accuracy which results in unnecessary ERCPs. We decided to estimate the sensitivity and specificity of the ASGE predictive model for the detection of choledocholithiasis with the hope that early EUS would obviate the need for unnecessary ERCPs among highly probable patients for choledocholithiasis based on ASGE criteria.

This is a prospective intervention and control study on the accuracy of ASGE criteria for the prediction of choledocholithiasis. To evaluate the sensitivity and specificity of ASGE criteria, patients were followed in two groups of controls who were treated based on ASGE guidelines and cases who underwent primary EUS. The clinical relevance of the ASGE criteria was estimated by sensitivity and specificity using SPSS Statistics 28 software. Then, absolute risk reduction utilizing primary EUS was also calculated. 

The sensitivity and specificity of the ASGE predictive guideline for choledocholithiasis were estimated to be 62.31% and 51.85%, respectively. Evaluation of the ASGE guideline also revealed that patients in the intermediate probability group who finally required ERCP based on EUS results (false-negatives) were estimated to be 49.1% and patients who were predicted to require ERCP but finally did not need ERCP (false positives) were estimated to be 37.68%. The comparison of the two groups revealed the need for ERCP in about 55.56% of the primary EUS group and 77.42% in the ASGE group. Utilization of primary EUS reduced the need for ERCP by an absolute risk reduction of 0.299. (Primary Endpoint)

ASGE guideline is associated with the overestimation of ERCP in cholelithiasis. The usage of primary EUS will reduce the need for ERCP.

Colorectal cancer (CRC) is considered one of the most prevalent cancers among Iranian men and women (1). Colorectal polyps, known as precursors of CRCs, are of great importance. Surveillance, locating, and removal of colorectal polyps make them the most modifiable factor apart from other genetic and environmental factors leading to CRCs. Colorectal polyps are defined as outpouchings from superficial and deep layers of mucosa of the colonic wall. They are classified as adenomas, serrated polyps, hyperplastic polyps, and hamartomas based on histological evaluation. Submucosal invasion precludes the possibility of endoscopic resection and should be ruled out via colonoscopic evaluation (2). Knowing this significance, the present study aims to present a brief review on classification, probability of endoscopic resection,complications of endoscopic polypectomy, as well as proper surveillance after polypectomy.

Nurses can be more successful in neutralizing the consequences of stressful factors in the work environment by using the job self-efficacy capability. Also, increasing self-efficacy and improving organizational justice could affect nurses' job burnout. This study aimed to determine the relationship between organizational justice and self-efficacy and job burnout of critical care departments nurses in 2022.

This descriptive analytical study of cross-sectional-correlation type was conducted on 220 nurses working in the critical care units of five teaching hospitals in Hamadan city in 2022. Niehoff and Moorman's organizational justice questionnaire, Riggs and Knight's job self-efficacy questionnaire, and Garosa et al.'s job burnout questionnaire were used to collect data. Data was analyzed using descriptive and inferential statistics in SPSS version 26 software.

The results showed that the mean and standard deviation (SD) of organizational justice in the participants was equal to 3.01 ± 0.67 which is at an optimal level. The mean and standard deviation of total self-efficacy and job burnout were 103.40 ± 10.93 and 28.26 ± 4.62, respectively, and at the average level. According to the findings, nurses' organizational justice significantly correlated with their self-efficacy (P < 0.001, r = 0.393). Also, the multiple linear regression model indicated that only the effect of distributive justice and individual self-efficacy beliefs were significant on job burnout (with 99% probability).

By increasing nurses' perception of organizational justice, there will be an increase and decrease in their job's self-efficacy and burnout, respectively. According to the identified relations, the attention of nursing managers and leaders to enhancing the level of organizational justice can improve nurses' job self-efficacy and slow down the process of nurse job burnout.

Resilience of the nurses in stressful work environments may have positive organizational effects. According to studies, employees' perception of organizational justice affects their professional commitment and resilience. This study aimed to investigate the relationship of organizational justice with professional commitment and resilience of nurses working in Medical-Educational Centers of Hamedan University of Medical Sciences in 2020-2021.

This descriptive-analytical study was conducted on 260 nurses working in in Medical-Educational Centers of Hamedan University of Medical Sciences. Sampling was done by stratified random sampling method. The research was performed using a demographic questionnaire, Niehoff and Morman Organizational Justice Questionnaire, Jafaraghaei Professional Commitment Questionnaire, and Connor and Davidson Resilience Questionnaire. Data was analyzed in SPSS v24 software using Pearson correlation and regression tests.

Perceived organizational justice was at an average level (2.94 ± 0.78), professional commitment was at a high level (2.80 ± 0.64), and resilience was at an average level (2.65 ± 0.61).Results showed that there was a statistically significant relationship between organizational justice and professional commitment (P=0.013, r=0.154) and professional commitment and resilience (P<0.001, r=0.607), but organizational justice and resilience (P=0.616, r=0.031) were not significantly related. Organizational justice and professional commitment together explain 0.379 of the variance of resilience.

Nurses' perception of organizational justice can increase their professional commitment, and higher professional commitment can increase their level of resilience. Therefore, hospital managers and administrators can increase the level of resilience in nurses by planning to improve the level of organizational justice and professional commitment of nurses.

Dietary intake is one of the modifiable risk factors for biliary stones. In recent studies, plant protein intake is associated with a lower risk of biliary stones in comparison to animal protein intake; however, the results are contradictory. The current study aims to compare the effect of animal protein and plant protein on the formation of biliary stone in one of the gastroenterology and liver disease centers in Iran.

110 participants who had a history of biliary stone and 230 controls who were normal in terms of biliary diseases and referred to the medical center from November 2017 to October 2018 enrolled in this study. Food frequency questionnaire (FFQ) was used for the nutritional assessment; moreover, demographic and anthropometric data, habitual history and comorbidities were collected. Statistical analysis was conducted by SPSS software.

Plant protein consumption was significantly lower (P=0.03) and animal protein intake was significantly higher (P=0.02) among men in case compared to controls. Furthermore, the relationship between biliary stone disease and animal protein intake was significant in crude model for men (OR: 1.03, 95% CI=1.01-1.05). In addition, the risk of biliary stone was significantly lower in patients with higher consumption of plant protein (for women: OR: 0.94, 95% CI=0.89-0.99, for both sexes: OR: 0.96, 95%CI=0.93-0.99).

The present study suggested that consumption of animal protein sources increased the risk of biliary stone, and intake of plant protein sources decreased the risk of biliary stone

Based on the importance of using new technologies in Logistics, recently researchers focus on studies related in intelligent logistics. The role of intelligent logistics in effective supply chain management is increasingly critical, and researchers and practitioners have recently focused their attention in designing more systems to address today's challenges. One of the major challenges for military organizations in the logistics field is to utilize information technology to advance the speed of transmission and to find information and goods in a supply chain. The origin of all new technologies in the field of commercial and military information and communication technology is at the disposal of the intelligence and security organizations of the hostile countries, in which case, the logistical activities and support of the internal and external military organs of the country. Seriously, it has disrupted intelligence and security operations in addition to imposing sanctions or international threats on organizations by leaking military logistics information. Under such circumstances, security is a crucial logistics process for military organizations and organizations. Therefore, in this study, we intend to evaluate and identify the components of intelligent logistics cyber security by reviewing the modern scientific and research and military literature active in the military logistics industry and then using the expert assessment approach to evaluat the components in one of the most important and strategic industries. Finally, with regard to the identification of intelligent logistics security components and indicators, the identified requirements will be evaluated and analyzed using a questionnanire completed by experts.

Esophageal-pleural (E-P) fistula is introduced to be an uncommon clinical finding maybe due to non-specific clinical pointers and vague radiologic clues. In this regard, the main drivers are esophageal traumatization, endoscopic dilation, irradiation and corrosive agent ingestion as well as major underlying esophageal diseases like carcinomas and tuberculosis. The presented case is a 51-year-old man with medical record of recurrent pneumonias resulted in right lobectomy who admitted to the medical institution with a significant empyema leading to chest tube insertion. It should be noted that the presence of food particles in the chest bottle in addition to the history of previous surgery raised suspicion of a post-surgical E-P fistula formation. Attempts were made to find fistula tract and insert an esophageal stent bypassing the fistula opening. However, investigations argued against E-P fistula as an ensuing event after surgery and arose the question that whether E-P fistula would be the cause or effect of pneumonia in the presented case?

Nursing is an independent discipline and a branch of medical sciences. Its mission is to provide the necessary health, treatment and rehabilitation services at the highest level to ensure, maintain or improve the health of society. Davis et al. (2005) emphasized the importance of measuring patient care quality. In their study, a standard questionnaire named quality patient care scale (QUALPAC) was used to measure the quality of patient care. This tool has been used since 1975 in different countries. Different studies have used this questionnaire with 68 items. The Persian version of this tool was validated in Iran by Khoshkho et al. Based on their results, the Persian version has 72 items rated on a five-option Likert scale. Different versions of QUALPAC been used in various studies conducted in Iran, and its reason is not clear. For example, in the study by Heydari and et al., the 65-item version of QUALPAC was used, with no reference was provided for the applied version.

One of the important categories in investing, especially in the stock market, is to pay attention to the issue of risk management for investors and companies. One of the most widely used measures in risk calculation, which includes both time horizon and confidence level, is the value at risk (VaR), which has been highly regarded by researchers and risk analysts over the past two decades. There are various methods, including parametric, semi-parametric and non-parametric, for calculating the risk arc, which can be used depending on the type of data. In this paper, by combining the generalization of Heterogeneous autoregressive model (HAR), ie Heterogeneous autoregressive quarticity model (HARQ) and extreme value theory, we introduce an efficient method for calculating the risk value of some stocks present in the Tehran Stock Exchange and compare the advantages and comparison with other approaches such as parametric and non-parametric. We will address the disadvantages of the introduced method. The statistical population of this research is an example of active companies that were present in the stock exchange from 1392 to 1397. It is noteworthy that the half-hour time frame has been adopted in order to achieve higher accuracy. It is also a method of data analysis using MATLAB software.

Lymphangiomas are benign lymphatic system abnormalities that can appear anywhere on the skin and mucous membranes. Lymphangiomas are caused by congenital or acquired lymphatic system disorders. In the congenital form, although the cause is unknown it is said that it is formed by the incorrect attachment of lymphatic channels to the main lymphatic drainage duct before the age of 5 years. lymphangiectasia as a subgroup of lymphangioma occurs seldom in the small bowel, especially in adults. If that happens, protein-losing enteropathy will be the most common presenting sign. In the present study, we introduce a case of a 40-year-old man without a history of any congenital or acquired diseases who was admitted to the emergency room due to long-lasting obscure overt gastrointestinal (GI) bleeding. Normal upper and lower GI endoscopies were suggestive of GI bleeding originating from the small intestine. Despite receiving iron supplements, he continued to have melena and remained anemic. Further evaluation of the small intestine by deep enteroscopy revealed multiple white spots histologically consistent with dilated lymphatics. Intestinal lymphangiectasia was eventually introduced to be the final diagnosis of the patient.

In the current clinical trial study, the potency of mirtazapine and nortriptyline was compared in patients with Functional Dyspepsia (FD) who had anxiety or depression.

FD usually accompanies other psychosocial disorders. According to previous studies, among these disorders, anxiety and depression have the most correlation.

This randomized clinical trial was organized in Taleghani hospital (Tehran, Iran). In two parallel groups, 42 patients were treated for 12 weeks, with 22 patients receiving 7.5 mg of mirtazapine and 20 patients receiving 25 mg of nortriptyline per day. To gain robust results, the patients with a positive history of antidepressant therapy, organic diseases, alcohol abuse, pregnancy, and major psychiatric disorders were excluded from the study. The subjects were examined by three questionnaires, including Nepean and Hamilton questionnaires. The patients were asked to answer the questions three times during the study: once before the onset of the treatment,  second during the treatment, and third at the end of the treatment.

 Based on Gastrointestinal (GI) manifestations, mirtazapine, in comparison to nortriptyline could significantly suppress the signs and symptoms of FD, including epigastric pains (P=0.02), belching (P=0.004), and bloating (P=0.01). Although the results from the use of mirtazapine compared to the use of nortriptyline (P=0.002) showed a lower mean depression score on the Hamilton questionnaire, no significant differences were found between the effects of these drugs on the anxiety scale of patients (P=0.091).

Mirtazapine is more effective for GI symptoms related to gastric emptying. Considering the level of anxiety, mirtazapine, compared to nortriptyline, revealed better outcomes in FD patients suffering from depression.