farahnaz joukar

Diabetes mellitus (DM) is highly consequential to global health among chronic diseases. Due to a limited researches that have examined relationships between liver enzymes and DM, this study aimed to investigate the link between elevated liver enzymes and diabetes among Prospective Epidemiological Research Studies in Iran (PERSIAN) Guilan cohort study (PGCS) population.

This cross-sectional study was conducted on 10519 individuals. The demographic and clinical information of the participants was recorded. The changes in alanine aminotransferases (ALT) and aspartate aminotransferases (AST), alkaline phosphatase (ALP), and γ-glutamyltransferase (GGT) were evaluated. IBM SPSS Version 21 was used to analyze the data, with a significance level < 0.05.

The frequency of diabetes was 24.1% and was more prevalent in women than men (27.4% vs. 20.2%, p< 0.001). After removing all confederates, patients with elevated ALT, AST, GGT, and ALP levels were 1.27, 1.27, 1.52, and 1.46 times more likely to have diabetes, respectively. The likelihood of developing diabetes rose in correlation with the number of elevated liver enzymes, up to almost 1.77-fold among subjects with three or four increased liver enzymes.

Patients diagnosed with diabetes exhibited significantly increased levels of liver enzymes compared to those without diabetes. Also, impairment of three or four liver enzymes demonstrated a positive correlation with an elevated likelihood of DM. This indicates the importance of considering the liver status in the management of the DM population.

 Esophageal varices (EVs) carry a significant risk of rupture and subsequent life-threatening bleeding. While previous research has investigated the effectiveness of the platelet count to spleen diameter ratio (PC/SD) as a non-invasive predictor of EVs in various populations, this study specifically focuses on the Iranian population to assess the applicability and effectiveness of this parameter in this region.

 Upper gastrointestinal endoscopy was performed on 147 cirrhotic patients to screen for EVs. Biochemical tests and ultrasonography were done to measure spleen diameter (SD) and calculate the PC/SD ratio. ROC analysis was done to determine the predictive performance of the parameters.

 Among the patients, 73% had EVs. The analysis showed the following: platelet count (PC) had an AUC of 0.695 with 78.7% sensitivity and 56.4% specificity; SD had an AUC of 0.750 with 49.1% sensitivity and 89.7% specificity; and the PC/SD ratio had an AUC of 0.734 with 60.2% sensitivity and 79.5% specificity. The PC/SD ratio exhibited a high positive predictive value of 93% but a low negative predictive value of 41.9%. Optimal cutoff values were determined as follows: PC≤ 100,000, SD< 163, and PC/SD ratio≤ 523.

 By identifying high-risk patients who may benefit from targeted endoscopic screening, this non-invasive method could contribute to improving overall patient care and reducing the need for invasive procedures. However, due to suboptimal performance results, it is crucial to use this approach with caution, as endoscopic screening remains the standard practice for the diagnosis and management of esophageal varices.

The upper gastrointestinal bleeding (GIB) is a common emergency in hospital admission among patients with internal diseases. The aim of this study was to investigate the outcomes of patients with non-variceal upper GIB‚ using the AIMS65 index in the Razi hospital in Rasht, 2018-2019.

In this cross-sectional study, 112 patients with GIB, referred to Razi Hospital in Rasht between 2017-2018 were selected using convenient sampling method and included in the study. The AIMS65 score was used to check GIB. In this score, some risk factors including albumin, INR, and hemoglobin levels and systolic blood pressure of both hands, consciousness based on Glasgow criteria, and age were documented. The score of the patients were calculated based on how many risk factors they had from 0 to 5. Based on this, patients are classified into two groups of high-risk or emergency (with a score of >2) and low-risk or non-emergency (with a score of < 2) and then endoscopy is performed on them.

Based on AIMS65 score, 73.2% of the patients had scores below 2 and classified in the non-emergency group, and the rest had scores higher than 2 and classified in the emergency group. The results showed that there was a statistically significant difference between the risk of in-hospital mortality, rebleeding, and the mortality status of the patients 3 months after the first referral. (p<0.05).

In this study, we concluded that AIMS65 score is effective in predicting in-hospital mortality and recurrent hemorrhage and its prognosis. However, it cannot be a suitable criterion in determining need, time, and endoscopic interventions for ICU hospitalization.

This study was conducted to investigate the treatment seeking behavior for COVID-19 symptoms among northern Iranian population and its related factors.

This hospital-based cross-sectional study was conducted to investigate the treatment seeking behavior for COVID-19 symptoms and its related factors in 602 confirmed COVID-19 cases for a period of 2 months between March and May 2020 in Guilan at the onset of the corona epidemic in Iran.

Professional treatment-seeking was observed in 18.6% of patients and most of patient reported home remedies (50.3%) and self-medication (31.1%) as first reaction to COVID-19 symptoms. The most prevalent symptoms of COVID-19 in the study population were anosmia (98.3%) and fever (70.1%). The multivariate logistic regression analyses revealed that patients with breathing difficulties symptom and history of respiratory disease had greater odds professional treatment of seeking respectively (adjusted odds ratio (OR) =1.6, P=0.03, (OR) =3.3, P =0.001). 

Roughly half of symptomatic COVID-19 patient reported home remedies as first treatment-seeking behaviors and only breathing difficulties symptom and past history of respiratory disease were identified as an independent predictor of professional treatment–seeking. We will certainly face pandemics in the future. However, the world must obviously prepare for future pandemics in light of the lessons learnt from the COVID-19 pandemic. We hope that the results of this study can be a lesson for the future.

Thyroid disorders, particularly hypothyroidism, can affect the movement of the digestive system. The aim of this study was to investigate the association between hypothyroidism and constipation.

In this cross-sectional study that was conducted on the PERSIAN Guilan Cohort Study (PGCS), all individuals between the ages of 35 and 70 years, irrespective of gender, were included. The questionnaires were completed using dedicated online software that included demographic data, clinical characteristics, and nutritional information. Hypothyroidism was defined based on taking levothyroxine medicine as stated by the patient and diagnosis of chronic constipation was based on self-report. Individuals were divided into two groups based on their constipation status and compared with respect to the desired variables. The relationship between hypothyroidism and constipation was examined using logistic regression analysis. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

The prevalence of hypothyroidism and constipation were 5.1% and 4.4% respectively, and both were more common in women than in men. In unadjusted model, there was no significant association between hypothyroidism and constipation (OR=1.28, 95% CI: 0.88–1.87, P=0.201). Similar result was obtained in fully adjusted model (OR=1.03, 95% CI: 0.70–1.53, P=0.875).

There was no significant association between hypothyroidism and constipation in this study. Since nutrition and the type of fruits and vegetables and the type of substances consumed have an effective role in eliminating constipation, we recommend that these items be considered in future studies.

Vitamin D is a basic nutrient and plays a very crucial role in preventing various diseases, so it is known as an indicator of health and survival.

 This study was conducted to determine the serum level of vitamin D in women receiving vitamin supplementation in Persian Guilan cohort study (PGCS). 

In this analytic cross-sectional study that was conducted on PERSIAN Guilan cohort, 614 subjects from 5633 women aged 35 to 70 years old who were taking vitamin D supplements were selected through census method. Required data were collected in two sections of demographic and social characteristics and serum measurement 25-hydroxy vitamin D3 at three levels of deficient (<10), insufficient (10-20) and sufficient (>20 ng/ml). Data analysis was done using descriptive and inferential statistics. P <0.05 was considered statistically significant.

The mean age of people was 50.3±8.7 years, of which 5.2 % of the subjects had vitamin D deficiency, 29.5% had insufficient serum level and 65.4% subjects with sufficient serum levels. Based on the results, there was a significant relationship between employment status, place of residence and housing area with vitamin D level (P<0.05), and non-employed persons (P=0.044), living in the city (P=0.002) and a residential house with a higher area (P=0.014) had higher levels of vitamin D. There was no significant association between serum vitamin D levels with age, body mass index, marital status, alcohol consumption, level of education and how to take vitamin D supplementation.

In the present study, about one third of vitamin consumers did not have a sufficient serum level despite taking the supplement, so it is expected that the country's health system, health officials, and policymakers pay attention to the education program of optimum consumption as well as appropriate prescription of vitamin D supplement.

 Liver steatosis has a wide range of conditions from simple steatosis to non-alcoholic steatohepatitis, fibrosis, and eventually cirrhosis. Several panels and scoring systems have been introduced to differentiate steatosis with or without advanced fibrosis and also the degree of fibrosis. This study aimed to evaluate eleven different scoring panels in patients with steatosis and compare their results with Fibro Scan.  

 The study was performed on 122 NAFLD patients who were confirmed by ultrasound. The patients were referred to the gastroenterologist in Razi hospital in the north of Iran from September 2017 to April 2018. All patients underwent Fibro Scan. Multiple scoring systems were calculated using the laboratory values. These results were compared with the results of Fibro Scan. AUC for each panel was calculated.

 In This study, 62 (50.8%) were men. The mean age of the patients was 47.1±11.7 years.  There were significant differences between patients with or without advanced fibrosis in three panels of APRI, NIPPON, and FIB4 (p=0.03, p=0.01, p=0.005, respectively). AUROC for APRI, NIPPON, and FIB4 were, 0.695 (CI=0.58-0.8, p=0.001), 0.642 (CI: 0.5-0.74, p=0.015) and 0.684 (CI: 0.5-0.7, p=0.002), respectively. None of the other panels had enough sensitivity for the diagnosis of advanced fibrosis.

 Given the cost-effectiveness of panels, their ease of calculation, and noninvasiveness, FIB4, NIPPON and APRI can be used as useful tools for following, and also for predicting progression to advanced fibrosis.

Cardiovascular disease (CVD) is one of the most prevalent diseases worldwide including in the Asian population. CVD risk assessment provides support for policymakers for prevention strategies. This research aimed to estimate the 10-year CVD risk and evaluate the agreement between three risk scores.

A descriptive study was conducted based on 9398 subjects aged 40–70 years from 10520 PERSIAN Guilan Cohort Study (PGCS) participants in Guilan, Iran. Baseline demographic data, comorbidities, and CVD variables were derived from cohort records. The 10-year CVD risk events for every individual were calculated using three risk score models including the American College of Cardiovascular / American Heart Association (ACC/AHA) tool, Framingham Risk Score (FRS), and World Health Organization (WHO) chart. The agreement between the CVD risk scores was evaluated using the kappa statistics.

The proportion of high-risk people based on WHO, FRS, and ACC/AHA was 17.5%, 16.1%, and 5.4%, respectively. WHO risk score can find the highest frequency of females with high CVD risk scores. The best agreement was observed between FRS and ACC/AHA (κw=0.672, complete agreement=82.3%). Agreement between the WHO and ACC/AHA as well as WHO and FRS was reported as κw=0.351 and κw=0.357, respectively.

WHO risk chart found the greatest number of people as the high-risk category. A substantial agreement was observed between FRS and ACC/AHA.

Brucellosis is a common zoonotic infection caused by the bacterial genus Brucella. It is one of the infectious diseases transmissible between humans and animals, and its clinical manifestations are very diverse and misleading. One of these manifestations is central nervous system involvement, which occurs in various forms. Better and more accurate identification of these diverse clinical manifestations can help physicians in the timely diagnosis and treatment of the disease.

In this study, we introduce a sixteen-year-old patient who complained of fever, low back pain, dizziness, and headache for two months. A detailed history of our patient revealed previous contact with sheep and consumption of unpasteurized milk. Further clinical tests confirmed the diagnosis of Brucella meningitis in this patient.

Patients with brucellosis can show a wide variety of clinical symptoms, and knowing these different clinical forms can help physicians in the early diagnosis of the disease. In a country like Iran, where brucellosis is endemic, any patient who presents with complex and unexplained neurological complaints, especially those with a history of brucellosis, should be considered for neurobrucellosis.

The precise knowledge of laboratory diagnostics such as the association between the cycle threshold (Ct) or the SARS-CoV-2 virus load can be used as a predictor of the infection risk with new strains of the SARS-CoV-2 virus for patients with Covid-19. This study was conducted based on the hypothesis that the Ct value of SARS-CoV-2 can also serve as a biomarker of disease severity, clinical outcome, and patient mortality.

In this cross-sectional study, the SARS-COV-2 qRT- PCR results of 443 hospitalized patients during 2019-1400 were examined, then the association between Ct with high viral load (Ct≤25) and lower viral load Ct >25 was determined.

Ct values in dead patients were significantly lower than discharged patients (P=0.005); Also, Ct values in the patients hospitalized in ICU were significantly lower than the patients hospitalized in Infection Control Units of the hospitals (P=0.002). Based on the adjusted analytical results, a high viral load (Ct≤25) increase chance of in-hospital death (OR=5.16, 95% CI: 2.36-11.28) and hospitalization in ICU (OR=6.87, 95% CI: 2.36-11.28).

In hospitalized patients with Covid-19, SARS-CoV-2 viral load was associated with mortality and hospitalization in the ICU. These findings show that the Ct value can be used as a tool to help identify patients who are at higher risk for severe outcomes of Covid-19 disease.

Non-alcoholic fatty liver disease (NAFLD) is the world's most common etiology of chronic liver disease. In this systematic review and meta-analysis, we estimated the prevalence of NAFLD in the Iranian children and adult population.

A comprehensive search of five international databases, including PubMed, ISI/WOS, ProQuest, Scopus, and Google Scholar, was done from inception to Nov 2022. Studies on NAFLD patients and their risk factors were selected for meta-analysis. The quality of the included studies was assessed by The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional, and cohort studies. The heterogeneity between studies was investigated using Cochran test and I2 statistics. Random and fixed effect models were used for heterogenic and non-heterogenic studies, respectively. We used Comprehensive Meta-Analysis version 3 for conducting meta-analysis.

Twenty studies were finally included. The total prevalence of NAFLD in children, boys, and girls was 6.7% (95% CI: 0.02-0.18), 12.5% (95% CI: 0.04-0.29) and, 10.1% (95% CI: 0.04-0.21), respectively. The total prevalence of NAFLD in obese children, obese boys, and obese girls was 42% (95% CI: 0.18-0.69), 44% (95% CI: 0.13-0.80), and 33 % (95% CI: 0.13-0.62), respectively. The total prevalence of NAFLD in adults was 36.9% (95% CI: 0.31-0.42). The prevalence of NAFLD in men and women was 33.8% (95% CI: 0.27-0.41) and 29.9% (95% CI: 0.21-0.40), respectively.

NAFLD prevalence in Iranian adults and obese children is considerable; however, data about the children population was insufficient.

The association between depression and inflammatory bowel disease (IBD) has been reported worldwide.

We aimed to investigate the prevalence of active and inactive IBD depression and its associated risk factors among patients with depression and IBD.

In this cross-sectional study, demographic data and clinical characteristics of 156 IBD patients referred to Razi Hospital, Rasht City, Iran, were recorded from 2015 to 2016. The Beck depression inventory (BDI) was administered to all patients, and their scores were classified as no, mild, moderate, and severe depression. Modified Truelove and Witts severity index (MTWSI) for ulcerative colitis (UC) and Harvey Bradshaw severity index (HBSI) for Crohn’s disease (CD) were used to quantitate IBD activity as active UC (scored ≥10) and active CD (scored ≥7).

About 35.9% of the patients (n=56) had depression. Patients with active IBD had significantly higher BDI scores than those with inactive IBD (14.41±10.34 vs 10.14±10.28, respectively, P=0.011). Except for income (P=0.001), no significant associations were detected between IBD status and other background variables (P>0.05). No patients in either active or inactive IBD groups had cancers. Based on the severity of depression, the patients were grouped as follows: 64.1% had no depression, 30.1% had mild depression, 5.8% had moderate depression, and 0.0% had severe depression. However, significant positive associations were seen between an increase in depression severity and having autoimmune diseases, a lower education level, and a history of IBD-related surgeries.

It seems that patients with active IBD are more depressed than inactive IBD patients.

Tuberculosis is a chronic granulomatous infection and has become a global concern. This disease is caused by Mycobacterium tuberculosis, but other types of Mycobacterium can also cause the disease. Tuberculosis usually affects the respiratory system, but other organs, called extrapulmonary tuberculosis, can be involved. Lymph node tuberculosis is one of the manifestations of extrapulmonary tuberculosis, especially in regions where tuberculosis is endemic. The involvement of salivary glands with tuberculosis is an uncommon condition. Here we present three cases (two adults and one child) with tuberculosis salivary gland lymphadenitis.

In all the cases, tuberculosis diagnosis was confirmed by biopsy. Although, the diagnosis of tuberculosis was easier in the child due to symptoms like night sweating and fever and positive purified protein derivative test, in adults, there were no abnormalities in the initial laboratory tests, and purified protein derivative tests were negative, which made the diagnosis of tuberculosis more complicated. Although, salivary gland involvement with tuberculosis is not common, it should be considered a differential diagnosis in patients with swelling of salivary glands. In addition, the diagnosis confirmation should be based on biopsy, and normal laboratory tests and negative purified protein derivative tests should not confuse us. An early diagnosis is essential, and early initiation of an anti-tuberculosis regimen can prevent the following complications.

Non-alcoholic fatty liver disease (NAFLD) is progressing considerably worldwide. Identifying the risk factors of NAFLD is a critical step in preventing its progression.

In November 2022, two independent researchers studied seven databases, including PubMed, ISI/WoS, ProQuest, Scopus, SID, Magiran, and Google Scholar, and reference list of relevant articles, searching studies that assessed NAFLD risk factors in the Iranian adult population. Heterogeneity between studies was assessed by Cochran’s test and its composition using I2 statistics. A random-effects model was used when heterogeneity was observed; otherwise, a fixed-effects model was applied. Egger’s regression test and Trim-and-Fill analysis were used to assess publication bias. Comprehensive Meta-analysis software (version 3) was used for the analyses of the present study.

The results of this study showed significant associations between NAFLD with age [n = 15, odds ratio (OR) = 2.12, 95% CI: 1.79 - 2.51], body mass index (n = 46, OR = 5.00, 95% CI: 3.34 - 7.49), waist circumference (n = 20, OR = 6.37, 95% CI: 3.25 - 12.48), waist-to-hip ratio (n = 17, OR = 4.72, 95% CI: 3.93 - 5.66), total cholesterol (n = 39, OR = 1.80, 95% CI: 1.52 - 2.13), high-density lipoprotein (n = 37, OR = 0.53, 95% CI: 0.44 - 0.65), low-density lipoprotein (n = 31, OR = 1.68, 95% CI: 1.38 - 2.05), triglyceride (n = 31, OR = 3.21, 95% CI: 2.67 - 3.87), alanine aminotransferase (n = 26, OR = 4.06, 95% CI: 2.94 - 5.62), aspartate aminotransferase (n = 27, OR = 2.16, 95% CI: 1.50 - 3.12), hypertension (n = 13, OR = 2.53, 95% CI: 2.32 - 2.77), systolic blood pressure (n = 13, OR = 1.83, 95% CI: 1.53 - 2.18), diastolic blood pressure (n = 14, OR = 1.80, 95% CI: 1.48 - 2.20), fasting blood sugar (n = 31,OR = 2.91, 95% CI: 2.11- 4.01), homeostatic model assessment for insulin resistance (n = 5, OR = 1.92, 95% CI: 1.48 - 2.59), diabetes mellitus (n = 15, OR = 3.04, 95% CI: 2.46 - 3.75), metabolic syndrome (n = 10, OR = 3.56, 95% CI: 2.79 - 4.55), and physical activity (n = 11, OR = 0.32, 95% CI: 0.24 - 0.43) (P < 0.05).

In conclusion, several factors are significantly associated with NAFLD. However, anthropometric indices had the strongest relationship with NAFLD in the Iranian adult population.

Tinnitus can be associated with many auditory and non-auditory factors, and its prevalence varies widely in the literature. There is no large sample of published data on tinnitus prevalence and its associated factors in Iran. Here, we analyzed the PERSIAN Guilan Cohort Study (PGCS) data and reported the prevalence of tinnitus and some of the risk factors related to tinnitus in the Iranian population. This cross-sectional study was conducted on 10520 men and women between 35 and 70 years old. The prevalence of tinnitus and associations between tinnitus and age, sex, habitat, marital status, employment status, socioeconomic status, educational level, lifestyle habits, and comorbid diseases were examined using simple and multiple logistic regression analyses.The prevalence of tinnitus was 6.4% in this study. Based on the adjusted analysis, only older age (odds ratio: 2.60, 95% confidence interval: 1.88 – 3.60), residency in a rural area (odds ratio: 1.22, 95% confidence interval: 1.03 – 1.44), cigarette smoking (odds ratio:1.33, 95% confidence interval: 1.04 – 1.72), and having other comorbidities (odds ratio: 2.75, 95% confidence interval: 2.19 – 3.44) were related to tinnitus. In addition, the results of subgroup analyses by sex were mostly consistent with the overall analysis.Our results revealed that the prevalence of tinnitus in the north of Iran is comparable with other communities. Age and other comorbidities were among the most related factors to tinnitus.

Cancer is the leading cause of death in the world after cardiovascular disease, and is the third leading cause of death in Iran.

This epidemiological study aims to investigate different types of cancers in Sowme’e Sara County, Guilan, Iran.

This analytical cross-sectional study is a part of the PERSIAN Guilan cohort study that was conducted on 10520 adult men and women in Sowme’e Sara County. The prevalence rate was determined per 100,000 people. Descriptive statistics (mean, standard deviation, frequency, and percentage) were used for describing data. Statistical analyzes were performed in STATA version 13 software. 

In this study, 94 patients with cancer and 98 types of cancer were recorded. Most of patients were female (n=65, 68.4%). The mean age at diagnosis in men and women was 47.61±11.23 and 44.30±7.87 years, respectively (Total=45.58±10.09 years). The most common cancers were breast cancer, brain & central nervous system cancer, and prostate cancer. The minimum age for diagnosis in men and women were 23 and 19 years, respectively,.

Screening for breast cancer in women and prostate cancer in men living in Sowme’e Sara County should be done which is currently underway using mammography and prostate specific antigen tests.

Evidence suggests that dietary pattern is related to incidence and grades of nonalcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the relationship between major dietary patterns and hepatic histologic features of newly diagnosed patients with NAFLD.

This cross‑sectional study included 260 newly diagnosed NAFLD patients. Hepatic fibrosis and steatosis were diagnosed using Fibroscan. Dietary information was obtained using a validated 168‑item semiquantitative food frequency questionnaire. The association between dietary patterns and odds ratio of the grade of fibrosis and steatosis was examined by multinomial logistic regression.

The mean ± SD age participant was 46.53 ± 11.71 years. Fifty‑seven percent of the participants were women. Two major dietary patterns were recognized: “Western dietary pattern” and “Mediterranean dietary pattern.” After adjustment for various confounders, adherence to the two extracted dietary patterns was not associated with odds of fibrosis and steatosis (P > 0.05). However, P was not significant. Patients in the second quartile of the Mediterranean dietary pattern had a higher risk for being in the F1 grade compared to those in the reference group in the crude and adjusted model.

The major dietary patterns of NAFLD patients living in Gilan were not related to the severity of their disease. More precise study design such as cohort or interventional studies is suggested to reveal the strength of this study findings.

Hematuria is one of the most common symptoms in nephrology and urology. Due to the lack of extensive meta-analysis studies on the epidemiology of hematuria in Iran, this study was conducted to determine the epidemiological status of hematuria in Iran.

In Sep 2020, researchers studied six international databases such as PubMed, ISI/WOS, ProQuest, Embase, Scopus, and Google Scholar for English papers and Iranian databases (SID and MagIran) for Persian papers. Joanna Briggs Institute (JBI) checklist was used to review and control the quality of articles. Heterogeneity between studies was assessed by Cochran's test and its composition using I2 statistics.

After several screening phase, the number of 25 article included to the final analysis. The prevalence of hematuria in the general population and children, in Iran were estimated at 16.4% (95% CI, - 0.05-37.9) and 1.6% (95% CI, 0.9-2.3) respectively. The odds ratio (OR) of women to men in the prevalence of hematuria in the general population 1.74, 95% CI: 1.20-2.52, P=0.003, patients with beta-thalassemia major 2.02, 95% CI: 1.11-3.65, P=0.020, children 2.61, 95% CI: 1.19-5.71, P=0.016, the elderly 1.50, 95% CI: 1.15-1.94, P=0.002, and taxi drivers 3.73, 95% CI: 2.58-5.38, P<0.001 was obtained.

The prevalence of hematuria in the general population is relatively high. Hematuria is a good predictor for detecting of bladder cancer and Idiopathic hypercalciuria and the physician should attention to microscopic hematuria.

Metabolic syndrome is associated with many factors related to fertility. Identifying the link between metabolic syndrome and reproductive conditions can help us identify high-risk groups for the disease. The present study was performed aimed to investigate the relationship between the age of first pregnancy and number of deliveries with metabolic syndrome and its components.

This cross-sectional analytical study at the first stage of the Guilan cohort study with 10520 individuals and a part of the PERSIAN adult cohort study with 5243 women who had experienced at least one pregnancy. Patients' demographic information as well as information about reproductive conditions such as first gestational age and number of pregnancies and indicators related to metabolic syndrome were collected. Data were analyzed by SPSS statistical software (version 21) and Chi-square test, t-test and adjusted odds ratio. P< 0.05 was considered statistically significant.

The prevalence of metabolic syndrome in the study population was 55.5% (n=2909). After adjusting other factors such as age, socioeconomic status and place of residence, the chance of developing metabolic syndrome in those who experienced their first pregnancy between the ages of 20-25 were 54% higher than those under the age of 20 (P = 0.029). After adjusting to other factors, those who had 3, 4 and more than 5 deliveries were 1.43, 1.80, and 2.55 times more likely to develop metabolic syndrome, respectively, than those who had one delivery (P<0.001).

Older age, number of births more than three, and associated chronic diseases increase the chance of developing metabolic syndrome. Considering that metabolic syndrome is associated with a wide range of non-communicable diseases, preventive measures are recommended in these individuals.

In this study, efficacy and consistency of disc diffusion (DD) and agar dilution (AD) methods in determining Helicobacter pylori susceptibility to antibiotics were evaluated using Brucella blood agar (BBA) in both methods and tetrazolium egg yolk agar (TEYA) in AD.

Twenty H. pylori isolates were tested for susceptibility to nine antibiotics; metronidazole (MTZ), clarithromycin (CLR), amoxicillin (AMX), tetracycline (TET), ofloxacin (OFX), levofloxacin (LVX), ciprofloxacin (CIP), furazolidone (FRZ), and rifampin (RIF). Antibiotics solutions were impregnated into blank paper disks on BBA in the DD method or added to BBA (ADB) or TEYA (ADT) media in the AD method. Suspensions of H. pylori isolates were surface or spot inoculated on solid media. Plates were incubated in CO2 incubator at 37°C for 5-7 days.

The highest rate of susceptibility to MTZ (65%) was determined by DD method compared with AD method (ADB: 40%, ADT: 30%). Both methods showed similar CLR (85%) and AMX (100%) susceptibility rates. Susceptibility to remaining antibiotics, determined by DD and ADB/ADT media were in respective order as 95%, 75% / 75% for TET, 100%, 95% / 85% for FRZ, 85%, 85% / 75% for OFX, 90%, 95% / 85% for LVX, 90%, 85% / 85% for CIP, and 100%, 85% / 75% for RIF.

DD and AD methods showed consistency in determining 161 (89.4%) susceptibility and resistance and inconsistency in determining 19 (10.6%) susceptibility and resistance (P < 0.05). DD is recommended as a cheap and easy method with the efficacy and precision comparable to the AD method in determining H. pylori susceptibility to antibiotics.

Early diagnosis of hepatic lesions can result in more successful treatment.

The present study aimed to diagnose hepatic space-occupying lesions by sonography in Guilan Cohort Center participants.

In this cross-sectional prospective epidemiological research studies of Iranian adults (PERSIAN) Guilan cohort study (Sowme'eh Sara, Guilan, Iran) conducted in 2014 - 2017, the sample included 960 individuals of both genders, aged 35 - 60 years. A radiologist examined all individuals with sonography to determine hepatic space-occupying lesions. Demographical and clinical characteristics were recorded via a questionnaire. Data analysis was performed using SPSS software (version 16).

Only 2.3% of the patients were diagnosed with hepatic lesions such as hemangioma, hepatic cysts, and other lesions with frequencies of 1.1%, 0.8%, and 0.4%, respectively. Also, there was a significant relationship between gender and the presence of hepatic lesions (P < 0.05). The frequencies of hepatic lesions were 1.7% and 3.6% in men and women and 1.6%, 2.5%, and 4.4% in the age groups of 35 - 45, 45 - 55, and over 55 years, respectively.

Hemangioma was the most common hepatic lesion diagnosed in ultrasonography examinations. Moreover, the only factor influencing the frequency of hepatic lesions was gender, which was found twice more in women than in men.

One of the main problems in patients with Helicobacter pylori (H. pylori) infection is the recurrence of this disease after eradication. 

This study aims to evaluate the recurrence rate of H. pylori infection 3-5 years after successful eradication in Iran.

In this descriptive cross-sectional study, participants with a history of H. pylori infection who had been treated in the past 3-5 years were examined for the recurrence of this infection. After obtaining their consent, demographic and clinical information was recorded through interviews and based on medical records. To confirm the recurrence rate, the carbon-14 urea breath test was performed.

Out of 169 participants, 41.4% were male, 86.9% were living in urban areas, 91.1% were non-smokers, and 3.6% had a history of alcohol consumption. The results of the urea breath test showed that only one patients (0.6%) had experienced recurrence after complete treatment.

 The recurrence rate of H. pylori infection in Iran is much lower than in the developed countries.

 Laboratory studies have shown that gastric epithelial infection cells with Helicobacter pylori (H. pylori) can increase autophagy. Disruption in this process can cause various diseases, including cancer.

 This study aims to compare the serum level of Autophag -Related Gene 5 (ATG5) in individuals with and without H. pylori infection.

 This case-control pilot study was conducted in 2018 on 44 individuals aged 35-50 years referred to the endoscopy ward of Razi Hospital in Rasht, Iran. Their age, gender, Body Mass Index (BMI), smoking, and symptoms were first recorded in a form. Based on Rapid Urease Test and pathology results, they included in two groups of patient (n=22) and healthy (n=22). Serum ATG5 levels were quantitatively assessed by an ELISA kit (EIAab, USA). 

 Most of participants (56.8%) were male, aged over 40 years (77.3%), a BMI < 25 kg/m2 (52.3%) and not smoking cigarettes (70.5%). The mean serum levels of ATG5 in individuals with and without H. pylori infections were 63.5 ± 15.4 and 57.1±18.9, respectively (P>0.05). The mean ATG5 level was higher in women than in men (P= 0.0047).

 Serum level of ATG5 is not significantly different between people with and without H. pylori infection. Further study is recommended using a larger sample size and based on a comparing gastrointestinal lesions.

In Budd-chiari syndrome (BCS), obstruction of the hepatic venous outflow tract occurs at a site from the small hepatic veins to the junction of the inferior vena cava with the right atrium, and this syndrome can have various causes. Remarkably, BCS can be classified as primary or secondary; primary BCS is caused by venous thrombus or phlebitis, while secondary BCS is due to venous compression or invasion of an extrinsic lesion, such as a tumor, abscess, or cyst. Antiphospholipid syndrome (APS) is an acquired cause of primary BCS.

Case Report:

A 24-year-old man, with complaints of abdominal pain, abdominand anorexia starting three months earlier, was admitted to Rasht Razi Hospital. The patient's pain did not relate to feeding, defecation and positioning. The patient had nausea and vomiting half an hour after feeding. He also mentioned a weight loss of about 5 kg and also,had blood pressure. He had no history of smoking, alcohol and opiums and had not any specific illness in his family. Due to abdominal distension and hepatosplenomegaly, an ultrasound examination was performed for the patient, ascites were diagnosed and the patient was subjected to ascites fluid paracentesis. High gradient of albumin and low protein were reported. The patient was first examined for cardiac examination and heart echocardiography and other examinations were reported as normal. A CT scan of the abdomen, pelvic and doppler ultrasonography was performed that showed ascites and enlargement of the caudate lobe. The findings were compatible with BCS. The diagnosis of BCS was confirmed by a hemodynamic study, and further investigation for the cause of BCS was positive. Antinuclear antibodies, deficiency of protein C and S were detected. LA was not present and aCL (IgM, IgG) were positive. Moreover, serology was negative for hepatitis B or C and serum protein electrophoresis was demonstrated high levels of gamma globulin. We concluded that the patient had chronic BCS secondary to APS in association with autoimmune hepatitis. Ultimately, the patient was treated with prednisolone 60 mg/daily and warfarin, and was referred to a transplantation-equipped center for liver transplantation.

In conclusion, BCS, although infrequent, is not a rare complication in patients with APS and may be the first clinical manifestation of this syndrome. In this patient, BCS caused by the initiation of AIH and secondary APS.

Introduction:

Hcnoch-Schonlein purpura is an IgA mediated small-vessel vasculitis and it is so common in children. The classic term of signs and symbols include polpuble purpura, arthralgia/arthritis, abdominal pain and also renal disease. The incidence of HSP in older age of the entire gastrointestinal tract (gastric, small intestine and large intestine) without arthritis / arthralgia and kidney involvement is rare. In patients with HSP, in older age people, kidney problems are more common than the children, which no kidney problem in this case.

Case Report:

A 57-year-old man who was admitted to the Razi Hospital, Rasht, Iran, with Perumblical colicky abdominal pain. During the outpatient surveys, Spiral CT Abdominal-Pelvic with IV oral contrast was determined by abdominal-Pelvic Ultrasonography through small bowel follow, ileum and jejunum involvement. After performing CT, Palpable purpura skin lesions appeared in the upper and lower extremities which w:as char:acterized by a low ALB outbreak, S / E (OB +), high fecal calprotectin, high ESR and normal leucocyte. In this way, at Razi Medical Education Center, the endoscopy showed stomach and duodenum involvement and colonoscopy shows the ascending, transverse, and descending colon. Skin sampling shown IgA sediment in Direct Immunofluorescence (DIF).

Conclusion :

HSP, although it occurs at an early age, has been reported in the patient due to the appearance of skin and abdominal pain and the absence of involvement of other basic organs such as the kidney, lung, and the negative effects of other vasculitis diseases on the basis of skin pathology.