ladan goshayeshi

Renal transplantation is the most effective therapeutic strategy in ESRD patients. One of the renal transplantation complications is gastrointestinal bleeding due to peptic ulcers beside other upper gastrointestinal diseases that have a great impact on patients’ morbidity and mortality.

The present study is designed for endoscopic assessment of the prevalence of upper gastrointestinal lesions and also Helicobacter pylori infection in ESRD patients waiting for renal transplantation who have no GI symptoms.

Our cross-sectional research was performed on 85 renal transplant candidates referred to organ transplantation center within 2016 to 2018. Patients who met inclusion criteria and didn’t have exclusion criteria underwent upper endoscopy. We performed biopsies in each case and data were classified according to endoscopic results, Helicobacter pylori infection and pathologic findings.

In 53 patients (62%) there were significant endoscopic findings. Erosive gastroduodenitis (32.5%) was the most prevalent finding. Abnormal histopathologic findings were found in 73% of patients and Helicobacter pylori infection was detected in 48.2%. We found significant correlation between H. Pylori infection and abnormal pathology (p=0.04).

Our results showed that asymptomatic gastrointestinal lesions and Helicobacter pylori infection were significantly prevalent in kidney transplant candidates thus routine upper endoscopy is recommended in them. This can result in early detection and treatment of gastric lesions before transplantation to prevent serious long-term complications.

Colorectal cancer (CRC) is the most prevalent cancer with high mortality worldwide. We aimed to evaluate the incidence of CRC based on the positive fecal immunochemical test (FIT) result in the Iranian population.

The present study was conducted on the health assessment data recorded in the SINA system in 2018 and 2019 from individuals who had participated in the national program, including asymptomatic people aged 50-69 years or had risk factors of colorectal cancer such as family or past personal history of CRC as well as symptomatic individuals, for the early detection and prevention of CRC in Mashhad, Iran.

The study participants included 140,463 eligible individuals, of whom 8,258 (5.88%) and 145 (2.21%) were positive for FIT and diagnosed with colon cancer, respectively. Unfortunately, only 654 people had undergone colonoscopy. Our results indicated that age, fast food intake (≥ two units per day), family history of CRC in first or second-degree relatives, some gastrointestinal diseases such as inflammatory bowel disease (IBD) and CRC, as well as bleeding per anus, constipation, abdominal cramp, and losing body weight were associated with increased risk of positive FIT. However, some other factors, including having a hard job, physical activity, and Iranian nationality (compared to non-Iranians), were associated with a low risk of positive FIT screening tests for CRC.

 A high number of high-risk persons in Mashhad were positive for the FIT test in 2018-2019, and many of them were diagnosed with CRC, according to the colonoscopy results. Therefore, screening is highly recommended as the first step in the early detection of CRC.

Some studies have shown that giardia infection is associated with some abdominal symptoms. The aim of this study was to determine the relationship between giardia duodenalis infection and irritable bowel syndrome (IBS). In this clinical trial study, 60 patients with non-constipation predominant IBS based on Rome III criteria were enrolled in the study. 30 patients with giardiasis who were diagnosed with stool Eliza as patients, and 30 other patients who did not have giardiasis as control enrolled to study. All patients were treated with 250 milligrams of metronidazole TDS for 5 days. Abdominal symptoms including abdominal pain, bloating, and diarrhea were determined and compared in both groups before and after treatment. The mean age and sex distribution of the two groups were similar (P>0.5). The pain, bloating, and diarrhea severity before treatment with metronidazole were not significantly different in the two groups. The pain and bloating and diarrhea severity in both groups significantly decreased after the treatment period, but reductions were significantly higher in the case group (P<0.001 and P<0.001 P<0.001, respectively). The mean score of global symptoms before treatment in both case and control groups was similar. (P=0.88), but after treatment it was 4.85±2.18 (P<0.001) and 10.48±2.14 (P<0.001) respectively and the difference between the two groups was significant (P<0.001). The recovery percentage was 0.61±0.16 in the case group and 0.14±0.17 in the control group (P<0.001). Giardia infection in patients with IBS seems to play a significant role in clinical manifestations of non-constipation IBS and treatment with metronidazole can improve these symptoms significantly.

Nowadays, improving anxiety, depression, and stress is important in managing non-alcoholic fatty liver (NAFLD). Thus, this study aimed to evaluate eight weeks of pomegranate peel (PP) supplementation on depression, anxiety, and stress scale changes among NAFLD patients.  This randomized clinical trial was conducted on 76 NAFLD patients assigned to the PP (n=39) or placebo (n=37) groups. Participants received the pomegranate peel (1500 mg/day) or placebo for eight weeks. PP capsules were prepared fromdry extract of PP by soaking. A diet with reduced calorie intake and healthy recommendations was given to all participants. The status of NAFLD was checked with two-dimensional elastography. Mental health was evaluated using depression, anxiety, and stress scale, and dietary intake was assessed by 3-day recall before and after the intervention.  The average age of the participants was 43.1±8.6 years, of whom 51.3% were women. In the PP group, weight, liver stiffness, and hepatorenal sonography index changes significantly differed from the placebo group before and after adjusting potential covariates, including weight and physical activity (P< 0.001). Depression and stress scores changed significantly in the PP group during the study before and after adjusting potential covariates (P= 0.002, 0.05, respectively). Anxiety score changes were insignificant between the two groups (P= 0.1).  Based on the results, eight-week supplementation of pomegranate peel ameliorated depression and stress symptoms among NAFLD patients.

 Helicobacter pylori infection is one of the most prevalent infections in many areas of the world, which is treated with different combinations of medications.

 This study aimed to investigate the response rate and outcomes of H. pylori-infected Iranian patients treated with triple therapy.

 The current study examined the records of patients with dyspepsia referred to Imam Reza hospital's gastroenterology clinic in Mashhad, Iran, diagnosed with H. pylori from 2017 to 2019. The patients received the triple therapy for H. pylori and were divided into responsive and non-responsive groups.

 Out of the 750 patients, 477 were included in the study. The response rate to H. pylori standard triple therapy was 79% after 14 days of treatment. Patients aged 30 - 39 years had the highest rate of treatment response. There was no significant relationship between the response rate to treatment and smoking (P = 0.74), alcohol consumption (P = 0.91), opium addiction (P = 0.89), history of aspirin (P = 0.46) or nonsteroidal anti-inflammatory drugs (NSAIDs) use (P = 0.66), diabetes (P = 0.18), renal failure (P = 0.054), and family history of GI malignancies (P = 0.51). Furthermore, patients with gastric ulcer (P = 0.43), duodenal ulcer (P = 0.66), and gastric precancerous lesions (P = 0.93) showed no significant difference in response to treatment.

 The H. pylori triple therapy regimen can be an effective medication strategy for H. pylori infection in the Iranian population.

A local outpatient clinic for diagnostic, therapeutic and counseling of patients without the need for hospitalization, which provides a variety of educational opportunities for learners. Considering the role of outpatient clinics in medical education, this study was conducted with the aim of promoting the education of trainees, interns and specialized and sub-specialized assistants of Mashhad University of Medical Sciences in the clinic of Imam Reza Hospital in 1399.

 The present qualitative study was conducted in the clinic of Imam Reza (AS) Hospital in Mashhad in 2016 with a content analysis approach. The study population consisted of managers of Imam Reza Hospital, faculty members and medical students, a total of 60 people were purposefully selected. In this study, focused interviews and group discussions were used to collect information. Content analysis method was also used to analyze the study data.

 Based on the findings of this study, at first, the current process of patient appointments and visits was identified. After that, the most important problems and executive shortcomings in the current process were discussed. The findings of the present study showed that the patient visit process in the teaching clinic of Imam Reza Hospital with problems such as inability to follow patients, inability to determine the exact time of attendance The patient faces the clinic, the accumulation of students in the visiting rooms, the lack of examination based on clinical standards, the lack of adequate educational facilities such as computer systems and examination equipment, and the lack of special subspecialty clinics and referral centers for special patients. Also, the most important solutions for removing administrative obstacles were identified. After reviewing the proposals, due to time and financial constraints; The following corrective measures were taken: improving educational facilities, modifying the queuing process, designing an in-hospital referral system, managing queues for patients, and setting up special clinics and sub-specialized referrals.

In this article, we tried to improve the quality of education in one of the main educational clinics in Mashhad. Review and reform of educational processes in the field of outpatient services should be on the agenda of managers and planners of hospitals and educational clinics; Because medical education in the context of outpatient services is one of the main educational infrastructures.

The Covid-19 disease pandemic has affected various aspects of life including medical education. Therefore, it has been inevitable to shift medical education programs towards "combined virtual and face-to-face learning and hybrid learning". In this regard, we activated a   virtual education system along with face-to-face training to improve the education of learners in the internal medicine department.

 A present quasi-experimental study without control group was performed on residents of the internal medicine department of Mashhad University of Medical Sciences residing in both Imam Reza and Ghaem hospitals from March 2020 to December 2021 by census. Virtual training started alongside face-to-face training. Student satisfaction was assessed using the Distance education learning environments survey (DELES) questionnaire, the validity and reliability of which have been assessed in previous studies. All learners who did not answer more than one of the 30 questions in the questionnaire and final year students were excluded from the study. Data analysis was performed using SPSS software (22).

 A total of 26 learners were participated in the survey, including 10 men (38.5%) and 12 women (46.5%) and 4 individuals with undisclosed gender. In this survey, the level of satisfaction with the new implemented integrated education program in the internal group was %66.66. The greatest scores given by the learners to the system belonged to the ability to share information and the opportunity to cooperate with other students.

The results of this survey showed that learners were very satisfied with the combined learning system as a part of their educational program. Improving learners' outcomes and feedback after moving to combined method of virtual and face-to-face training, despite all the constraints imposed during the Covid-19 Pandemic era, promises a brighter future in training programs of the internal medicine department.

Pandemic covid  19 has had a profound effect on health and education systems around the world, and many day-to-day works in teaching hospital settings, including hours and teaching methods, have changed dramatically due to student and physician safety and changing inpatients. And medical education policymakers face many challenges in optimizing the education and evaluation of medical students, and should make more use of alternative methods of online education and training technologies and make fundamental changes to traditional methods of medical education. This section is a review of educational curricula and emphasis on educational minimums, which is important to remove and change or create new teaching methods. Different countries pay attention to the fact that the safety of students and professors is an important and necessary point in educational institutions at this critical stage. These points underscore the importance of greater interdisciplinary collaboration and creativity in training and greater adaptation to change.

Coronavirus disease 2019 (Covid-19) is expanding worldwide. Although it seems to be a purely respiratory disease, occasional reports of lesions in other organs have been published. We report here an asymptomatic child with Covid-19 and with the main symptom of abdominal pain distension and without any respiratory symptoms. A 14-year-old male patient with main complaints of fever, malaise, anorexia, and severe abdominal pain was admitted to a hospital in Mashhad, Iran. Laparotomy revealed distension of the small intestine and an adhesive ileocaecal band that had produced ileum herniation without free fluid in the abdomen. Chest radiography and high-resolution computed tomography of the lungs showed bilateral and diffuse, peripheral dense areas of ground-glass appearance. A nasopharyngeal swab for diagnosis of Covid-19, was ordered due to lymphopenia together with these diffuse lung infiltrations, which showed a positive result. This led to drug treatment with lopinavir/ritonavir, hydroxychloroquine, ribavirin/oseltamivir, and meropenem. The patient was febrile and developed tachycardia on the third day, accompanied by a respiratory rate of 44/min. At this point, tracheal intubation was done, but the patient died after 3 hours due to cardiac arrest. The case report brings forth the hypothesis that the gastrointestinal manifestation may be an atypical symptom of Covid-19 infection and highlights the importance of the diagnosis based on combined laboratory-based data and scanning imagery.

There are disagreements about the diagnostic value of the current risk stratification systems in patients with acute upper gastrointestinal bleeding (UGIB). The present study aimed to determine the diagnostic value of Glasgow-Blatchford score in UGIB patients.

This study was conducted on 182 patients with UGIB, who underwent endoscopy in Emergency Department of Imam Reza Hospital, Mashhad, Iran. Glasgow-Blatchford Score (GBS) of each patient was estimated by using the clinical and laboratory parametres. The relationship between Blatchford score and endoscopic findings was assessed. Additionally, the sensitivity and specificity of GBS were measured based on high- and low-risk patients.

According to the results, GBS had a high sensitivity (90.9%), specificity (79%), as well as positive (76%) and negative predictive values (92.2%). However, no significant relationship was observed between the Glasgow-Blatchford score and re-bleeding.

As the findings of the present study indicated, Glasgow-Blatchford was a good predictive method for the determination of the high risk and low-risk patients with UGIB. Nevertheless, this method showed poor performance in the prediction of re-bleeding.

Hepatitis E infection is caused by the hepatitis E virus (HEV) and is a self-limiting disease with moderate-to-high prevalence in various regions. Considering that HEV is endemic in Iran, the present study aimed to systematically review the prevalence of HEV in Iran.
This systematic review was performed in May 2016 to investigate the prevalence of Hepatitis E infection in Iran via searching in databases such as PubMed, Scopus, and IranMedex using the following approach: (((Hepatitis E OR HEV)) AND (epidemiology OR frequency OR prevalence)) AND Iran. After collecting the proper documents, the required data were extracted and described.
In total, 24 relevant articles with 12,555 study populations were collected in this study. The results of the review indicated that the prevalence of HEV is relatively high in the Iranian population. In the reviewed literature, the prevalence of HEV varied from 2.3% to more than 40%.
According to the results, the prevalence of HEV in Iran is similar to the rate reported in the other developing countries. Therefore, it is recommended that routine tests be conducted for the diagnosis of hepatitis E, especially in the suspected cases of acute non-A, non-B, and non-C hepatitis.

Colorectal cancer is one of the most common cancers in terms of morbidity and mortality worldwide. a lot of research have been done in this field in Iran and worldwide, which have positive results. The aims of this study were firstly doing a statistical study on colorectal cancer in Mashhad, Iran, and finally predicting the colorectal location of cancer based on the clinical data by using data mining science and­ decision tree model.
The data of 316 patients with colorectal cancer (including 14 features) were extracted from the archive of Imam Reza Hospital, Mashhad. The instrument used in this research was RapidMiner data mining software that would try to be extract the details of the relevant data by statistical surveys and then would do initial simulations and the use of classification and decision tree method have predicteion the location of cancer.
Male to female ratio of 56% to 44%, family history of 37%, more young patients, and relatively more distally located cancers (39%) compared with the proximal (35%), and rectum (26%) were the striking findings of this study. The final and most important stage of research models were presented, which was able to predict the location of the cancerous tumor with 80% accuracy.
Similarities with global statistics, such as the ratio of men to women and family history were observed. But there were also differences with global statistics including the Iran’s younger patients and relatively more patients with distal cancers. The efficiency of data mining techniques to predict the location of cancer as well as cost reduction was among the most important results of this study.

Atherosclerosis is involved in inflammatory diseases, and inflammation can be a valuable predictor of cardiovascular disease. On the other hand, an increase in intima-media thickness (IMT) is usually considered as a primary marker of atherosclerotic lesions. Hence, measurement of IMT may be useful for early detection of atherosclerosis in patients with inflammatory bowel disease (IBD). The aim of this study was to systematically review the literature in which the IMT had been evaluated as diagnostic marker for the detection of atherosclerosis in patients with IBD.
A systematic literature search was performed in PubMed, Scopus, and Google scholar using the following search method ((inflammatory bowel disease OR IBD OR Crohn’s disease OR ulcerative colitis)) AND (intima OR intima media thickness OR intimal medial thickness OR IMT OR carotid intima-media thickness OR CIMT) to evaluate the association between IBD and IMT. After collecting the eligible documents, the desired data were extracted and analyzed.
Of total 278 collected documents, only 14 relevant articles with total 1333 participants including 720 patients with IBD and 613 healthy controls were included for data assessment. The results of the articles did not support significant association between IMT and IBD. However, in some studies it was shown that IMT was elevated in patients with IBD.
The results of this survey showed that there was no significant difference in IMT between the patients with IBD and healthy control groups; therefore, IMT cannot be considered as a predictor of atherosclerosis and future cardiovascular events in patients with IBD.

The relationship between primary hyperparathyroidism and pancreatitis has yet to be established firmly. We present a patient with acute pancreatitis and a hypercalcemic crisis induced by a parathyroid adenoma. A 72-year-old woman presented with lethargy and a constant pain in the epigastric region. She had a medical history of diabetes mellitus, hypertension, nephrolithiasis, and ischemic heart disease. Blood examination revealed leukocytosis and high serum amylase and lipase levels. Ultrasound exam confirmed the diagnosis of acute pancreatitis with a normal biliary tract and no gallstones. On further evaluation severe hypercalcemia (24 mg/dL) was detected, which was treated with 0.9% sodium chloride solution and calcitonin. The acute pancreatitis and its symptoms resolved after 3 days. Ultrasound exam and technetium 99 m sestamibi scan showed a parathyroid lesion. Ultimately the patient underwent right thyroid lobectomy because of refractory hypercalcemia. The pathology report was indicative of a parathyroid adenoma. Subsequently, the parathyroid gland was resected with normalization of calcium, parathyroid hormone, and amylase levels and the patient was discharged in good condition 7 days after surgery. Apart from the acute supportive management, common to all cases of acute pancreatitis, definite management must be tailored to the specific cause. Hypercalcemia during the course of pancreatitis must prompt an investigation for primary hyperparathyroidism with early surgical intervention if a parathyroid source is detected.

Lynch Syndrome (LS) is a genetically inherited autosomal disorder that increases the risk of many types of cancer, especially colorectal cancer (CRC). Identifying these subjects improves morbidity and mortality. We aimed to assess the prevalence of LS with both clinical criteria and universal strategy in Mashhad, Iran.
In this retrospective study, we screened 322 patients with CRC between 2013 and 2016 in Mashhad, Iran. CRCs were screened based on Amsterdam II criteria, revised Bethesda guideline, and universal strategy. Information regarding the clinical criteria was obtained by interviewing the patients or, their families. Tumors were screened by pathologists with IHC staining of four Mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, and PMS2). Tumors with absent IHC staining of MLH1 were tested for BRAF mutations to exclude sporadic CRCs.
Of 322 CRCs, 33 cases were found to be deficient-MMR; 22 of these had concurrent loss of MLH1 and PMS2, followed by concurrent loss of MSH2 and MSH6 in 8 CRCs. Twenty-two cases with a loss of MLH1 underwent testing for the BRAF mutation, 4 of which were recognized as a positive BRAF mutation. Finally, 29 CRCs were found as being positive screen for LS. Poor sensitivity (21.74%) was found for the Amsterdam II criteria and a poor positive predictive value (15.39%) for the revised Bethesda.
Application of clinical criteria may not be effective enough to identify LS and at least 2-antibody panel (PMS2, MSH6) should be conducted for newly diagnosed CRCs.

Hepatitis delta virus (HDV) is an RNA virus that causes hepatitis. Since HDV is dependent on hepatitis B virus (HBV) for its pathogenesis, two major types of HDV and HBV infection is coinfection with HBV in anti-HBs negative individuals, or superinfection in chronic HBV carriers. Therefore, the prevalence of HDV depends on the frequency of HBV infection in various populations. In this study, we aimed to systematically review the prevalence of HDV in Iran.
A systematic literature search was performed in August 2016 in PubMed, Scopus, and Iran Medex using the following keywords (((hepatitis delta virus OR HDV)) AND (prevalence OR frequency OR distribution OR epidemiology)) AND Iran to investigate the prevalence of HDV in Iran. After literature search and selection of appropriate documents, the desired data were extracted and described.
A total of 14 articles with overall 6300 study population with HDV infection were collected. The results of this study showed that the prevalence of HDV varied from zero in the north to 19.7% in the south of Iran (in HIV infected patients).
The prevalence of HDV was relatively high among Iranian patients with chronic HBV infection. Furthermore, the results of this study showed that the prevalence of HBV/HDV coinfection has increased during the last decade in Iran.

It is long known that vitamin D deficiency was common in patients with liver disease, but little is known on the therapeutic effects of vitamin D, especially in patients with chronic liver disease. In this study, we aimed to systematically review the literatures and study the evidences in which the effects of vitamin D supplementation had been investigated on the severity of chronic liver disease or liver cirrhosis.
A systematic literature search was performed by using the following key terms “vitamin D supplementation” and “chronic liver disease” in the PubMed, Scopus and Google scholar to find relevant articles. After collecting the eligible documents, data were extracted and described based on the purpose of this review.
Of total 196 articles found, only 7 relevant documents with 518 studied patients were included. The results of this study showed that the levels of 25(OH) D were considerably lower in patients with chronic liver disease. Findings showed that vitamin D supplementation can rise up the mean serum level of 25(OH) D in patients with severe vitamin D deficiency, especially patients with liver cirrhosis.
The results of this review showed that vitamin D deficiency is associated with the severity of liver disease and may have prognostic value in the assessment of liver disease. Also, it was shown that vitamin D supplementation may be helpful for the treatment of liver disease at least in certain groups of patients.

Chronic hepatitis B infection (CHB) is a major global health problem. Hepatitis B e antigen (HBeAg)-negative is a common type of CHB in Iran. Liver damage in HBeAg-negative CHB leads to progressive form of the liver disease with poor prognosis. Therefore, it seems necessary to perform a comprehensive evaluation of different spectrum of laboratory measurements accompanying histological findings. The aim of this study was to evaluate the association between the biochemical, virologic and histologic features in HBeAg-negative CHB. Furthermore, we assessed the application of new cut-off values for alanine aminotransferase in HBeAg-negative CHB patients.
HBeAg- negative CHB patients referring to hepatology clinics at Ghaem and Imam Reza hospitals during two years period were enrolled. Patients with alcohol consumption, liver mass, fatty liver and whom with positive results of Anti HDV, Anti HCV or Anti HIV were excluded. Liver enzymes were requested and Hepatitis B viral loads were measured by real time polymerase chain reaction (RT-PCR) in all patients. Liver biopsies were assessed by two expert pathologists. The relationship between viral loads, liver enzymes and histopathological features was analyzed using descriptive and analytic statistical methods.
One hundred and fifty HBeAg-negative and HBe Ab-positive CHB patients (males=110, mean age=38.44±11.34 years) were assessed. Serum ALT levels had a significant relation with the logarithm of serum HBV-DNA levels (P In HBeAg-negative CHB patients, serum AST levels had a better predicting value for liver necrosis and inflammation. Moreover, age could be regarded as an independent predictor of the stage of liver fibrosis. This study revealed that the new cutoff values for ALT had superiority over the conventional values to identify patients with a higher risk of liver fibrosis.

Delay in diagnosis of celiac disease (CD) occurs frequently, although its consequences are mostly not known. One of the presented symptoms in pediatric patients with CD is the short stature. However, far too little attention has been paid to physical features including height of adult patients with CD. This study was undertaken to evaluate whether patients suffering from CD are shorter in comparison with the general population without CD. As well, we evaluated probable correlations between demographic and physical features, main complains, serum anti tTG level, and intestinal pathology damage between short (lower quartile) versus tall stature (upper quartile) patients with CD.
This was a retrospective cross-sectional study on 219 adult patients diagnosed as having CD in the Celiac Disease Center, between June 2008 and June 2014 in Mashhad, Iran. The exclusion criteria were ages less than 18 and more than 60 years. Height was compared with a group of 657 age- and sex-matched control cases from the healthy population. The probable influencing factors on height such as intestinal pathology, serum level of anti-tissue transglutaminase (anti-tTG), serum vitamin D, and hemoglobin level at the time of diagnosis were assessed and were compared in short (lower quartile) versus tall stature (upper quartile) patients with CD.
Both male (n=65) and female (n=154) patients with CD were shorter than their counterpart in the general population (males: 168.5±8.6 to 171.3±7.2 cm, p Adults with CD are shorter compared with healthy adults. There is a direct correlation between height and anemia and bone mineral density. This finding highlights the importance of early detection and treatment of CD.

Colorectal cancer (CRC) is the third leading cause of cancer deaths in the world, and hereditary factors and family history are responsible for the incidence and development of the disease in 20 to 30% of cases. Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is the most common hereditary form of CRC that is inherited in an autosomal dominant manner. This study consisted of a systematic literature review of research articles that described the prevalence of HNPCC in Iranian patients with CRC.
A systematic literature search was conducted in the PubMed, Scopus, IranMedex, and Google Scholar databases to identify relevant articles that describe HNPCC or Lynch syndrome in patients with CRC in Iran. For this purpose, a keyword search of the following terms was employed: (((Hereditary nonpolyposis colorectal cancer OR HNPCC OR Lynch syndrome)) AND (colorectal cancer OR familial colorectal cancer OR colon cancer OR rectal cancer OR bowel cancer)) AND IRAN. All eligible documents were collected, and the desired data were qualitatively analyzed.
Of the 67 articles that were found via the initial database search, only 12 were deemed to be of relevance to the current study. These articles included a total population of 3237 and this sample was selected and qualitatively analyzed. The findings of the review revealed that the frequency of mutation in MLH1, MSH2, PMS2, and MSH6 genes varied between 23.1% and 62.5% among the studied families. This indicated that HNPCC is linked with up to 5.5% of the total cases of colorectal cancers in Iran.
The results of this study revealed that the hereditary form of HNPCC or Lynch syndrome is significantly high among patients with CRC in Iran.

There are no data on familial aggregation of colorectal cancer (CRC) in northeastern Iran. The aim of this study was to determine the prevalence of early-onset CRC and patients suspected for hereditary non-polyposis colorectal cancer (HNPCC) based on the clinical criteria in this area.
Documents were collected from two hospitals in Mashhad regarding 326 inpatients during 2013-2015. Demographics, clinical, and tumor-related features were recorded. Interviews were done to identify cancer in the family up to second-degree relatives.
326 patients with CRC (48.5% male) were evaluated. The mean age at diagnosis was 55.44±14.85 years, with 91 patients (27.9%) below 45 years old. Eleven (3.4%) patients fulfilled the Amsterdam II criteria and 136 (41.7%) patients met at least one criterion of the revised Bethesda guideline. There was no difference between early- and late-onset CRC regarding the frequency of CRC in 1st degree relatives or tumor site (p=0.73, p =0.64). However, CRC in second-degree relatives and cases suspected for HNPCC were more common in early-onset of the disease (p =0.022, p =0.024). The patients who fulfilled the Amsterdam II criteria had lower mean age and higher frequency of proximal cancer (p =0.03, p =0.048).
As CRC is common in the young population and CRC clustering and patients suspected for HNPCC are also frequently encountered, measures should be taken to CRC screening policy and genetic studies in this area.

Vitamin D deficiency is believed to cause variety of abnormalities such as liver stiffness and fibrosis. It is also shown that vitamin D deficiency may result in chronic liver disease or liver cirrhosis. In this study, we aimed to systematically review the literature wherein the relationship between vitamin D deficiency and the severity of chronic liver disease or liver cirrhosis had been investigated.
PubMed, Scopus, and Google scholar were searched using the following search method (((vitamin D deficiency OR vitamin D insufficiency OR insufficient vitamin D)) AND (chronic liver disease OR chronic hepatitis OR cirrhosis OR liver cirrhosis)) AND (severity OR intensity) to evaluate the role of vitamin D deficiency or vitamin D inadequacy in the occurrence and severity of chronic liver disease. Articles were collected and the data were extracted.
Totally, 641 articles were found through searching the databases and reference list scanning. Of the collected documents, only 19 articles with 4895 studied patients were included and analyzed. The results of this study showed that almost 80% of patients with chronic liver disease had severe vitamin D deficiency.
Vitamin D deficiency is associated with the occurrence of chronic liver disease. The severity of liver cirrhosis is also associated with the level of 25(OH)D in progressive liver disease.

We reported on a case of Eosinophilic granulomatosis with polyangiitis (EGPA), formerly named Churg-Strauss syndrome (CSS) with colon ulceration, abdominal pain and heart failure With fatal progression of disease within 2 weeks. A 21-year-old woman with a history of bronchial asthma and allergic rhinitis was admitted with severe abdominal pain, nausea and vomiting for two weeks before admission Laboratory findings included remarkable leukocytosis and eosinophilia, colonoscopy revealed erosion and ulceration in rectum and sigmoid,. After 2 days severe heart failure with pulmonary edema occurred with wrist drop,On the basis of the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated This case was rare presentation of churg- strauss with gastrointestinal involvement and fatal progressive manner, Improved awareness of gasterointestinal EGPA may allow for timely management of this disorder.

This study aimed to explore demographic characteristics and clinical presentations of celiac disease (CD) in Northeastern Iran. This was a cross-sectional retrospective study of 193 adults with CD who presented to Mashhad University Gastroenterology Clinic between 2008 and 2013. Patient data that included mode of presentation and the presence of any concomitant illnesses were collected. Intestinal biopsy and serum anti-tissue transglutaminase (anti-tTG) were used for diagnosis. Mucosal lesions were classified according to modified Marsh classification. Overall, 132 females and 61 males, with a mean age at diagnosis of 32.6 ± 13.2 years were included. The patient’s chief complaints in order of decreasing frequency were dyspepsia (24.6%), diarrhea (20%), anemia (12.8%), and flatulence (7.2%). Bone disease was seen (osteopenia, osteoporosis) in 30% of patients. A positive family history of CD was found in 17.9% of cases. There were 64% who had serum anti-tTG >200 units/ml and 78% had a Marsh classification grade 3 on duodenal biopsy. The histology grade (Marsh) did not show any correlation with anti-tTG serum levels, age, body mass index (BMI) or hemoglobin levels. In Northeastern Iran, CD was seen more commonly in females and with non-diarrheal presentations. Abdominal discomfort, anemia and bone disease were most common primary presentations in this area. Histology grade showed no significant correlation with level of anti-tTG, BMI or hemoglobin levels. We suggest screening for CD in unexplained abdominal discomfort, bone disease and anemia.