فهرست مطالب raika jamali

Metabolic-associated fatty liver disease (MAFLD) is a common cause of liver-related mortality and morbidity worldwide. However, there is a paucity of literature on the relationship between cardiovascular disease (CVD) risk factors and quality of life (QoL) in patients with MAFLD.

This study aimed to examine the association between QoL and CVD risk factors in an Iranian MAFLD population.

This study was conducted on MAFLD patients, referred to the gastroenterology clinic of a general hospital from September 2017 until September 2018. The QoL and Framingham Risk Score (FRS) were determined using the WHOQOL-BREF questionnaire and an online web calculator, respectively. A hierarchical multiple linear regression model was developed to evaluate the association between QoL and FRS after adjusting for the sociodemographic characteristics.

This study was performed on 200 participants. All domains of QoL were associated with older age, hypertension, smoking, diabetes mellitus, higher systolic blood pressure, and lower high-density lipoprotein levels in the univariate regression analysis (P < 0.05 for all). Meanwhile, FRS was adversely correlated with the total QoL score (correlation coefficient: -0.49; 95% CI: -0.61, -0.35; P < 0.001). After adjusting for the sociodemographic variables, the results of the hierarchical multiple linear regression model showed that age, smoking, diabetes mellitus, hypertension, and FRS were correlated with the overall QoL score (P < 0.05 for all). Hypertension was the main predictor of the total QoL score (B = -5.51, 95% CI: -7.18, -3.68; P < 0.05). A higher FRS was inversely associated with the physical domain of QoL (B = -0.05, 95% CI: -0.09, -0.01; P < 0.05), the environment domain of QoL (B = -0.04, 95% CI: -0.09, -0.01; P < 0.05), and the total score of QoL (B = -0.04, 95% CI: -0.08, -0.02; P < 0.05).

According to the results of this study, a higher risk of developing CVD may reduce QoL in patients with MAFLD. Hypertension, diabetes mellitus, and smoking were the key predictive determinants of QoL in this population. Further studies are suggested to determine if modification of the mentioned risk factors can improve QoL in MAFLD patients.

To evaluate the effects of Helicobacter pylori (HP) eradication on liver function tests (LFT) and fat content (LFC) in non-diabetic non-alcoholic steatohepatitis (NASH).

This randomized clinical trial included dyspeptic HP infected non-diabetic NASH participants. The intervention arm received HP eradication treatment, while the control arm did not get any HP treatment. In the meantime, the standard management of NASH was performed in both trial arms. Mean alterations in LFT were the primary outcome and the secondary outcomes included the mean changes in LFC and serum metabolic profile. The trial follow-up period was 5 years.

40 participants (female: 20), with a mean age of 41.58 (±12.31) years, were enrolled in the study. The HP eradication arm included 20 participants (female: 11) with a mean age of 40.25 (±10.59) years, and the control arm consisted of 20 individuals (female: 9) with a mean age of 42.90 (±13.97) years. The tests of within-subjects effects showed a significant decrease in mean serum alanine aminotransferase (ALT; P=0.007), triglyceride (TG; P=0.04), cholesterol (P=0.004), and fasting blood sugar (FBS; P<0.001), and an increase in high-density lipoprotein (HDL; P=0.04) in both research groups during the study period. The tests of between-subjects effects demonstrated a more significant decrement of FBS in HP eradicated patients than the controls (P=0.02). The reduction in waist circumference, aspartate aminotransferase (AST), ALT, alkaline phosphatase, triglyceride, cholesterol, low-density lipoprotein, insulin, and LFC were more prominent in the intervention group than the controls; however, these differences were not statistically significant.

Adding HP eradication treatment to standard NASH treatment showed more therapeutic effect thanthe standard NASH treatment protocol alone regarding the decrement of FBS in participants with dyspeptic non-diabetic NASH. Considering the non-statistically significant improvement in other metabolic indices and LFT in this trial, further studies are recommended.

Inlet patch (IP) lesion is the presence of gastric columnar epithelial tissue outside of the stomach. Symptoms such as a lump in the throat, chronic cough, laryngitis, or other mouth-throat symptoms may be IP-related only and have no other abnormalities. This study aimed to determine the relationship between globus sensation and structural disorder of Inlet Patch in patients with gastroesophageal reflux disease

The case-control study was performed in patients who were referred to the endoscopy ward of Sina Hospital in Tehran from October 2016 to October 2017. Inclusion criteria were diagnosis of gastroesophageal reflux and endoscopic indications. Patients who had endoscopic indications and underwent endoscopy were evaluated. Information on reflux esophagitis and inlet patch structural disorder were determined. Symptoms of reflux, including a lump in the throat, were identified and recorded. Then the frequency of globus sensation in patients with inlet patch structural disorder (patient group) and without it (control group) was compared.

A total of 100 patients with gastric reflux participated in this study. Patients included 42 men (42%) and 58 women (58%). The mean age of patients was 41.17±10.35 years (18-77 years). The severity of mild reflux was 57%, moderate reflux was 27% and severe reflux was 16%. 28% of patients had a lump in the throat and 12 patients had an inlet patch. There was a statistically significant relationship between inlet patch and globus sensation (p=0.001). All patients with inlet patch had globus sensation. 81.8% of patients without inlet patch did not feel a lump in the throat. The results showed a statistically significant difference between the two groups with and without inlet patch in terms of globus sensation in general and in terms of different clinical variables (p=0.001).

The findings of the study showed that inlet patch had a significant relationship with the feeling of a lump in the throat and all patients with inlet patch felt Globus sensation.As the result, to diagnose a patient with an inlet patch, other causes such as esophagitis, hernia, heartburn and metabolic syndrome should be ruled out.

We aimed to assess the gastrointestinal (GI) manifestations of patients with severe acute respiratory syndrome coronavirus 2 infection and determine factors predicting disease prognosis and severity among patients with GI symptoms.

In this retrospective study, we evaluated laboratory confirmed (by real-time polymerase chain reaction) inpatient cases of coronavirus-associated disease 2019 (COVID-19), referred to Sina hospital, a tertiary educational hospital of Tehran University of Medical Sciences, from March 10 to May 20, 2020. Demographic and clinical characteristics, laboratory data, outcomes and treatment data were extracted and analyzed using SPSS version 20.

A total of 611 patients (234 women and 377 men) were included with 155 patients having GI symptoms. The most prevalent reported GI symptom was nausea/vomiting in 115 (18.8%) of patients. A total of 20 patients (3.2%) only had GI symptoms (without respiratory symptoms). There was no statistically significant difference in the clinical outcomes, disease severity, intensive care unit (ICU) admission and mortality between patients with and without GI symptoms. Aspartate Aminotransferase level was associated with 446% increased risk of disease severity (adjusted odds ratio: 5.46, 95% CI: 2.01 to 14.81) (P=0.040) among patients with GI symptoms. Additionally, we found that treatment with antibiotics in addition to mechanical ventilation was associated with increased survival among patients with GI symptoms (Pearson Chi square: 6.22; P value: 0.013).

More attention should be paid to patients with only GI symptoms for early patient detection and isolation. Moreover, patients with GI manifestations are not exposed to higher rates of disease severity or mortality.

This study aimed to investigate the effects of smoking reduction on liver function tests and metabolic parameters in non-alcoholic steatohepatitis (NASH) smokers.

In addition to standard treatment, all patients participated in 6 sessions of “motivational interview” workshops to encourage smoking decrement. The clinical trial consisted of two successful and unsuccessful arms. Those who decreased daily cigarette smoking more than 50% were labeled as “successful” group. The “unsuccessful” group consisted of those who were decreased the daily cigarette smoking less than 50%. The successful and unsuccessful groups were 43 (41%) and 61 (59%) patients respectively. The data regarding number of daily cigarette smoking, liver function tests and metabolic parameters were checked twice, in 3 and 6 months’ time after starting the intervention.

Liver function tests, metabolic parameters and liver fat content (LFC) were decreased in both arms after 6 months. The mean alanine aminotransferase, alkaline phosphatase, fasting blood sugar, insulin, cholesterol, low density lipoprotein, LFC, and waist circumference (WC) was lower in successful arm than in unsuccessful.

It seems that concomitant standard treatment and cigarette smoking reduction has more effect in decrement of alanine aminotransferase, serum metabolic parameters, WC and LFC in NASH smokers.

There is a paucity of literature regarding the medical students’ perspectives on web-based training of clinical reasoning.

This study aimed to describe the implementation of a web-based training course of clinical reasoning for medical students and to evaluate their satisfaction with the program.

This cross-sectional study was conducted at the Tehran University of Medical Sciences in 2018. Fifty internal medicine interns were consecutively enrolled. The study consisted of two phases. The first phase focused on the development of a web-based training module of clinical reasoning. The second focused on evaluating the trainee’s satisfaction with the virtual course. The educational content of the program was prepared by an expert panel and incorporated in a web-based educational tool designed for virtual training purposes. The students’ satisfaction with the virtual course was assessed using a questionnaire. Each item of the questionnaire was scored from 0 (0) to 1.5 (100). The content validity of the questionnaire determined by an expert panel, and its reliability was measured.

The mean score of each item of the questionnaire ranged from 77.3 to 85.3 which showed that the participants agreed with the items of the questionnaire. Also, Cronbach’s alpha coefficient was excellent in nine items of the questionnaire, good in four items, and acceptable in three items. The intraclass correlation coefficient was also estimated as 0.98.

The participants were satisfied with the web-based training tool for clinical reasoning, used in the present study. The developed questionnaire also showed good validity and reliability for the assessment of trainees’ satisfaction with the web-based training module of clinical reasoning.

There are controversial ideas about the application of metabolic indices for the prediction of non-alcoholic steatohepatitis (NASH). In this study, we evaluated some novel metabolic indices for the screening of NASH.

This prospective case-control study was performed in a gastroenterology outpatient clinic. Consecutively selected patients with persistently elevated aminotransferase levels and evidence of fatty liver in ultrasonography were enrolled. Those with other etiologies of aminotransferase elevation were excluded. The remaining was presumed to have NASH. The control group consisted of age and sex-matched subjects with normal liver function tests and liver ultrasound examinations.

Finally, 94 patients with steatohepatitis and 106 controls were included in the project. The mean liver fat content (LFC), aspartate aminotransferase, and alanine aminotransferase levels were significantly lower in the control group than in the NASH group. LFC was independently associated with the presence of NASH in logistic regression analysis. LFC had a good area under the curve for the prediction of NASH in ROC (receiver operating characteristic curve) analysis.

LFC seems to be a reliable metabolic index for the detection of patients with NASH.

Non-alcoholic steatohepatitis (NASH) is increasing worldwide due to the metabolic syndrome epidemy. According to the current evidence, a higher cardiovascular disease risk (CVDR) is observed in NASH individuals than the general population.

The relationship between liver fat content (LFC) and CVDR in a cohort of NASH patients was evaluated in this research.

Consecutively selected patients with increased aminotransferase levels and fatty change in liver ultrasonography were enrolled in the study. Those with known causes of viral hepatitis, any hepatotoxic medications or alcohol consumption, autoimmune hepatitis, cigarette smoking, and ischemic heart disease were excluded from the project. The remaining was presumed to have NASH. The Framingham risk score (FRS) and LFC were calculated by means of an online calculator and a valid formula, respectively. The correlation between LFC and independent variables was measured using the Pearson correlation test. The P-value of less than 0.05 was considered significant. The statistical analysis was performed using SPSS program version 18.

Finally, two hundred NASH patients were included in the study. Considering diabetes mellitus as a confounder, there was a fair relationship between LFC and FRS (R=0.26 and 0.23, respectively, p<0.05) in the second and third visits. Even after adjustment for known cardiovascular risk factors, LFC was associated with increased CVDR (OR=9.181; 95% CI: 2.00-42.14, p=0.01). The cut-off value of 9.1% for LFC had a sensitivity of 92% and a specificity of 87% for discrimination of the FRS >20% and <20%.

LFC might independently be correlated with CVDR in NASH patients. If further research confirmed this relationship, the inclusion of LFC into the FRS formula would provide an appropriate CVDR estimation tool in NASH.

After kidney transplantation, several factors should be checked to predict the risk of rejection. Liver enzymes are such predicting factors so liver function test abnormalities (LFTA) can consider the rejection possibility in kidney transplant recipients (KTR).

Through a retrospective cohort study, 659 KTR were studied. The source of all grafts was from deceased donors. Amongst these cases, 67 patients showed a significant rise in creatinine as the rejection indication. Several liver indexes like alanine transaminase (ALT), aspartate transaminase (AST), direct bilirubin (Bil D), total bilirubin (Bil T), and liver ultrasound reports, gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), prothrombin time (PT) INR in addition to creatinine were examined for three-six post-transplant in KTR.

Our study exposed that liver functional tests regularly had considerable statistical differences between KTR with creatinine increase and with no creatinine increase. Despite these differences between the two groups AST, ALT and ALP serum levels were still within the normal range in both groups. The same result was seen over Bil D and Bil T.

Liver function test abnormalities can not adequately predict the rejection. Some other elements should be taken into consideration like inflammation factors like erythrocyte sedimentation rate (ESR or sed rate), and C-reactive protein (CRP).

  The aim of this present study was to assess the relationship between serum zinc levels and liver histopathological findings in non-alcoholic steatohepatitis (NASH) patients. This case-control study was performed in consecutively selected NASH patients who had been referred to a general hospital. The control group consisted of age and sex-matched individuals with normal physical examinations, laboratory findings, and liver ultrasounds. Serum zinc level was measured using atomic absorption spectrophotometry. Liver histopathological findings were determined based on non-alcoholic fatty liver activity score. A cohort of eighty biopsy-proven NASH patients and eighty controls were enrolled in the study. The mean serum zinc level was significantly lower in the NASH group compared with the controls. The mean serum zinc concentration was significantly lower in moderate and severe lobular inflammation groups than the mild group. After multiple adjustments for potential contributing variables, serum zinc level was associated with the severity of lobular inflammation. Nonetheless, it was not associated with liver steatosis and fibrosis. A serum zinc value of 89 (µg/dl) yielded a sensitivity and specificity of 93% and 86%, respectively, characterizing patients with lobular inflammation of less than two inflammatory foci per high-power field (HPF) from more advanced groups. Furthermore, a value of 79.55 (µg/dl) yielded a sensitivity and specificity of 87% and 100%, respectively, distinguishing those with a lobular inflammation grade of less than four foci per HPF from more advanced cases. Serum zinc level might be associated with the severity of lobular inflammation in NASH

This review aimed at investigating the effectiveness of Helicobacter pylori eradication in improving the symptoms of patients with functional dyspepsia in Iranian adult population.
This study was a systematic review. Data were collected from the Medline database by searching some keywords including "Helicobacter pylori", "eradication", "effectiveness", "dyspepsia", and "Iran". After obtaining the full text of articles, the critical review was performed based on article titles and abstracts. For each article, information regarding benefits, side effects and efficacy was identified. Then, scenarios were extracted according to the mentioned data.
From a total of 28 reviewed papers, 6 were systematic reviews (with the level of evidence 1a), 18 articles were randomized interventional trials (with the level of evidence 1b) and 4 articles were longitudinal studies (with the level of evidence 2b). Most studies reported improvement in symptoms, although some of them did not report the statistically significant difference. After extracting data related to the scenarios from the articles, they were rated regarding the clinical advantage and the ability to localize each scenario.
Considering the results of analyzing the articles and extracted scenarios, Helicobacter pylori eradication is recommended in Iranian adult patients with functional dyspepsia, normal upper gastrointestinal endoscopy, and documented Helicobacter pylori infection.

To evaluate the association between disease severity and hepatic steatosis in patients with ulcerative colitis (UC) and non-alcoholic steatohepatitis (NASH). Consecutively selected UC patients admitted to the gastroenterology clinic were enrolled in the study. UC severity was assessed by Truelove and Witts classification. Patients with severe UC were excluded from the study. NASH was determined based on persistently elevated serum aminotransferase levels and detection of fatty liver ultrasound. Patients with other etiologies for elevated aminotransferase levels were excluded. Liver fat content (LFC) was assessed by measuring liver fat score (LFS). One hundred patients (42% male) were included in the study. According to liver ultrasound examination, 62 (%) patients were identified with grade 1 fatty liver disease, and 38 (%) patients were classified as advanced (grade 2 and 3) fatty liver disease. Sixty-one patients had left-sided UC and (46%) had mild UC disease severity index. LFS was significantly higher in UC patients with the moderate disease than patients with mild disease (3.53±2.68 vs. 5.89±2.85, respectively; P

Hearing loss is an important impairment that occurs in the diabetics and affects their quality of life. There is still a paucity of studies on the relationship between diabetes and hearing loss.
This case-control study compared the prevalence of hearing loss in a sample of diabetics with that in an age and sex matched group of healthy controls.
Cases were consecutively selected from the diabetics registered in two diabetes centers during February to December 2013. Controls were age and sex matched healthy volunteers admitted to a blood bank. Pure tone audiometric test (PTA) was performed by audiometer for the evaluation of hearing impairment. Then, the existence of hearing impairment in different intensities was compared between the two groups considering the effect of diabetes duration, BMI, and serum creatinine (Cr) level.
Eighty diabetics and eighty healthy controls were included. Hearing loss in sounds with high frequencies was more common in the diabetics than the controls. The mean serum creatinine level was significantly higher in the diabetics with hearing loss than those without hearing loss at noise frequencies of 4 KHz and 8 KHz (P According to the results, hearing impairment in high frequency sounds was more common in the diabetics than the healthy individuals. Also, the severity of hearing loss in patients with diabetes was associated with the levels of creatinine (diabetic nephropathy). The hypothesis of the relationship between diabetes and hearing loss through nephropathy should be more examined in future studies.

Nonalcoholic fatty liver disease (NAFLD) includes steatosis, nonalcoholic steatohepatitis, fibrosis and liver cirrhosis. The oxidative stress enzymes are the diagnostic markers to prediction of histologic status of liver in nonalcoholic steatohepatitis disease. The aim of the study was to assessment of relationship between serum Zinc (Zn) levels with pathologic manifestation in patients with nonalcoholic steatohepatitis.
This cohort study was done in patients with nonalcoholic steatohepatitis that had been visited in gastrointestinal clinic of Sina Hospital, Tehran, Iran from April, 2014 to April, 2015. Control group included the patients with no clinical manifestation of nonalcoholic steatohepatitis and normal liver ultrasonography, lab test and liver biopsy. Serum Zn level was measured with atomic absorption spectroscopy. Normal Serum level of Zn was considered 10.7-22.9 µmol/L (70-150 µg/dL) and less than 7 µg/dL was considered as Zn deficiency. Pathological findings were grading according to NAFLD activity score.
One hundred twenty patients were selected for the study in two equal groups. Six and 26 patients were excluded in case and control groups, respectively due to no consent to lab test. Finally, 54 patients (35 male/19 female) and 34 patients (22 male/12 female) in control group were participated in data analysis. The mean age on case and control group was 37.02±9.82 year and 33.24±12.01 year, respectively (P= 0.111). Zn level in case and control groups were 90.82±13.69 and 88.82±13.10, respectively. There were no statistically significant differences between two group in serum Zn level (P= 0.50). Also, there were no statistically significant differences between pathological grading in case group participants (steatosis: P= 0.640; Lobular inflammation: P= 0.882; fibrosis: P= 0.531).
The finding of the study showed no significant association between serum zinc level and hepatic steatosis, lobular inflammation and fibrosis of the liver in nonalcoholic steatohepatitis.

Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic hepatitis, which can lead to cirrhosis and hepatocellular carcinoma..
The aim of the study was to evaluate the correlation between serum adipocytokines and the histologic findings of the liver in patients with non-alcoholic fatty liver disease (NAFLD)..
Patients and This case-control study was performed on those with persistent elevated liver enzymes and with evidence of fatty liver in ultrasonography. After exclusion of patients with other etiologies causing abnormal liver function tests, the resulting patients underwent liver biopsies. NAFLD was diagnosed based on liver histology according to the Brunt scoring system..
Waist circumferences and levels of blood glucose (after fasting), insulin, triglycerides, alanine aminotransferases (ALT), and aspartate aminotransferases (AST) were higher in patients with NAFLD than in those in the control group. ALT, AST, and gamma glutamine transferase (GGT) levels were lower in patients with liver steatosis of a grade of less than 33% than those with higher degrees of steatosis. Serum low-density lipoprotein (LDL), cholesterol, and hepcidin levels were significantly higher in those with lobular inflammation of grade 0 - 1 than in those with inflammation of grade 2 - 3 (Brunt score). Meanwhile, AST was significantly lower in those with lobular inflammation of grade 1 than in those with grade 2-3. Hepcidin and resistin levels were significantly higher in patients with moderate to severe fibrosis than in those with mild fibrosis..
It seems that surrogate liver function tests and adipocytokine levels were correlated with the histologic findings of the liver..

Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders particularly affecting the quality of life (QOL). Evaluating QOL in IBS patients is a valuable method of defining a psychobiological pattern of disease. Various disease specific and general instruments are now available to measure health-related QOL (HRQOL) in IBS patients. Though, no comparison has been made between these tools especially in non-western countries. We aimed to compare QOL measures between two specific and general QOL questionnaires in a sample of Iranian IBS patients. A total of 250 IBS patients were diagnosed based on Rome III criteria (mean age 29.6 ± 9.6 years). HRQOL was assessed using disease specific quality of life for IBS (IBS-QOL) and generic World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaires. Patients also completed Speilberger`s “State/Trait Anxiety Inventory” and “Beck Depression Inventory-II” for the evaluation of anxiety and depression symptoms. The severity of symptoms was independently associated with HRQOL in patients using WHOQOL-BREF and IBS-QOL (r = -0.48 and -0.39 respectively, P < 0.001). In linear regression analysis, a strong correlation was observed between the HRQOL scores of IBS-QOL and the WHOQOL-BREF questionnaires (standard β = 0.86 (95%CI: 1.15 - 1.44), P value < 0.001). Controlling for anxiety and depression symptoms did not influence the strength of observed correlation. The WHOQOL-BREF is a psychometrically sound, rapid and convenient instrument whose HRQOL measure is as valid and accurate as the disease-specific IBS-QOL questionnaire. It seems reasonable to use the WHOQOL-BREF alongside the IBS-QOL.

Considering the possible risks of performing endoscopy training on patients, the use of a moulage prior to training seems reasonable. The aim of this study was to evaluate residents’ rate of satisfaction with the training process and their ability in performing upper gastrointestinal endoscopy using gastric moulage prepared in Sina Hospital, Iran. This study was conducted on 20 residents of the endoscopy ward at Sina Hospital from September 2012 to September 2013. The endoscopy training program consisted of 3 steps of training with gastric moulage, observation, and training on human subjects. The present educational development plan was evaluated through studying the 2 criteria of residents’ satisfaction and ability. The satisfaction of residents with the endoscopy training course was evaluated by a self-report questionnaire. The residents’ ability in performing upper gastrointestinal endoscopy was evaluated by measuring the time of reaching the gastro-esophageal junction and pyloric valve. The reliability and validity of the self-report questionnaire were 64% (0.60-0.89) and 78% (0.12-0.95), respectively. Over 90% of residents agreed with the items of the self-report questionnaire. The highest rate of agreement belonged to the item that interpreted the effect of this method on lowering residents’ anxiety in performing endoscopy (100%). The mean ± standard deviation of time of reaching the gastro-esophageal junction and pyloric valve were 162.0 ± 13.54 and 272.8 ± 13.75 seconds, respectively. The results of this study showed that training residents using gastric moulage prepared in Sina Hospital was associated with residents’ satisfaction and the successful obtaining of the endoscopy skill.

Pentoxifylline might have a role in the suppression of inflammatory cytokines in non-alcoholic fatty liver disease (NAFLD). The aim of study was to evaluate the effect of Pentoxifylline on liver function tests in non-diabetic subjects with NAFLD.

This clinical trial was performed in 120 NAFLD patients. They were divided to two groups by Balance Block Randomization method. A dietitian in both arms performed regulation of daily calorie intake. Pentoxifylline was prescribed to intervention arm at the dose of 1200 m/g per day. Liver function tests were checked at 2 months interval up to 6 months.

Fifty-four patients in control group and fifty-six ones in Pentoxifylline group were evaluated. The participants mean of age was 36. 65 ± 8. 82 years. The mean aminotransferase levels were not statistically different in two arms at the study period. However، the speed of aminotransferase reduction was faster in Pentoxifylline arm. The mean aminotransferase levels were decreased during the study period in each arm.

Pentoxifylline was not effective in reducing aminotransferase in NAFLD patients.

Irritable bowel syndrome has significant impacts on the quality of life (QOL) but IBS subtypes may be different in QOL. This study aimed to assess QOL in IBS subtypes and also two prevalent questionnaires applied to evaluate the QOL in IBS.

In this case-control study conducted in Kashan in 2010-2013. One hundred and eighty- eight patients with IBS with 215 of non-IBS patients were included in the baseline. Subjects divided into three subtypes based on symptoms of diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) and IBS with mixed bowel habits (IBS-M) and in each subtype were 42, 62 and 84 patients, respectively. All IBS subjects completed questionnaires containing the disease-specific QOL for IBS (IBSQOL), World Health Organization QOL Assessment-BREF (WHOQOL-BREF) and IBS severity scores (IBSSS). The non-IBS subjects completed the WHOQOL-BREF only.

Mean scores of IBSQOL in person with subtypes of IBS-D, IBS-C and IBS-M were 74.34 ± 19.01, 76.77 ± 22.91 and 73.15 ± 26.51, respectively which was not significantly different (P value = 0.507). As well as mean scores of WHOQOL-BREF in person with subtypes of IBS-D, IBS-C and IBS-M were 81.01 ± 16.23, 88.32 ± 15.66, and 82.65 ± 16.67, respectively, which were not significantly different (P value = 0.412) but mean scores of WHOQOL-BREF in non-IBS subjects was 89.53 ± 11.71 which was significantly different from IBS subjects (P value = 0.022). Strong positive relationship between two instruments was shown (r = 0.826 when P < 0.05).

The WHOQOL-BREF instrument showed poorer QOL in IBS patients. The QOL was not different significantly among IBS-M, IBS-C, and IBS-D subtypes. We found that WHOQOL-BREF instrument strongly correlate with QOLIBS instrument.

Investment in science is vital for the development and well-being of societies. This study aims to assess the scientific productivity of countries by quantifying their publication of systematic reviews taking the gross national income per capita (GNIPC) into account. Medline and ISI Web of Science were searched for systematic reviews published between 1st January 2006 and 31st December 2010. The productivity of each country was quantified by exploring the authors’ affiliation. The GNIPC was used according to the World Bank Report. Concentration index (CI) was calculated as the index of inequality. CI of percentage of systematic reviews as a function of percentage of countries ranked by GNIPC was 0.82 which indicates inequality in production of systematic reviews in pro rich countries. Countries with high income produced 206.23 times more systematic reviews than low income countries, while this ratio for lower middle and upper middle countries was 9.67 and 12.97, respectively. The highest concentration index was observed in clinical sciences (0.76) and the lowest in public health (0.61). This study demonstrates a significant gap between industrialized and non-industrialized countries in the production of systematic reviews. Addressing this gap needs tremendous national and international efforts.

Context: Viral hepatitis is still considered as a major health concern. Defining the extent of the burden of this condition is the mainstay in choosing better strategies for its prevention and management. The aim of this study was to review the current knowledge on the worldwide prevalence of viral hepatitis, including Iran..Evidence Acquisition: A MEDLINE search spanning January 2000 to January 2012 was performed to identify the published literature addressing viral hepatitis. Viral hepatitis, prevalence, hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis E virus (HEV) were the keywords used for this search. Original research, review articles, and some selected references of those articles were reviewed.. Prevalence of viral hepatitis is widely different throughout the world. Overall prevalence of viral hepatitis is declining due to the improvements in preventive measures and immunization strategies.. There are few studies on the prevalence of viral hepatitis in the general population of Iran. Most of the reports are from specific groups of patients. Further epidemiologic studies on the general population of Iran are recommended to discover the real burden of viral hepatitis..

Due to the increasing outbreak of irritable bowel syndrome (IBS) and its relation to hospital costs and disruptions to quality of life, this study is an attempt to investigate patient quality of life and its relationship with IBS according to the results of the WHQOL-BREF Questionnaire. This descriptive-analytic, cross-sectional study enrolled 250 patients and 250 healthy participants who referred to the Gastroenterology Clinic of Sina Hospital, affiliated with Tehran University of Medical Sciences during 2012. The diagnosis of IBS was determined by a gastrointestinal expert based on ROME-III Criteria. Then, the study was explained to participants prior to administration of this questionnaire. The level of life quality in patients with IBS was less than the control group. There was no significant difference between groups in terms of age, gender, education level, marital status, and place of residency. There was no significant difference in the above factors among patients in the subgroups of IBS. Regression analysis between quality of life and independent variables showed a correlation between quality of life to severity of IBS symptoms and disease duration. The results of the study indicated that quality of life correlated with severity of symptoms and disease duration. The quality of life in IBS patients can be enhanced by efficiently controlling symptoms.