Govaresh
Volume:28 Issue: 4, Winter 2024

The Celiac National Institute has recently devised a diagnostic algorithm for celiac, which has been adopted from the most recent guidelines and articles worldwide. All Iranian provinces are requested to set all diagnoses based on the newest national protocol devised by the National Institute of Celiac Disease; however, some incompatibilities are observed. Therefore, this study was conducted to demonstrate these incompatibilities.

In this descriptive-analytical study, we enrolled 250 cases of celiac disease referred to the province registry system and revised the diagnosis based on the national protocol for celiac disease diagnosis. All data were analyzed using SPSS software version 26.

Among the 250 patients diagnosed with celiac disease, 88 (35.2%) had incompatibility. The mean age of the patients was 37.19 years. 28 people (31.8 %) were men. Results indicated that in 40.9% of incompatibility cases, only pathology tests were performed, and in 52.3% of incompatibility cases, only serological tests were performed. In 6.8% of cases, both tests were performed, but the diagnosis was indefinite. Pathological results indicated that 0.5% of patients were in Marsh 1, 19% in Marsh 2, 35.7% in 3a, 23.8% in 3b, and 19% in Marsh 3c phases.

There are cases of diagnostic incompatibilities between the most recent national protocol for celiac disease and physicians’ practice. Therefore, it is vital that practitioners are trained with the national protocol for celiac disease diagnosis..

Irritable bowel syndrome (IBS) is a prevalent functional disorder of the gastrointestinal tract that affects approximately 11% of people worldwide. The exact mechanisms underlying IBS remain unclear, but evidence suggests that low-grade inflammation is involved in its pathophysiology. Interleukin-6 (IL-6) is a key cytokine that mediates inflammatory responses in the intestinal mucosa and has been linked to the development of IBS. Our study aimed to provide an overview of the current knowledge on the role of IL-6 in IBS.

The present study was conducted based on a search on the PubMed database, where only 26 articles investigated the role of IL-6 in irritable bowel syndrome were found.

Our review revealed that patients with IBS had higher levels of IL-6 in their serum/plasma. Furthermore, increased expression of IL-6 mediated by cholinergic signalling was associated with increased abdominal pain/discomfort and bloating. More recently, an interaction between IL-6 and corticotrophin-releasing factor was shown to provide more insight into the mechanisms underlying IBS symptoms during stressful periods, which are experienced by almost two-thirds of patients with IBS. Elevated levels of IL-6 were also correlated with increased fatigue and intestinal inflammation. Targeting IL-6 expression or IL-6 signalling pathway using probiotics, vitamin D3 or a replacement diet may offer a novel therapeutic strategy to improve IBS symptoms, abdominal pain, bloating and fatigue after consumption of ancient wheat products.

Further studies are needed to elucidate the causal relationship between IL-6 and IBS, as well as the molecular pathways and cellular targets of IL-6 in the gut.

Parasitic infections in children are one of the most important health and health problems worldwide, especially in developing countries. Diarrheal diseases such as those caused by Entamoeba histolytica are among the causes of death in children, so the purpose of this systematic review and meta-analysis is to determine the prevalence of Entamoeba histolytica in Iranian children.

This study is a systematic review and meta-analysis by examining the Scientific Information Database (SID), Medline (PubMed), Scopus and Google Scholar until March 2023.

In a review of 12 studies with a sample size of 10,982 Iranian children, the prevalence of Entamoeba Histolytica in Iranian children was reported to be 1% (95% CI 0.6-1.7%). The meta-regression results showed that in examining the factors influencing the heterogeneity of studies and examining the effect of sample size on this heterogeneity, it was reported that with increasing sample size, the prevalence of Entamoeba histolytica in Iranian children decreased (P<0.05) and also with the increase in the year of conducting studies, the prevalence decreases in Iranian children (P=0.289).

The results of the present study show that the prevalence of Entamoeba histolytica in Iranian children is not at a very high level, but to continue preventive measures and reach lower levels, it still requires the attention of health policymakers in this area to carry out extensive information and screening to prevent the effects of this parasitic disease on children.

With the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posing a global health emergency, selfmedication with ivermectin has been observed in certain Latin American countries. This study aimed to characterize the clinical features of liver injury associated with ivermectin when used as self-medication for treating coronavirus disease 2019 (COVID-19).

We reviewed the clinical records of patients diagnosed with severe COVID-19 at the Emergency Room of Rebagliati Hospital in Lima, Peru, in March 2021. The criteria of the Drug-Induced Liver Injury (DILI) Expert Working Group and the Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method (CIOMS/RUCAM) were utilized to establish the diagnosis of drug-induced liver injury and assess causality, respectively.

We report five cases of ivermectin-induced liver injury (IILI), comprising four men and one woman, with a mean age of 49.3±12.3 years. The mean daily dose, duration, and total dose of ivermectin were 32.9±21.8 mg/day, 2.6 ± 0.6 days, and 89.6±71.4 mg, respectively. On average, IILI occurred 11±3.8 days after the initiation of treatment, and none of the cases developed jaundice. The mean levels of alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase were elevated 8±4.4, 1.7±0.9, and 10.9±5.0 times above the upper limit of normal, respectively. Two patients exhibited a hepatocellular pattern, two had a mixed pattern, and one displayed a cholestatic pattern. All cases were classified as mild and achieved recovery. Causality assessment categorized four cases as "possible" and one case as "highly probable.".

The findings emphasize the need for further pharmacovigilance studies on IILI when used for COVID-19 treatment.

To date, magnetic resonance imaging (MRI) plays a critical role in the management of rectal cancer. Although neoadjuvant chemoradiotherapy (nCRT) is a gold standard approach in advance to surgical management, it might alter the tissue texture, affecting MRI findings applied for decision-making in a procedural approach.

The current study aimed to assess the predictive parameters in MRI associated with response to nCRT in rectal cancer.

The current cross-sectional study has been conducted on 50 patients with rectal cancer who were candidates for nCRT during 2020- 21. Data including tumor markers and MRI parameters including tumor signal, tumor stage (TMN), lymph node involvement, mesorectal fascia (MRF), extramural venous invation (EMVI), peritoneal reflection invasion and tumor size were gathered at baseline and within 4-6 weeks after nCRT. The predictive factors for response to nCRT were evaluated using tumor regression grade (TRG) and TNM staging.

Tumor size (P<0.001), MRI signal intensity (P=0.038), tumor appearance in diffuse weighted imaging (DWI) (P<0.001), tumor stage (P<0.001), lymph node involvement (P<0.001), MRF (P<0.001), EMVI (P<0.001), and peritoneal reflection invasion (P<0.001) remarkably improved in post-nCRT assessments. Tumor size was associated with 3.75 (95%CI: 1.61-8.72) and 2.64 (95%CI: 1.40-4.97) folds, and lymph node involvement was associated with 77% (95%CI: 0.21-15.02) and 60% (95%CI: 0.21- 11.96) increased probability of response to treatment based on TRG and TNM, respectively.

Based on the findings of this study, nCRT could remarkably improve adenocarcinoma of rectal cancer-related laboratory and imaging parameters; however, tumor size and lymph node involvement were the only predicting factors for response to nCRT.

Celiac disease (CD) is an enteropathy associated with a genetic disorder and several constitutive genes. This study examines the genes and factors affecting CD.

This review was conducted on structured findings up to September 2023 regardless of language published according to the protocol of systematic review articles (PRISMA). To identify relevant studies, online searches were generally conducted in PubMed, Google Scholar, MEDLINE, and SCOPUS databases.

Many studies have been conducted on CD genes, and researchers have achieved good results. So far, 60 genomic loci related to CD have been discovered, which is the most important genetic loci of CD related to HLA(Human Leukocyte Antigen). Most of the gene loci identified in autoimmune diseases have pleiotropic effects and cause disruption of the immune system, which in turn causes CD.

According to the linkage studies conducted on genetic regions, the most important genetic positions identified in CD are HLADQ2 and HLA-DQ8. Due to the progress of genetic science and the uncertainty of the genomic position of this disease, they have not been able to use genetic science to prevent this disease. Considering the common genes that this disease has with other gastrointestinal diseases as well as thalassemia, there may be newer and more effective genetic approaches to treat this disease in the future.

Hepatocellular carcinoma (HCC) can invade the gastrointestinal (GI) tract and cause GI bleeding. Although HCC invasion to the GI tract is rare, its prognosis is very poor. Here, we reported a 67-year-old man with GI bleeding manifestation. Esophagogastroduodenoscopy (EGD) showed lesions in gaster and duodenal, while abdominal CT confirm a solid epigastric mass with invasion to gaster. We performed a laparotomy biopsy, while the diagnosis of HCC was established by histopathological and IHC studies. Because of its difficulty to diagnose and its ability to masquerade as other GI bleeding, it is important to increase awareness about the issue.

A group of diseases resulting from the abnormal aggregation of amyloid fibrils, mainly in the extracellular spaces of tissues, is known collectively as amyloidosis. Clinical presentations of gastrointestinal (GI) amyloidosis are mainly GI bleeding, malabsorption, protein-losing enteropathy, and dysmotility. Here, we describe an 87-year-old woman presenting with acute onset of sharp, constant, and non-radiating epigastric pain that was accompanied by nausea or vomiting. After a thorough investigation, we finally found an isolated jejunojejunal intussusception by laparotomy. The pathological study revealed massive small bowel involvement by amyloidosis in immunostaining. To our knowledge, this is the first report of small intestinal obstruction resulting from intussusception due to intraluminal amyloid polypoid nodules, as the first presentation of light-chain amyloidosis. Amyloidosis should be considered in old patients with intraluminal masses of the proximal small bowel.