Background:Fatty liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD) have recently been recognized as a major global health issue, and there is much evidence linking MASLD with a range of extrahepatic comorbidities. The current study evaluated extrahepatic comorbidities in patients with MASLD and highlighted the necessity of a multidisciplinary approach to its management. Methods:A cross-sectional study was conducted at a tertiary center in Tehran. Fatty liver was diagnosed via ultrasonography findings. Exclusion criteria included those with other liver diseases, such as chronic viral hepatitis. Participants underwent liver stiffness measurement using Fibroscan, and clinical data and liver function tests were collected, and questionnaires for DASS-21 and the Pittsburg Sleep Quality Index (PSQI) were completed. We conducted a chi-square test and ANOVA test to evaluate and explore the extrahepatic comorbidities and manifestations associated with fatty liver disease. Results:Of the 385 study participants, 50.6% had severe steatosis, and 29.1% had severe fibrosis. Several comorbidities, such as hypertension (fibrosis: P=0.033, steatosis: P=0.011), diabetes (fibrosis: P=0.006, steatosis: P=0.002), and poor sleep quality (fibrosis: P=0.015), were significantly associated with the severity of non-alcoholic fatty liver disease (NAFLD). There were statistically significant differences in mean scores of depression and anxiety across different levels of fibrosis and steatosis (P<0.05). Conclusion:MASLD is a multisystem disorder with widespread extrahepatic manifestations impacting many organs and systems. Patients with MASLD should be screened for comorbidities such as diabetes, cardiovascular disease, and mental health conditions to improve overall health outcomes and prevent disease advancement.
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that can affect various organs. This report describes a 65-year-old woman who presented with abdominal pain, weight loss, and elevated liver enzymes. After the diagnostic workup, a percutaneous biopsy of the liver lesions showed histological changes in EHE. What stands out in this case is that imaging studies revealed multiple cystic lesions with fluid-fluid levels, even though such manifestation is not typically seen in this disease. This case emphasizes the importance of considering EHE in the differential diagnosis of hepatic lesions, even in atypical presentations.
Background:First-degree relatives (FDRs) of patients with colorectal cancer (CRC) possess a higher risk of developing CRC. Colonoscopy is among the most effective screening methods for preventing CRC. This study aimed to assess screening rates among FDRs of patients with CRC and determine obstacles to screening in this population. Methods:This cross-sectional study was conducted in Isfahan, Iran. A total of 160 asymptomatic FDRs were identified and considered eligible for inclusion in the analysis. Results:The mean age of FDRs was 50 years, and 65.6% were at high risk for CRC. Only 32.4% underwent screening according to guidelines, and all of them were classified as high-risk. Index patients (IPs) aged under 50 and receiving a recommendation for screening were identified as two main factors associated with guideline-based CRC screening. Among FDRs who did not undergo colonoscopy, 64.4% were unaware of the risk of CRC, and 56.3% lacked knowledge about the procedure. Conclusion:Urgent implementation of effective interventions and improved education for both healthcare providers and patients on risk-based CRC screening for FDRs is crucial. Further descriptive investigations are needed to identify barriers to CRC screening in this population.
Background:Recurrent perirectal abscesses in children under 2 years pose management challenges due to high relapse risks, with limited evidence comparing long-term outcomes of antibiotic therapy versus surgical drainage. This study aimed to compare antibiotic treatment approaches and surgical interventions in managing this condition. Methods:This retrospective cohort study analyzed 336 medical records of children under two years old with perianal abscesses treated at Hazrat Masoumeh Children's Hospital from 2012-2019. Patients were divided into three groups: antibiotic treatment only, spontaneous drainage, and incision and drainage. Data, including demographics, abscess characteristics, and treatment outcomes (recurrence, fistula formation), were analyzed using SPSS software version 26. Results:A retrospective cohort study of 336 children with perianal abscesses found no significant differences in age, weight, sex, or nutritional status among the three treatment groups (P>0.05). However, statistically significant differences were observed in abscess location (distance from the anus) and size, with the incision and drainage group having larger and more distally located abscesses (P<0.05). Colic was less prevalent in the antibiotic-only group. The spontaneous drainage group had a significantly higher recurrence rate (37%). Antibiotic type distribution was similar across groups. The antibiotic-only group showed symptom resolution within 3-10 days, averaging 6 days. Conclusion:In general, according to the lowest rate of recurrence in the group receiving antibiotics and the average duration of short treatment of 6 days, the antibiotic approach is the preferred and primary method for the treatment and prevention of abscess recurrence.
Esophageal squamous cell papilloma (ESP) is a benign tumor that is rarely found in the esophagus. Human papillomavirus (HPV) has been known to play a role in the development of ESP. In most cases, ESP is asymptomatic but may also manifest with dysphagia, heartburn, and epigastric pain. Although rare, ESP has the potential to become malignant; thus, early detection and removal of the tumor is essential. Here, we report a rare case of ESP in a 29-year-old woman.
Background:Abnormal levels of liver enzymes have been reported in patients with COVID-19 and severe clinical presentation. However, limited studies exist in our region regarding the impact of COVID-19 on the liver's function. Thus, we aimed to investigate liver enzyme changes and their association with prognosis and outcome in hospitalized patients with COVID-19 in Jordan. Methods:This retrospective cohort study included 359 patients with COVID-19 who were admitted to Ministry of Health hospitals all around Jordan during the second pandemic wave of COVID-19. Data such as liver enzymes, patients demographics, and outcomes were collected and statistically analysed. Results:Approximately 39.6% of infected patients had elevated liver enzymes, and 5.9% had elevated enzymes more than twice the upper limit of normal (ULN). Among these patients, 40.8% had both aspartate aminotransferases (AST) and alanine aminotransferases (ALT) elevation, 52.1% had AST elevation alone, and 7.0% had ALT elevation alone. Factors associated with worse prognosis and outcome were older age, male sex, and comorbid autoimmune conditions. The peak and at-discharge values of AST and ALT showed significant differences. Conclusion:Liver enzyme abnormality is common among patients with COVID-19 and AST is the most common abnormality. AST and ALT elevation can be associated with longer hospital stays, older age, and male sex.
Background:IThis study aimed to investigate the concordance of endoscopic ultrasonography (EUS) results and biochemical analysis of cyst fluid obtained through fine needle aspiration (FNA) in diagnosing mucinous pancreatic cysts. Methods:In this retrospective study, the medical records of 81 patients with pancreatic cystic lesions were examined. EUS results and cyst fluid analysis (carcinoembryonic antigen [CEA] and amylase) concordance rate was evaluated, and the agreement between the two methods was assessed through Cohen's kappa coefficient. Results:The concordance rate of EUS and cyst fluid analysis with CEA cutoff point>192 ng/mL was 52.5% and 69.2%, respectively, for mucinous cystic neoplasm (MCN) and Intraductal papillary mucinous neoplasm (IPMN) diagnosis. The sensitivity and specificity of cyst fluid analysis for MCN and IPMN (taking EUS as the reference) were 59.1% and 93.33%, respectively. The positive predictive value was equal to 97.5%, and its negative predictive value was 34.14. Using the CEA<5 ng/mL cutoff point for detecting serous cystic neoplasm (SCN) cysts was associated with the sensitivity, specificity, and positive and negative predictive values of 73.3%, 78.8%, 44%, and 92.8%, respectively. The concordance rate of EUS and pancreatic cyst fluid analysis was 65.43%, with a kappa correlation coefficient of 0.326. Conclusion:The specificity and positive predictive value of CEA>192 for the diagnosis of mucinous pancreatic cysts is high, but it is associated with moderate sensitivity and a low negative predictive value. Altogether, there is a moderate agreement between the results of EUS and biochemical analysis of FNA cyst fluid in diagnosing mucinous pancreatic cysts.
Background:Irritable bowel syndrome (IBS) is a chronic condition characterized by recurring abdominal discomfort and irregular bowel movements. Currently, IBS diagnosis lacks specific radiological, biochemical, or endoscopic markers. Chromogranin A (CgA), a gastrointestinal protein, shows variation between patients with IBS and healthy controls. This study aimed to evaluate differences in CgA concentrations between these groups. Methods:This review was conducted in 2023 using the PRISMA 2020 guidelines. All observational research was retrieved from MEDLINE, EBSCO-Host, ScienceDirect, and ProQuest electronic databases using a predefined search strategy. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and meta-analysis was conducted using Review Manager (RevMan) 5.4. Results:Nine out of 14 studies eligible for meta-analysis revealed significantly higher CgA cell density (P=0.0001) in all patients with IBS compared with controls. This difference persisted across colon regions (left: P=0.04, right: P=0.0009) and duodenum (P<0.00001). Subgroup analysis found no significant disparity in CgA cell density between diarrhea and constipation-predominant IBS within the duodenum or colon. Conclusion:CgA cell density showed trends toward IBS compared with control groups, with significant concentration differences found in the duodenum, left, and right colon. Therefore, current findings might offer a histopathological approach to confirm the IBS diagnosis.
Background:Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disease in which the patients may be asymptomatic or complain of heartburn and regurgitation or pulmonary symptoms. Aim of the study: Examine the serum level of soluble HLA-G (sHLA-G) in patients with GERD, which can be used as a biomarker for early detection of GERD. Methods:The study was a case-control prospective study that enrolled 40 patients who consulted the Gastroenterology Unit-Al-Kindy Teaching Hospital and were diagnosed with GERD by their physician. They were compared with 40 control healthy individuals from January 2023 to May 2024. Serum samples were used for quantitative assessment of sHLA-G using a sandwich enzyme-linked immunosorbent assay. Results:A higher proportion of females were observed in the GERD group compared with the control group (72.5% vs. 42.6%). This difference was statistically significant (P=0.006). A statistically non-significant difference was observed in sHLA-G levels between patients with GERD and healthy controls (P=0.158). The median sHLA-G level was non-significantly higher in patients with GERD (0.529 ng/mL) compared with the controls (0.523 ng/mL). Conclusion:The present study provides early evidence for an association between elevated sHLA-G levels and GERD with limited diagnostic value. It revealed a significant negative correlation between sHLA-G levels and sex. Further studies are needed to elucidate the mechanisms underlying this relationship and explore the potential of sHLA-G as a diagnostic or therapeutic target for GERD.
Background:According to the high prevalence of anal fistulas and the recurrence of the disease following surgery, different methods have been suggested for appropriate treatment of this disease; however, there is no consensus on the most effective method. This study aimed to compare the healing time, recurrence rate, fecal incontinence, and quality of life associated with endorectal advancement flap versus cutting Seton insertion for high-type anal fistulas. Methods:In this retrospective cohort study, 81 patients with trans-sphincteric high-type perianal fistula, including 53 men and 28 women, were studied for 5 years (2019-2024). The Patients included in this study were divided into two categories. One of them underwent an endorectal advancement flap, and the other one underwent cutting Seton insertion. SPSS software was used for statistical analysis. Results:37 (45.7%) patients underwent endorectal advancement flap, and 44 (54.3%) patients had cutting Seton insertion. There was no significant difference in recurrence rate, incontinence, and quality of life between the two groups, while the healing time in the group that underwent endorectal advancement flap was significantly different and shorter in comparison with the patients who underwent cutting Seton insertion (30 versus 60 days, respectively, P=0.016). Conclusion:Our study results showed a more significant reduction in the healing time with endorectal advancement flap surgery than the cutting Seton insertion procedure in patients who suffered from trans-sphincteric high-type anal fistula without any significant difference regarding the recurrence rate, incontinence, and quality of life.
Background:This systematic review, grounded in coping theory, examines the relationship between coping strategies and quality of life (QoL) in patients with inflammatory bowel disease. It synthesizes current findings and guides future research to address existing knowledge gaps. Methods:A comprehensive search of Scopus, PubMed, Google Scholar, and Web of Science (from April 2000 to April 2024) identified 17 peer-reviewed studies. Results:Coping strategies directly and indirectly influence the QoL of patients with inflammatory bowel disease (IBD). Adaptive strategies, such as problem-solving and seeking social support, consistently improve QoL even in patients with active disease by promoting better disease management and emotional well-being. Maladaptive strategies, such as avoidance and emotional detachment, lead to decreased QoL and increased psychological distress. In addition, self-efficacy and psychological resilience play a key role in mediating the relationship between coping and QoL. However, coping strategies differ by disease stage and between demographic groups. Conclusion:This study identifies significant gaps in research, such as limited multi-center and longitudinal studies, cross-cultural inconsistencies, and insufficient focus on specific populations. These gaps restrict understanding of the long-term effects of coping strategies. Future research should combine quantitative and qualitative methods to better capture patients' experiences, aiding the development of personalized interventions.
Background:White light imaging (WLI) is the current standard colonoscopy technique for diagnosing colorectal polyps in Indonesia. Various endoscopic imaging techniques have been developed to improve the accuracy of diagnosing colorectal polyps, one of which is narrow band imaging (NBI). We conducted a diagnostic study comparing the performance of NBI against WLI in distinguishing neoplastic from non-neoplastic colorectal polyps. Methods:This was a diagnostic study that analyzes endoscopic pictures of colorectal polyps in patients who underwent colonoscopy using the WLI and NBI techniques. Previously collected biopsy tissue specimens were re-examined by a single pathologist. Results:There were 117 subjects analyzed, and the proportion of subjects with neoplastic polyps was 65.8%. Common indications for colonoscopy were hematochezia (24.8%) and abdominal pain (23.9%). WLI showed moderate inter-observer reliability (kappa value=0.591), while NBI showed significant reliability (kappa value=0.674). NBI demonstrated better sensitivity (84.4%; 95% CI 74.4%-91.7%) and accuracy (78.6%; 95% CI 70.1%-85.7%) compared with WLI (sensitivity 74%; 95% CI 62.8%-83.4% and accuracy 71.8%; 95% CI 62.7%-79.7%). However, the specificity was the same (67.5%; 95% CI 50.9%-81.4%). Conclusion:NBI has better performance than WLI in distinguishing neoplastic and non-neoplastic colorectal polyps.
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third leading cause of cancer-related death, with a 5-year survival rate of 10%-12%. It usually develops in the setting of chronic liver disease (CLD), with chronic viral hepatitis, alcohol, and non-alcoholic fatty liver disease (NAFLD) being the most common risk factors. Some patients are at higher risk of developing hepatocellular cancer, so it is important to screen them regularly to diagnose the disease at an early stage and improve their chances for curative treatment. Six-monthly ultrasound with or without alpha-fetoprotein (AFP) is the currently recommended surveillance method. AFP has been used as a biomarker for liver cancer; however, it has low sensitivity and specificity, which necessitates the search for other, more accurate biomarkers. Promising biomarkers include lens culinaris agglutinin-reactive AFP, des-gamma-carboxy prothrombin, methylated DNA markers, plasma microRNA expression, circulating tumor DNA, and circulating tumor cells. In addition, combinations of biomarkers, like the GALAD score and the Doylestown algorithm, may help in the early detection of HCC. In this review, we summarize the screening tests for early detection of HCC that have been studied over the last decade.
Background:The quality of bowel preparation is one of the key determinants of a successful colonoscopy. Bowel preparation regimens have evolved greatly over the past few decades, with attempts to improve the efficiency and tolerability; still an ideal agent or regimen continues to be oblivious. To compare the efficacy, safety, and tolerance of three bowel preparation regimens for colonoscopy: split dose of oral sulfate solution (OSS), split dose of polyethylene glycol (PEG), and same-day single dose PEG. Methods:This study was a randomized, single-blind control design with three study groups. Group A received a split dose of OSS, group B received a split dose of PEG, and Group C received a single dose of PEG for bowel preparation. The quality of preparation was assessed using the Boston Bowel Preparation Scale (BBPS), and the adverse effects and tolerance were noted. The data were compared statistically for any significant difference between the regimens. Results:Mean total BBPS scores were 8.08, 7.52, and 7.92 for groups A, B, and C, respectively (P=0.076). Segmental BBPS scores were statistically similar for the right and transverse colon but differed for the left colon (A: B: C=2.79: 2.54: 2.75; P<0.01). Gastrointestinal side effects and electrolyte disturbances were similar across the three groups. Split-dose preparations were associated with more significant sleep disturbances than single-dose PEG (P<0.001). Patients who received OSS reported more taste intolerance (P<0.01), while those who received single PEG reported more volume intolerance (P<0.001). Conclusion:Split-dose OSS, split-dose PEG, and single-dose PEG regimens provide adequate and comparable bowel preparation for colonoscopy with good patient tolerance and no significant adverse effects. Overnight PEG and OSS preparations were associated with more substantial sleep disturbances. OSS is associated with more taste intolerance, while single PEG is associated with more volume intolerance.
Background:The incidence of non-alcoholic fatty liver disease (NAFLD) has increased with the global increase in the outbreak of obesity, type 2 diabetes, and metabolic syndrome, reaching a 25% prevalence. However, there is currently no effective treatment for this disease apart from lifestyle modification. Furthermore, NAFLD commonly presents without symptoms, hence, leading to potentially severe and irreparable consequences. Methods:This study was based on a systematic review. The search used the keywords "non-alcoholic fatty liver" and "risk factor" across the PubMed, Scopus, and Web of Science databases. First, the articles were evaluated based on their abstract and then on their full text. The risk factors were extracted from the articles and entered into the Excel form, and then a dataset was provided to the expert panel. The risk factors were investigated, and those related to NAFLD were selected. Results:The results led to the identification of 180 risk factors in 15 categories. First, the risk factors mentioned in fewer than five articles were removed. Then, the remaining 101 risk factors were presented to the expert panel, of which 39 risk factors related to NAFLD were selected. Conclusion:In summary, this study shows that NAFLD is caused by various factors such as metabolic syndrome, certain diseases, demographic information, specific surgeries, drug consumption, different foods and beverages, occupation, physical activity status, and socioeconomic status. Recognizing these risk factors enables doctors to make earlier diagnoses, potentially preventing disease progression. Additionally, it is possible to develop treatment strategies aimed at reducing the risk factors of the disease, which could result in fewer patients suffering from NAFLD in the future.
Background:Gastroesophageal reflux disease (GERD) and bipolar disorder impose substantial global burdens on individuals and healthcare systems. Previous studies suggest a bidirectional association between GERD and bipolar disorder. By searching and reviewing the results of existing studies, this systematic review and meta-analysis aims to review the two-way relationship between GERD and bipolar disorder. Methods:This study adhered to PRISMA Guidelines, including a comprehensive search of PubMed and Scopus for observational longitudinal studies. Quality (risk of bias) assessment employed the Newcastle-Ottawa Scale, and RevMan version 5.3 facilitated meta-analysis. Results:Five longitudinal studies (161888 patients) revealed a significant bidirectional link between GERD and bipolar disorder. Patients with GERD had a 2.29-fold higher risk of bipolar disorder (OR=2.29 [1.64, 3.21]; P<0.001), while individuals with bipolar disorder had a 2.80-fold higher risk of GERD (OR=2.80 [1.36, 5.76]; P=0.005). This study also identified independent risk factors, including sex, age under 60 years, and alcohol consumption disorders, influencing the occurrence of bipolar disorder in patients with GERD, as well as there is an influence of the number of psychoactive drugs in the occurrence of GERD in patients with bipolar disorder. Conclusion:These findings highlight a bidirectional relationship between GERD and bipolar disorder, emphasizing the necessity for integrated care models and personalized treatment plans. The results underscore the importance of considering both gastrointestinal and mental health aspects in managing these interconnected conditions.
Colorectal cancer (CRC) is a common malignancy with high mortality. Despite advancements in understanding its molecular causes and improved drug therapies, patient survival rates remain low. The main reasons for the high mortality rate are cancer metastasis and the emergence of drug-resistant cancer cell populations. While genetic changes are recognized as the main driver of CRC occurrence and progression, recent studies suggest that epigenetic regulation is a crucial marker in cancer, influencing the interplay between genetics and the environment. Research has shown the significant regulatory roles of non-coding RNAs (ncRNAs) in CRC development. This review explores epigenetically regulated ncRNAs and their functions, aiming to understand key regulatory mechanisms that impact CRC development. Additionally, it discusses the potential use of these ncRNAs in CRC diagnosis, prognosis, and targeted treatments.
