Ahmad Hormati

Background: Helicobacter pylori (H. pylori) is one of the most common human pathogens, affecting almost half of the population of the world. Some specific virulence genes of this bacterium have a significant causal effect on the outcome of gastrointestinal diseases. Therefore, the aim of this study was to evaluate the expressions of the cagA, dupA, sabA, babA, and iceA1 genes of H. pylori cultured from biopsy specimens of patients with GC and PUD and to compare these expressions with those in NUD patients as the control group. Methods: The patients with gastrointestinal disorders referred to Shahid-Beheshti Hospital in Qom, Iran, were enrolled in this study. Eleven biopsies per patient were collected and used for culture, pathology, and rapid urease tests. Based on endoscopic and pathological findings, patients were separated into three groups: GC, PUD, and NUD. Colonies suspected of H. pylori were initially investigated using conventional evaluations and then confirmed by PCR assay. Also, the RT-qPCR method was used to evaluate the expression of target genes, including cagA, dupA, sabA, babA, and iceA1 in isolated strains. Results: One hundred and seventy-seven patients, including 31 GC, 55 PUD, and 91 NUD, were included in this study. Among the enrolled patients, 29 patients were positive for H. pylori based on three evaluation methods. The expression of bacterial cagA, dupA, and babA genes in the GC patients was statistically higher than in the NUD group. The expression of the sabA gene in the strain isolated from the GC group was lower than in the control group. No significant difference was observed between the GC group and the control group regarding the iceA1 gene. Conclusion: Our finding shows that the expressions of cagA, dupA, and babA virulence genes in H. pylori strains isolated from gastric biopsies of both GC and PUD patients are significantly higher than the NUD ones. Therefore, screening and treating the infection caused by this bacterium and determining the genotype in patients may prevent the progression of the disease.

Fasciola hepatica is a parasitic trematode that infects humans, typically through the consumption of contaminated water or raw vegetables. The infection progresses through acute and chronic phases, with the latter often presenting as jaundice, cholangitis, pancreatitis, and cholecystitis due to bile duct obstruction. We report the case of a 53-year-old Iranian woman who experienced persistent eosinophilia, nausea, right upper quadrant and epigastric pain, and occasional chills for one year. Imaging revealed a dilated common bile duct (CBD) with sludge, and endoscopic retrograde cholangiopancreatography (ERCP) successfully identified and extracted five live Fasciola hepatica parasites. This case illustrates the vital role of early recognition and intervention in fascioliasis, as timely endoscopic management can prevent severe complications. Increased awareness among clinicians, especially in regions where the disease is uncommon, is essential to ensure prompt diagnosis and effective treatment of this often-overlooked infection.

Background: Functional dyspepsia (FD) is felt as a discomfort or pain on the center line or upper abdomen. In this study, we investigated the effect of Govarcin herbal capsule on FD so that if it is effective, it can be used in the treatment of patients with this disease. Methods: Totally, 106 patients enrolled in a double-blind, clinical trial study. The participants had FD and were divided into two groups receiving Govarcin and Metoclopramide by block randomization. The patients were treated for four weeks, taking one Govarcin capsule or Metoclopramide tablet after each meal. The rate of improvement in patients was assessed by mitigation of clinical symptoms, including epigastric pain, fullness, discomfort, nausea, vomiting and heartburn. Also, before and after intervention, we used Nepin questionnaire and ROME III. SPSS statistics 25 software was used for data analyzing. Results: Clinical symptom score changes between Govarcin and Metoclopramide patients’ groups showed that there was no significant difference in any of the clinical symptom scores (except for heartburn, p-vale=0.012) between the study groups. Nepean score in Govarcin group before and after treatment was 19.3±4.8 and 8.9±2.8, respectively (p-value<0.001). For Metoclopramide group, these values were 19.8±3.5 and 9.4±2.1 respectively (p-value<0.001). No significant difference was found in terms of Nepean score between the Govarcin and Metoclopramide groups (p-value=0.995). Conclusion: Govarcin herbal capsule can be used to remedy symptoms in patients with FD. It seems that Guarcin is as effective as metoclopramide in fighting symptoms of FD as no significant difference in efficacy has been demonstrated between them.

Background: Endoscopy provides valuable diagnostic information and intervention therapies for gastroenterologists. Therefore, various drugs have been used to induce sedation in patients undergoing endoscopy, whereas none have been considered preferred by endoscopists. In the current study, we decided to use the combination of magnesium sulfate, ketamine, and their synergistic effects for creating partial analgesia to increase the satisfaction of endoscopists and patients.Methods: This study is a Double-Blind Randomized Clinical Trial that investigates the sedative effect of ketamine, magnesium sulfate, and propofol in endoscopy. Patients were selected from individuals over 12 years old and with American Society of Anesthesia (ASA) physical status I or II. The study was performed on 210 patients classified as ASA (I have no underlying disease) or II (with underlying controlled disease). The whole group was relieved of pain through sedation according to Ramsay criteria, satisfaction with the operation, duration, recovery, nausea and vomiting, hypotension, and decreased oxygen saturation were compared.Results: A total of 155 patients were enrolled in our study, including 51 patients (midazolam and propofol), 55 patients (midazolam and ketamine), and 49 patients (midazolam and ketamine and magnesium). The results showed that preoperative heart rate, intraoperative systolic blood pressure, intraoperative diastolic blood pressure, postoperative heart rate, postoperative systolic blood pressure, and postoperative heart rate were significantly different between the groups.Conclusion: The satisfaction of the endoscopic was achieved to a great extent, mainly in the group receiving midazolam and propofol and in the group receiving midazolam and ketamine. In most cases, the satisfaction of the endoscopic was acceptable, and the low satisfaction of the endoscopic was more in the group receiving midazolam. Ketamine and magnesium were observed. The two compounds midazolam-ketamine, and midazolam-propofol, have a more favorable effect than the combination of midazolam, ketamine, and magnesium.

Objective: Interleukin 17 (IL-17) plays an important role in the inflammation of the gastric mucosa and, in severe cases, the development of gastric cancer. Thus, the authors aimed to evaluate the IL-17F A7488G polymorphism in Helicobacter pylori (H. pylori) patients. Patients and methods: A total of 86 adults (in two H. pylori-positive and H. pylori-negative groups) were included in the study. To identify the infection, rapid urease test and polymerase chain reaction (PCR) were performed. The cagA gene was also evaluated as a bacterial virulence factor. PCR–restriction fragment length polymorphism was used to investigate the IL-17F A7488G polymorphism in gastric biopsies using the NlaIII enzyme. Results: 96.5% of patients in both groups did not show any mutation and had AA genotype, and only three patients infected with cagA-carrying H. pylori strains had polymorphism in the IL-17F A7488G gene, which included AG (one case) and GG (two cases) patterns. No significant relationship was found between these polymorphisms in the two groups of H. pylori-positive and H. pylori-negative patients, while, interestingly, a significant difference was observed between the polymorphisms and the presence of the cagA gene. Conclusion: This report is one of the first to demonstrate the association of IL-17F A7488G polymorphism with H. pylori infection and the presence of the cagA gene. Although no significant association between IL-17F polymorphism and H. pylori infection was found in the population of this study, the patients with mutated genotypes were positive for the cagA gene, which was statistically significant. Therefore, the possibility of the role of pathogenic strains in causing mutations in cytokine genes is more conceivable.

Background This multicenter multinational RCT designed to compare the efficacy of suppository indomethacin and NAC for prevention of PEP. Methods: During a 6-month period, all of the ERCP cases in seven referral centers were randomly assigned to receive either 1200 mg oral NAC, indomethacin suppository 100 mg, 1200 mg oral NAC plus indomethacin suppository 100 mg or placebo 2 hours before ERCP. The primary outcomes were the rate and severity of any PEP. Results: A total of 432 patients included (41.4% male). They were originally citizens of 6 countries (60.87% Caucasian). They were randomly allocated to receive either NAC (group A, 84 cases), rectal indomethacin (group B, 138 cases), NAC + rectal indomethacin (group C, 115 cases) or placebo (group D, 95 cases). The rate of PEP in groups A, B and C in comparison with placebo were 10.7%, 17.4%, 7.8% vs 20% (P=0.08, 0.614 & 0.01 respectively). The NNT for NAC, indomethacin and NAC + indomethacin was 11, 38 and 8 respectively. Conclusion: Oral NAC is more effective than rectal indomethacin when compared to placebo for prevention of PEP and the combination of NAC and Indomethacin had the lowest incidence of PEP and may have synergistic effect in preventing of PEP (IRCT20201222049798N1; 29/12/2020).

Background: In this double-blinded randomized clinical trial, we aimed to compare the safety and efficacy of a combination of dexmedetomidine and ketamine (DK) with propofol and fentanyl (PF) for sedation in colonoscopy patients. Methods: In this study, 64 patients who underwent colonoscopy were randomized into two groups: 1) A, which received PF, and 2) B, which received DK for sedation. Among 64 patients, 31 patients were included in PF, and 33 patients were included in the DK group. Both groups were similar in terms of demographics. Patients’ sedation score (based on Ramsay sedation scale) and vital signs were recorded at 2, 5, 10, and 15 minutes. Complications including apnea, hypotension, hypoxia, nausea, and vomiting, along with gastroenterologist satisfaction and patients’ pain score (based on Wong-Baker faces pain assessment scale), were recorded by a checklist. Data were analyzed by SPSS v.18 software, using chi-square, independent t-tests, and repeated measures analysis with p<0.05 as the criterion for significant differences. Results: The mean score of sedation was 4.82±0.49 in the DK group and 5.22±0.45 in the PF group (p value=0.001). Serious complications, including hypotension (p value=0.005) and apnea (p value=0.10) were significantly higher in the PF group. Satisfaction of gastroenterologist (p value= 0.400) and patients’ pain score (p value = 0.900) were similar among groups. Conclusion: Combination of DK provides sufficient sedation with fewer complications in comparison with PF in colonoscopy patients. Clinical Trial Registration No: The study was also registered at the Iranian Center for Clinical Trials (No. IRCT20161205031252N11).

Background and aims: Acute respiratory distress syndrome (ARDS) treatment is supportive, and there is no currently approved treatment for it. This study, therefore, aimed to investigate the effect of endotracheal administration of N-acetyl cysteine (NAC) and heparin on the level of secretion and partial thromboplastin time (PTT) in ARDS patients under mechanical ventilation. Methods: In this clinical trial study, 70 patients aged over 18 years (30 women and 40 men) admitted to the intensive care unit were randomly selected following the allocation rule and then divided into two groups (intervention and control). In addition to the routine and available treatments in the ward given to the patients in both groups, the control group also received 10 mL of normal saline every six hours through the endotracheal route, while the intervention group received 500 units of heparin plus 200 mg of NAC dissolved in 10 mL of normal saline every six hours through the same administration route. Results: The mean and standard deviation levels of PTT in the control and intervention groups were 30.3743 ± 7.78008 and 32.2286 ± 8.31047, respectively, with no significant difference (P>0.05); the volume of secretion on days 1-3 was not significantly different between the two groups, but the difference was statistically significant from day 4 onwards (P<0.05). Conclusion: Taking the combination of NAC and heparin through the endotracheal route was effective in reducing pulmonary secretion, and may have been considered a considerable positive step in providing patients suffering from acute respiratory failure and under mechanical ventilation with supportive care. However, it is recommended that further clinical studies be conducted before arriving at any definitive conclusion.

Background: Helicobacter pylori is one of the most common human bacterial infections, accounting for the infection of half of the world's population. The polymerase chain reaction (PCR) has high specificity and sensitivity in diagnosing this bacterial infection. Objectives: The present study aimed to compare the sensitivity and specificity of the fliD gene and the most widely used glmM gene in the PCR technique. Methods: The research population encompassed patients with indications for upper endoscopy. This cross-sectional study compared the sensitivity and specificity of a proposed gene (fliD) with the most widely used glmM gene to detect the H. pylori infection in tissue samples. Results: The participants encompassed ninety-nine participants aged above 18 years. Their median age was 45.92 ± 13.63 years. The most common complaints of the patients were epigastric pain and heartburn. Our described gold standard detected 61.6% and 38.4% as positive and negative, respectively. The sensitivity and specificity were 72.1% and 100.0% for the routine PCR (glmM gene) and 80.3% and 94.7% for the proposed PCR (fliD gene). Conclusions: Different genes have been used to detect H. pylori in PCR. The glmM gene is easily used to diagnose the H. pylori infection; however, according to the present findings, the fliD gene has higher sensitivity than the glmM gene. Accordingly, the former can be used as a screening gene for the H. pylori infection in the PCR technique.