Computational Science and Its Applications – ICCSA 2020, 2020
There is a growing evidence that variation in gut microbial communities has important association... more There is a growing evidence that variation in gut microbial communities has important associations with overall host health, and that the diversity and the richness of such communities is helpful in distinguishing patients at high risk of life-threatening post-transplantation conditions. The aim of our paper is to provide an expressive and highly interpretable characterization of microbiome alterations, with the goal of achieving more effective transplantations characterized by a rejection rate as low as possible, and to avoid more severe complications by treating patients at risk in a timely and effective way. For this purpose, we propose using topic models to identify those bacterial species that have the most important weight under the two different experimental conditions (healthy and transplanted patients, or patients whose fecal microbiota has been sampled both in pre- and post-transplantation phases). Topic models are Bayesian statistical models that are not affected by data scarcity, because conclusions we can draw borrow strength across sparse gut microbiome samples. By exploiting this property, we show that topic models are expressive methods for dimensionality reduction which can help analyze variation and diversity in gut microbial communities. With topic models the analysis can be carried out at a level close to natural language, as the output can be easily interpreted by clinicians, since most abundant species are automatically selected and the microbial dynamics can be tracked and followed over time.
BACKGROUND: Celiac disease (CD) is a common cause of malabsorption that is definitively diagnosed... more BACKGROUND: Celiac disease (CD) is a common cause of malabsorption that is definitively diagnosed by abnormal bowel biopsy, symptoms and histologic changes to gluten free diet. The symptoms of irritable bowel syndrome (IBS) are common in our community as the majority of people in Guilan, north of Iran, consume rice daily. Also, a number of celiac patients are unknown, and IBS are mistakenly diagnosed. OBJECTIVE: This study aimed to evaluate the prevalence of CD among IBS patients. METHODS: A total of 475 consecutive patients with IBS, confirmed by Rome IV, underwent celiac serological tests antitissue transglutaminase antibodies (IgA-tTG, IgG-tTG) after obtaining a written consent form. In case of positive serological tests, biopsy was performed from small intestine after endoscopy RESULTS: Thirty-one (6.53%, 95% CI: 4.55–9.22) patients were positive for celiac serology. Based on Marsh-Oberhuber criteria, out of 9 patients with positive pathology 77.78% (95% CI: 40.19–96.05) had mar...
Introduction: Although the Rockall scoring system is designed to predict morbidity, mortality and... more Introduction: Although the Rockall scoring system is designed to predict morbidity, mortality and bleeding in patients, the accuracy and validity of these indicators had not been reviewed among the patients of the north of Iran, Guilan. The aim of this study was to evaluate the Rockall scoring system among primary nonvariceal upper gastrointestinal bleeding (NVUGIB) patients in Guilan province, north of Iran. Materials and Methods: This cross-sectional study was performed in 197 patients with primary nonvariceal manifestation of upper gastrointestinal bleeding at a reference educational hospital. All patients underwent endoscopy within 12 hours of presentation of symptoms. After demographic data, endoscopic findings and history of gastrointestinal diseases registrations, Rockall scores were calculated. Also, the patients were divided into three groups: (1) low risk, (2) intermediate risk and (3) high risk. Results: Twenty-seven of the patients were classified as high risk (21 males and 6 females). Eleven of them were aged 80 years old and 6 cases were older. The number of cases with the history of alcohol consumption and smoking were 3 and 7, respectively. Previous gastrointestinal bleeding history and previous endoscopy history were observed among 4 subjects in two different groups. Six of eight patients with rebleeding were considered as high risk group. The mean Rockall score among patients with and without rebleeding were 2.9±1.7 and 6±1.8, respectively (P= 0.02). Validation of Rockall score showed accuracy of 0.995 with 95% confidence between 0.983-1.000. High risk group patients, with Rockall scores greater than 6, had the possibility of rebleeding with the sensitivity of 100% and the specificity of 93.3%. Conclusion: According to the results of this study, the Rochall score was effective in rebleeding prediction. Therefore, we recommend the use of this score in emergency departments for patients in order to additional monitoring and treatment for prevention of rebleeding in hospital.
Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with ... more Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with varied incidence and the onset age of disease worldwide. Overall, 161 participants who were under patronage of a local relief foundation and referred to the endoscopy ward of Razi Hospital affiliated to the Guilan University of Medical Sciences. These patients have been aged more than 50 or more than 40 years with history of colorectal cancer in their first-degree family were enrolled from March 2016–March 2017. Demographic information were collected. Colonoscopy was performed and histopathological evaluation of observed lesions and polyps was done. Most of participants were female (113 individuals, 70.2%) and aged 50–60 years (83 individuals, 51.6%). Seventy-four (46%) had certain lesions. Most of colonoscopy findings were observed in the ascending colon in which depressed polyps and diverticulum were most frequent. However, rectum showed the most histological findings. All polyps of de...
International Journal of Environmental Research and Public Health, 2021
Spatial analysis of COVID-19 vaccination research is increasing in recent literature due to the a... more Spatial analysis of COVID-19 vaccination research is increasing in recent literature due to the availability of COVID-19 vaccination data that usually contain location components. However, to our knowledge, no previous study has provided a comprehensive review of this research area. Therefore, in this scoping review, we examined the breadth of spatial and spatiotemporal vaccination studies to summarize previous findings, highlight research gaps, and provide guidelines for future research. We performed this review according to the five-stage methodological framework developed by Arksey and O’Malley. We screened all articles published in PubMed/MEDLINE, Scopus, and Web of Science databases, as of 21 September 2021, that had employed at least one form of spatial analysis of COVID-19 vaccination. In total, 36 articles met the inclusion criteria and were organized into four main themes: disease surveillance (n = 35); risk analysis (n = 14); health access (n = 16); and community health pr...
Background: Colorectal cancer (CRC) requires the presence of a variety of factors predisposing a ... more Background: Colorectal cancer (CRC) requires the presence of a variety of factors predisposing a tumorigenic milieu. Excluding familial clustering and hereditary CRC syndromes, the development of sporadic CRC from precancerous lesions is influenced by tissue inflammation, modulation of intestinal immunity, hormones, dietary habits and gut microbiota composition. As concerning the last two aspects, the intestinal presence of equol, the most biologically active metabolite of the soy isoflavone daidzein and the presence of a genetic determinant of gut microbiota able to metabolize daidzein, seem to lower the CRC risk. It has been hypothesized that the anaerobic microorganisms of the Bacteroides genus play a role in equol production. Aim: To evaluate the presence of (i) anaerobic gut microbiota and (ii) the urinary levels of soy isoflavones (daidzein, genistein and equol) in patients with and without precancerous lesions, challenged with a daidzein-rich soy extract. Methods: Consecutive...
Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Here... more Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Here, we report a case of a young man with acute motor axonal neuropathy (AMAN) subtype of GBS having hepatitis A virus (HAV) infection. A 30-year-old man with icterus was referred to emergency center of Razi Hospital. He complained of flu-like symptoms 10 days before the onset of icterus. Also, he suffered from gradual fatigue and weakness with dark urine. He experienced neurological symptoms of muscle paralysis (ascending from the legs to hands). Neurological consultant suspected GBS at the first step based on clinical examinations. He was candidate for five sessions of plasmapheresis. The ultrasonography revealed liver span 166 mm, which was greater than the normal range, with normal parenchymal echo. The gallbladder wall was thicker than normal and gallstone with lesion was not seen in different conditions. He was discharged after total improvement of neurological symptoms and muscular p...
Background: Strongyloidiasis is self-limited by the complete immune system, it may be complicated... more Background: Strongyloidiasis is self-limited by the complete immune system, it may be complicated and causes hyperinfection in immunocompromised patients. Objective: Here, we report a case of an immunocompromised patient with duodenal involvement of Strongyloides stercoralis. Case Report: A 65-year-old man presented with severe pain in central abdomen and periumbilical regions. He had no history of alcohol consumption, smoking and surgery but the history of RA (Rheumatoid Arthritis) and hypothyroidism taking immunosuppressive medications. The patient underwent endoscopy and colonoscopy which pathological analysis of the biopsies revealed remarkable findings in favor of Strongyloidiasis. After two consecutive day’s consumption of ivermectin 200µg/kg, the symptoms were completely removed. Also, the stool examination was negative for S. stercoralis larvae two weeks after end of the treatment. Conclusions: It seems that in immunocompromised patients with gastrointestinal symptoms assump...
Objective Numerous factors may contribute as triggers to the exacerbation of the condition of pat... more Objective Numerous factors may contribute as triggers to the exacerbation of the condition of patients with inflammatory bowel disease. Methods The medical files of 109 patients with the positive history of inflammatory bowel disease exacerbation between March 2016 and March 2017 were assessed retrospectively. Data were obtained using the inflammatory bowel disease data bank software. The parameters were obtained from the inflammatory bowel disease data bank software. The mentioned parameters were assessed in terms of type and severity of disease using chi-square test in SPSS software. Moreover, binary logistic regression test was used to assess the associations between season of disease onset and inflammatory bowel disease exacerbation as odds ratios with 95% confidence intervals (95% CI). Results Overall, (88.1%) of cases with inflammatory bowel disease exacerbation, had ulcerative colitis. The mean age of patients was 38.14 ± 14.66 years. The disease duration in all patients (ulc...
Objective Ulcerative colitis usually affects the rectum and potentially can involve the whole col... more Objective Ulcerative colitis usually affects the rectum and potentially can involve the whole colon. Noninvasive methods such as fecal calprotectin measurement may be considered as a reliable and inexpensive approach in assessing disease severity or treatment change strategy. Methods In this retrospective cross-sectional study, records of 56 ulcerative colitis patients who hospitalized with exacerbation between May 2016 and April 2017 were assessed based on IBD Data Bank Software in Gastrointestinal and Liver Diseases and Research Center (GLDRC), Guilan province, Iran between. A questionnaire of demographic characteristics, clinical findings and fecal calprotectin level was completed. Montreal classification severity of ulcerative colitis and Mayo disease activity index were scored. Data were analyzed for descriptive and analytical analysis. Results Fecal calprotectin was significantly different in terms of disease severity based on both Mayo score (p = 0.007) and Montreal classific...
Male, 26 Final Diagnosis: AIH-PSC overlap syndrome Symptoms: Palpable liver more than 5 cm below ... more Male, 26 Final Diagnosis: AIH-PSC overlap syndrome Symptoms: Palpable liver more than 5 cm below the costal margin and both firm and nodular • 8-kg weight loss during the last 2 months • clay-colored stool • dark urine • general fatigue • generalized icterus • light abdominal tenderness in the right upper quadrant with isolated hepatomegaly • loss of appetite • neither spider angioma nor stigmata • no clinical evidence of ascites or lymphadenopathy • nonspecific abdominal discomfort • normoactive bowel sound • pruritus Medication:-Clinical Procedure: Lab tests • MRCP • Pathological analysis Specialty: Gastroenterology and Hepatology Objective: Challenging differential diagnosis Background: In patients with the diagnosis of autoimmune hepatitis (AIH), the presence of cholestatic features raise the possibility of an overlap syndrome with primary sclerosing cholangitis (PSC). Here, we present a unique case with AIH-PSC overlap syndrome and innumerable liver masses. Case Report: A 26-year-old man presented with generalized icterus. Based on the serological findings of hypergamainmunoglobulinemia and positive anti-nuclear antibody tests, together with an abnormal cholangiogram, he was diagnosed with overlap syndrome (AIH-PSC). Liver imaging revealed innumerable liver masses with a benign appearance in the pathological evaluation. To rule out the colon abnormalities that usually coexist with such liver masses, colonoscopy was performed and showed no significant changes. The liver masses were nonmalignant and were resolved after immunosuppressant therapy. Conclusions: Because AIH-PSC overlap syndrome is rare, it is suggested that radiological evaluation of the biliary tree should be performed routinely in adults diagnosed with AIH to reduce the missed diagnosis of overlap syndrome and liver masses.
Inflammatory myofibroblastic tumor Symptoms: 2-3 kg weight loss • Helicobacter pylori positive wh... more Inflammatory myofibroblastic tumor Symptoms: 2-3 kg weight loss • Helicobacter pylori positive which were eradicated after treatment course • hypogastric region discomfort • no association between the pain, defecation and eating • no history of HIV, diabetes, smoking and alcohol consumption was recorded • no symptoms of nausea, vomiting, fever and shaking chills • normal vital signs • tenderness in the right lower quadrant of the abdomen with no rebound state was noted Medication:-Clinical Procedure: Lab examinationt-imaging-colonoscopy-surgery Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Inflammatory myofibroblastic tumors (IMTs) are scarce tumors with discrete immunohistochemical and molecular attributes which are not related to a particular location. There are different reports about the intrinsic nature of these tumors as benign to possibly malignant. Case Report: Here we report the case of a 68-year-old man referred to the Internal Medicine Department of Razi Hospital in Rasht (a city in the north of Iran) due to right lower quadrant (RLQ) discomfort with no specific symptoms. Colonoscopy revealed a mass-like lesion. Polymorphonuclear cells (PMNCs) admixed by some eosinophils were demonstrated histopathologically. Immunohistochemical evaluation was positive for vimentin, CD34, smooth muscle actin, and ALK, and negative for CD117 and desmin. The tumor was successfully removed by surgery with no chemotherapy. No recurrence was reported. Conclusions: We have performed surgical excision of the mass with no chemotherapy and no recurrence. Although recurrence is reported to be low, we recommend long-term follow-up after surgery.
Computational Science and Its Applications – ICCSA 2020, 2020
There is a growing evidence that variation in gut microbial communities has important association... more There is a growing evidence that variation in gut microbial communities has important associations with overall host health, and that the diversity and the richness of such communities is helpful in distinguishing patients at high risk of life-threatening post-transplantation conditions. The aim of our paper is to provide an expressive and highly interpretable characterization of microbiome alterations, with the goal of achieving more effective transplantations characterized by a rejection rate as low as possible, and to avoid more severe complications by treating patients at risk in a timely and effective way. For this purpose, we propose using topic models to identify those bacterial species that have the most important weight under the two different experimental conditions (healthy and transplanted patients, or patients whose fecal microbiota has been sampled both in pre- and post-transplantation phases). Topic models are Bayesian statistical models that are not affected by data scarcity, because conclusions we can draw borrow strength across sparse gut microbiome samples. By exploiting this property, we show that topic models are expressive methods for dimensionality reduction which can help analyze variation and diversity in gut microbial communities. With topic models the analysis can be carried out at a level close to natural language, as the output can be easily interpreted by clinicians, since most abundant species are automatically selected and the microbial dynamics can be tracked and followed over time.
BACKGROUND: Celiac disease (CD) is a common cause of malabsorption that is definitively diagnosed... more BACKGROUND: Celiac disease (CD) is a common cause of malabsorption that is definitively diagnosed by abnormal bowel biopsy, symptoms and histologic changes to gluten free diet. The symptoms of irritable bowel syndrome (IBS) are common in our community as the majority of people in Guilan, north of Iran, consume rice daily. Also, a number of celiac patients are unknown, and IBS are mistakenly diagnosed. OBJECTIVE: This study aimed to evaluate the prevalence of CD among IBS patients. METHODS: A total of 475 consecutive patients with IBS, confirmed by Rome IV, underwent celiac serological tests antitissue transglutaminase antibodies (IgA-tTG, IgG-tTG) after obtaining a written consent form. In case of positive serological tests, biopsy was performed from small intestine after endoscopy RESULTS: Thirty-one (6.53%, 95% CI: 4.55–9.22) patients were positive for celiac serology. Based on Marsh-Oberhuber criteria, out of 9 patients with positive pathology 77.78% (95% CI: 40.19–96.05) had mar...
Introduction: Although the Rockall scoring system is designed to predict morbidity, mortality and... more Introduction: Although the Rockall scoring system is designed to predict morbidity, mortality and bleeding in patients, the accuracy and validity of these indicators had not been reviewed among the patients of the north of Iran, Guilan. The aim of this study was to evaluate the Rockall scoring system among primary nonvariceal upper gastrointestinal bleeding (NVUGIB) patients in Guilan province, north of Iran. Materials and Methods: This cross-sectional study was performed in 197 patients with primary nonvariceal manifestation of upper gastrointestinal bleeding at a reference educational hospital. All patients underwent endoscopy within 12 hours of presentation of symptoms. After demographic data, endoscopic findings and history of gastrointestinal diseases registrations, Rockall scores were calculated. Also, the patients were divided into three groups: (1) low risk, (2) intermediate risk and (3) high risk. Results: Twenty-seven of the patients were classified as high risk (21 males and 6 females). Eleven of them were aged 80 years old and 6 cases were older. The number of cases with the history of alcohol consumption and smoking were 3 and 7, respectively. Previous gastrointestinal bleeding history and previous endoscopy history were observed among 4 subjects in two different groups. Six of eight patients with rebleeding were considered as high risk group. The mean Rockall score among patients with and without rebleeding were 2.9±1.7 and 6±1.8, respectively (P= 0.02). Validation of Rockall score showed accuracy of 0.995 with 95% confidence between 0.983-1.000. High risk group patients, with Rockall scores greater than 6, had the possibility of rebleeding with the sensitivity of 100% and the specificity of 93.3%. Conclusion: According to the results of this study, the Rochall score was effective in rebleeding prediction. Therefore, we recommend the use of this score in emergency departments for patients in order to additional monitoring and treatment for prevention of rebleeding in hospital.
Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with ... more Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with varied incidence and the onset age of disease worldwide. Overall, 161 participants who were under patronage of a local relief foundation and referred to the endoscopy ward of Razi Hospital affiliated to the Guilan University of Medical Sciences. These patients have been aged more than 50 or more than 40 years with history of colorectal cancer in their first-degree family were enrolled from March 2016–March 2017. Demographic information were collected. Colonoscopy was performed and histopathological evaluation of observed lesions and polyps was done. Most of participants were female (113 individuals, 70.2%) and aged 50–60 years (83 individuals, 51.6%). Seventy-four (46%) had certain lesions. Most of colonoscopy findings were observed in the ascending colon in which depressed polyps and diverticulum were most frequent. However, rectum showed the most histological findings. All polyps of de...
International Journal of Environmental Research and Public Health, 2021
Spatial analysis of COVID-19 vaccination research is increasing in recent literature due to the a... more Spatial analysis of COVID-19 vaccination research is increasing in recent literature due to the availability of COVID-19 vaccination data that usually contain location components. However, to our knowledge, no previous study has provided a comprehensive review of this research area. Therefore, in this scoping review, we examined the breadth of spatial and spatiotemporal vaccination studies to summarize previous findings, highlight research gaps, and provide guidelines for future research. We performed this review according to the five-stage methodological framework developed by Arksey and O’Malley. We screened all articles published in PubMed/MEDLINE, Scopus, and Web of Science databases, as of 21 September 2021, that had employed at least one form of spatial analysis of COVID-19 vaccination. In total, 36 articles met the inclusion criteria and were organized into four main themes: disease surveillance (n = 35); risk analysis (n = 14); health access (n = 16); and community health pr...
Background: Colorectal cancer (CRC) requires the presence of a variety of factors predisposing a ... more Background: Colorectal cancer (CRC) requires the presence of a variety of factors predisposing a tumorigenic milieu. Excluding familial clustering and hereditary CRC syndromes, the development of sporadic CRC from precancerous lesions is influenced by tissue inflammation, modulation of intestinal immunity, hormones, dietary habits and gut microbiota composition. As concerning the last two aspects, the intestinal presence of equol, the most biologically active metabolite of the soy isoflavone daidzein and the presence of a genetic determinant of gut microbiota able to metabolize daidzein, seem to lower the CRC risk. It has been hypothesized that the anaerobic microorganisms of the Bacteroides genus play a role in equol production. Aim: To evaluate the presence of (i) anaerobic gut microbiota and (ii) the urinary levels of soy isoflavones (daidzein, genistein and equol) in patients with and without precancerous lesions, challenged with a daidzein-rich soy extract. Methods: Consecutive...
Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Here... more Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Here, we report a case of a young man with acute motor axonal neuropathy (AMAN) subtype of GBS having hepatitis A virus (HAV) infection. A 30-year-old man with icterus was referred to emergency center of Razi Hospital. He complained of flu-like symptoms 10 days before the onset of icterus. Also, he suffered from gradual fatigue and weakness with dark urine. He experienced neurological symptoms of muscle paralysis (ascending from the legs to hands). Neurological consultant suspected GBS at the first step based on clinical examinations. He was candidate for five sessions of plasmapheresis. The ultrasonography revealed liver span 166 mm, which was greater than the normal range, with normal parenchymal echo. The gallbladder wall was thicker than normal and gallstone with lesion was not seen in different conditions. He was discharged after total improvement of neurological symptoms and muscular p...
Background: Strongyloidiasis is self-limited by the complete immune system, it may be complicated... more Background: Strongyloidiasis is self-limited by the complete immune system, it may be complicated and causes hyperinfection in immunocompromised patients. Objective: Here, we report a case of an immunocompromised patient with duodenal involvement of Strongyloides stercoralis. Case Report: A 65-year-old man presented with severe pain in central abdomen and periumbilical regions. He had no history of alcohol consumption, smoking and surgery but the history of RA (Rheumatoid Arthritis) and hypothyroidism taking immunosuppressive medications. The patient underwent endoscopy and colonoscopy which pathological analysis of the biopsies revealed remarkable findings in favor of Strongyloidiasis. After two consecutive day’s consumption of ivermectin 200µg/kg, the symptoms were completely removed. Also, the stool examination was negative for S. stercoralis larvae two weeks after end of the treatment. Conclusions: It seems that in immunocompromised patients with gastrointestinal symptoms assump...
Objective Numerous factors may contribute as triggers to the exacerbation of the condition of pat... more Objective Numerous factors may contribute as triggers to the exacerbation of the condition of patients with inflammatory bowel disease. Methods The medical files of 109 patients with the positive history of inflammatory bowel disease exacerbation between March 2016 and March 2017 were assessed retrospectively. Data were obtained using the inflammatory bowel disease data bank software. The parameters were obtained from the inflammatory bowel disease data bank software. The mentioned parameters were assessed in terms of type and severity of disease using chi-square test in SPSS software. Moreover, binary logistic regression test was used to assess the associations between season of disease onset and inflammatory bowel disease exacerbation as odds ratios with 95% confidence intervals (95% CI). Results Overall, (88.1%) of cases with inflammatory bowel disease exacerbation, had ulcerative colitis. The mean age of patients was 38.14 ± 14.66 years. The disease duration in all patients (ulc...
Objective Ulcerative colitis usually affects the rectum and potentially can involve the whole col... more Objective Ulcerative colitis usually affects the rectum and potentially can involve the whole colon. Noninvasive methods such as fecal calprotectin measurement may be considered as a reliable and inexpensive approach in assessing disease severity or treatment change strategy. Methods In this retrospective cross-sectional study, records of 56 ulcerative colitis patients who hospitalized with exacerbation between May 2016 and April 2017 were assessed based on IBD Data Bank Software in Gastrointestinal and Liver Diseases and Research Center (GLDRC), Guilan province, Iran between. A questionnaire of demographic characteristics, clinical findings and fecal calprotectin level was completed. Montreal classification severity of ulcerative colitis and Mayo disease activity index were scored. Data were analyzed for descriptive and analytical analysis. Results Fecal calprotectin was significantly different in terms of disease severity based on both Mayo score (p = 0.007) and Montreal classific...
Male, 26 Final Diagnosis: AIH-PSC overlap syndrome Symptoms: Palpable liver more than 5 cm below ... more Male, 26 Final Diagnosis: AIH-PSC overlap syndrome Symptoms: Palpable liver more than 5 cm below the costal margin and both firm and nodular • 8-kg weight loss during the last 2 months • clay-colored stool • dark urine • general fatigue • generalized icterus • light abdominal tenderness in the right upper quadrant with isolated hepatomegaly • loss of appetite • neither spider angioma nor stigmata • no clinical evidence of ascites or lymphadenopathy • nonspecific abdominal discomfort • normoactive bowel sound • pruritus Medication:-Clinical Procedure: Lab tests • MRCP • Pathological analysis Specialty: Gastroenterology and Hepatology Objective: Challenging differential diagnosis Background: In patients with the diagnosis of autoimmune hepatitis (AIH), the presence of cholestatic features raise the possibility of an overlap syndrome with primary sclerosing cholangitis (PSC). Here, we present a unique case with AIH-PSC overlap syndrome and innumerable liver masses. Case Report: A 26-year-old man presented with generalized icterus. Based on the serological findings of hypergamainmunoglobulinemia and positive anti-nuclear antibody tests, together with an abnormal cholangiogram, he was diagnosed with overlap syndrome (AIH-PSC). Liver imaging revealed innumerable liver masses with a benign appearance in the pathological evaluation. To rule out the colon abnormalities that usually coexist with such liver masses, colonoscopy was performed and showed no significant changes. The liver masses were nonmalignant and were resolved after immunosuppressant therapy. Conclusions: Because AIH-PSC overlap syndrome is rare, it is suggested that radiological evaluation of the biliary tree should be performed routinely in adults diagnosed with AIH to reduce the missed diagnosis of overlap syndrome and liver masses.
Inflammatory myofibroblastic tumor Symptoms: 2-3 kg weight loss • Helicobacter pylori positive wh... more Inflammatory myofibroblastic tumor Symptoms: 2-3 kg weight loss • Helicobacter pylori positive which were eradicated after treatment course • hypogastric region discomfort • no association between the pain, defecation and eating • no history of HIV, diabetes, smoking and alcohol consumption was recorded • no symptoms of nausea, vomiting, fever and shaking chills • normal vital signs • tenderness in the right lower quadrant of the abdomen with no rebound state was noted Medication:-Clinical Procedure: Lab examinationt-imaging-colonoscopy-surgery Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Inflammatory myofibroblastic tumors (IMTs) are scarce tumors with discrete immunohistochemical and molecular attributes which are not related to a particular location. There are different reports about the intrinsic nature of these tumors as benign to possibly malignant. Case Report: Here we report the case of a 68-year-old man referred to the Internal Medicine Department of Razi Hospital in Rasht (a city in the north of Iran) due to right lower quadrant (RLQ) discomfort with no specific symptoms. Colonoscopy revealed a mass-like lesion. Polymorphonuclear cells (PMNCs) admixed by some eosinophils were demonstrated histopathologically. Immunohistochemical evaluation was positive for vimentin, CD34, smooth muscle actin, and ALK, and negative for CD117 and desmin. The tumor was successfully removed by surgery with no chemotherapy. No recurrence was reported. Conclusions: We have performed surgical excision of the mass with no chemotherapy and no recurrence. Although recurrence is reported to be low, we recommend long-term follow-up after surgery.
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Papers by Sara Mavaddati