Clinical Phenotype and Disease Course of Inflammatory Bowel Disease in Iran: Results of the Iranian Registry of Crohn's and Colitis (IRCC)

BACKGROUND

Data on the epidemiology of inflammatory bowel disease (IBD) in the Middle East are scarce. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the Middle East.

METHODS

We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) from 2017 until 2022. We collected information on demographic characteristics, past medical history, family history, disease extent and location, extra-intestinal manifestations, IBD medications, and activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions history, history of colon cancer, and IBD-related surgeries.

RESULTS

In total, 9746 patients with ulcerative colitis (UC) (n=7793), and Crohn's disease (CD) (n=1953) were reported. The UC to CD ratio was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. The male-to-female ratio was 1.28 in CD patients. A positive family history was observed in 17.9% of UC patients. The majority of UC patients had pancolitis (47%). Ileocolonic involvement was the most common type of involvement in CD patients (43.7%), and the prevalence of stricturing behavior was 4.6%. A prevalence of 0.3% was observed for colorectal cancer among patients with UC. Moreover,15.2% of UC patients and 38.4% of CD patients had been treated with anti-tumor necrosis factor (anti-TNF).

CONCLUSION

In this national registry-based study, there are significant differences in some clinical phenotypes such as the prevalence of extra-intestinal manifestations and treatment strategies such as biological use in different geographical locations.

Synergistic effects of hydro extract of jujube fruit in combination with Mesalazine (orally) and Asacol (intra-colonic) administration in ameliorating animal model of ulcerative colitis

This study was done to investigate the synergistic impacts hydro extract of jujube fruit in combination with Mesalazine (orally) and Asacol (intra-colonic) administration in ameliorating animal model of ulcerative colitis (UC). After the induction of UC and with the development of signs, the treatment groups daily received the hydro extract of jujube fruit (200 mg/kg, orally, enema), Mesalazine (30 mg/kg, orally) and Asacol (10 mg/kg, enema). After 10 days, rats were euthanized and were studied. Findings indicated a significant increase in Myeloperoxidase (161.66 ± 10.40), Nitric oxide (216.01 ± 17.55), IL-6 (138.54 ± 7.02), and TNF-α (123.87 ± 9.80) colon tissue levels and pathological damage of positive control group compared with the negative control group. Hydro extract of jujube fruit in combination with Mesalazine (orally) and Asacol (intra-colonic) group represented a higher capability in significantly decreasing Myeloperoxidase (73.33 ± 9.07), Nitric oxide (81.66 ± 10.50), IL-6 (51.69 ± 5.19), TNF-α (30.59 ± 5.50) levels and pathological damage in compared with the other treatment groups. Considering accessibility and affordability of jujube fruit and the side effects of routine drugs, taking a combination of jujube fruit with low doses of routine pharmaceutical drugs can improve and cure ulcerative colitis disease.

Regulation of carbohydrate metabolism by nitric oxide and hydrogen sulfide: Implications in diabetes

Nitric oxide (NO) and hydrogen sulfide (H₂S) are two gasotransmitters that are produced in the human body and have a key role in many of the physiological activities of the various organ systems. Decreased NO bioavailability and deficiency of H₂S are involved in the pathophysiology of type 2 diabetes and its complications. Restoration of NO levels have favorable metabolic effects in diabetes. The role of H₂S in pathophysiology of diabetes is however controversial; H₂S production is decreased during development of obesity, diabetes, and its complications, suggesting the potential therapeutic effects of H₂S. On the other hand, increased H₂S levels disturb the pancreatic β-cell function and decrease insulin secretion. In addition, there appear to be important interactions between NO and H₂S at the levels of both biosynthesis and signaling pathways, yet clear an insight into this relationship is lacking. H₂S potentiates the effects of NO in the cardiovascular system as well as NO release from its storage pools. Likewise, NO increases the activity and the expression of H₂S-generating enzymes. Inhibition of NO production leads to elimination/attenuation of the cardioprotective effects of H₂S. Regarding the increasing interest in the therapeutic applications of NO or H₂S-releasing molecules in a variety of diseases, particularly in the cardiovascular disorders, much is to be learned about their function in glucose/insulin metabolism, especially in diabetes. The aim of this review is to provide a better understanding of the individual and the interactive roles of NO and H₂S in carbohydrate metabolism.

Therapeutic effects of curcumin and ursodexycholic acid on non-alcoholic fatty liver disease

Fatty liver disease is commonly associated with inflammation, oxidative stress and apoptosis of hepatocytes. This study was designed to investigate the combinational therapeutic effects of curcumin (CMN) and Ursodeoxycholic acid (UDCA) on non-alcoholic fatty liver disease (NAFLD). Male Wistar rats were divided into 8 groups: NAFLD-induced rats, NAFLD-induced rats + CMN, NAFLD-induced rats + UDCA, and NAFLD-induced rats that received CMN + UDCA. CMN (200 mg/kg) and UDCA (80 mg/kg) was administered orally for 14 and 28 consecutive days. Biochemical and histopathological analysis were conducted in all the groups. It was seen that co-administration of CMN and UDCA significantly reduced fatty degeneration, cellular necrosis, edema, and immune cell infiltration compared to non-treated NAFLD-induced rats. Whereas, combinational therapy caused a significant decrease in levels of SGOT and SGPT enzymes and expression of p53, caspase III, iNOS and bcl-2 mRNA and proteins, in variant with the treatment of CMN and UDCA, respectively. Co-administration of CMN and UDCA was also associated with the restoration of the levels of serum TG and HDL-C however, had no effect on LDL-C. It also resulted in an in TAC, GSH- PX, and SOD and decrease in MDA level. Our study concludes that combinational therapy of CMN and UDCA is effective for the treatment of NAFLD, as compared to their solo treatment.

Vitamin D Receptor Gene Haplotype and Late-Onset Obesity in Iranian Azeri Turkish Women

INTRODUCTION

A large body of literature has revealed the association between vitamin D3-VDR complex and obesity. The aim of the present study was to survey the rate of the VDR polymorphisms in obese women and to determine whether there may be an association between VDR BsmI and Tru9I haplotypes and obesity in Iranian Azeri Turkish women.

MATERIAL AND METHODS

65 Iranian Azeri Turkish women were enrolled in the study and PCR amplification and direct sequencing of PCR products were used for genotypings.

RESULTS

The findings of this study showed that VDR BsmIG allele, VDR BsmI G/G genotype, VDR BsmI A/A genotype, Tru9IA allele and Tru9I A/A genotype were more frequent in obese women compared to controls. The frequency of VDR BsmIG/Tru9IA (GA), VDR BsmIG/Tru9IG (GG), VDR BsmIA/Tru9IG (AG), and VDR BsmIA/Tru9IA (AA) haplotypes were 19.74%, 42.11%, 38.16% and 0% in cases, and 11.11%, 40.74%, 42.59 and 5.56% in controls. Statistically significant differences were found between cases and controls regarding the VDR AA haplotype (P=0.03).

CONCLUSIONS

Our findings demonstrated that the VDR AA haplotype frequency was significantly lower in subjects with obesity compared with normal controls. This study shows that the VDR AA haplotype is significantly associated with a decreased risk of obesity in the tested group. This report is the first of its kind in the West Azerbaijani population.

Association between Celiac Disease and Intussusceptions in Children: Two Case Reports and Literature Review

Association between celiac disease and intussusception has been reported in adult. Although intussusception is common in children, it rarely has been reported in association with celiac disease. Two children, 5 and 7 years old, with celiac disease are reported here, whose initial presentation was intussusception prior to investigation for concomitant failure to thrive. They presented with acute and severe abdominal distention with vomiting, and donuts and pseudo-kidney appearance in abdominal ultrasonography. One patient's intussusception had reducted spontaneously, however the other had required surgery. In investigation for concomitant failure to thrive, tissue transglutaminase levels were very high and duodenal biopsies revealed celiac disease. Thus celiac testing is recommended in children with intussusception and growth failure.

Therapeutic effects of oral zinc supplementation on acute watery diarrhea with moderate dehydration: a double-blind randomized clinical trial

BACKGROUND

To assess the therapeutic effects of oral zinc supplementation on acute watery diarrhea of children with moderate dehydration.

METHODS

All 9-month to 5-year-old children who were admitted with acute watery diarrhea and moderate dehydration to the Children Ward of Motahari Hospital, Urmia, Iran in 2008 were recruited. After the application of the inclusion and exclusion criteria, the patients were randomly allocated to two groups: one group to receive zinc plus oral rehydration solution (ORS) and the other one to receive ORS plus placebo. All the patients were rehydrated using ORS and then receiving ORS for ongoing loss (10 ml/kg after every defecation). Additionally, the patients in the intervention group received zinc syrup (1 mg/kg/day) divided into two doses. A detailed questionnaire was filled daily for each patient by trained pediatrics residents; it contained required demographic characteristics, nutrition and hydration status, and disease progression. The primary outcome (frequency and consistency of diarrhea) and the secondary outcomes (duration of hospitalization and change in patients' weight) were compared between the two groups.

RESULTS

The mean diarrhea frequency (4.5±2.3 vs. 5.3±2.1; P=0.004) was lower in the group receiving zinc +ORS; however, the average weight was relatively similar between the two groups (10.5±3.1 vs. 10.1±2.3; P=0.14). The qualitative assessment of stool consistency also confirmed earlier improvement in the treatment group in the first three days of hospitalization (P <0.05). The mean duration of hospitalization was significantly lower in the patients receiving zinc supplements (2.5±0.7 vs. 3.3±0.8 days; P=0.001).

CONCLUSION

Our results imply the beneficial effects of therapeutic zinc supplementation on disease duration and severity in patients with acute diarrhea and moderate dehydration in Iran.

TRIAL REGISTRATION NUMBER

IRCT201201241580N2.

Idiopathic hypercalciuria in children with vesico ureteral reflux and recurrent urinary tract infection

PURPOSE

Our aim was to determine association of vesicoureteral reflux (VUR) and idiopathic hypercalciuria in children with recurrent and single episode of urinary tract infection (UTI).

MATERIALS AND METHODS

The study group consisted of 45 children with VUR and recurrent UTI, and 2 control groups: 45 normal healthy children (control group 1) and 45 children with VUR and single episode of UTI (control group 2). Idiopathic hypercalciuria was defined as urine calcium to creatinine ratio more than 0.8 (mg/mg) in infants younger than 1 year old, and more than 0.2 (mg/mg) in older children (without any detectable causes for hypercalciuria).

RESULTS

The study group consisted of 26 (57.8%) girls and 19 (42.2%) boys, with the mean age of 41.14 +/- 22.1 months. Nine (20%) subjects had hypercalciuria. The control group 1 composed of 22 (48.9%) girls and 23 (51.1%) boys, with the mean age of 43.98 +/- 16.23 months. In this group, 6 subjects (13.3%) with hypercalciuria were detected. The control group 2 composed of 23 (51.1%) girls and 22 (48.9%) boys, with the mean age of 39.96 +/- 24.2 months. In group 2, 7 subjects (15.6%) with hypercalciuria were detected.

CONCLUSION

Comparison between such results was not statistically significant. Despite reports of different studies about accompanying of hypercalciuria with recurrent UTI with or without anatomical abnormalities, according to the present study, idiopathic hypercalciuria is not a major contributing factor to recurrent UTI in children with VUR.