Background: A few studies have indicated inverse relationships between serum ghrelin and gastric ... more Background: A few studies have indicated inverse relationships between serum ghrelin and gastric and esophageal cancers but those associations have been restricted to specific populations, including smokers and overweight individuals. We examined the association between ghrelin and gastroesophageal cancers and atrophic gastritis in a population-based setting. Methods: In total 220 gastroesophageal cancers, comprising non-cardia and cardia gastric cancer, esophageal adenocarcinoma, esophageal squamous cell carcinoma (SCC) and age and gender-matched controls were recruited. Serum ghrelin, pepsinogen I/II ratio (PGI/II) and anti-H.pylori IgG antibodies were measured. Relationships between ghrelin and gastroesophageal cancers, after adjustment for PGI/II ratio, H.pylori status and smoking, were tested using logistic regression. Furthermore, in 125 endoscopically normal volunteers, with and without histological atrophic gastritis, the relationship with ghrelin was compared. Results: Seru...
BACKGROUND Nonalcoholic steatohepatitis is a common cause of chronic liver disease. It is importa... more BACKGROUND Nonalcoholic steatohepatitis is a common cause of chronic liver disease. It is important to have a uniform and validated method for scoring liver histology in these patients. Therefore, we propose a modification of the Brunt system by scoring the four histologic features separately and reporting their sums as the nonalcoholic steatohepatitis activity index. METHODS A nonalcoholic steatohepatitis activity index was defined which scored the grade of disease activity between 0 and 12 according to four histologic features: steatosis, hepatocyte ballooning, portal inflammation, and lobular inflammation. Fibrosis was separately scored between 0 and 4. A total of 60 liver specimens collected from nonalcoholic steatohepatitis patients were scored by two pathologists at the time of biopsy and after three months. Liver enzyme levels were also correlated with the histologic score. RESULTS The intra-rater agreement (weighted kappa) for various variables of the scoring system was betw...
Effective prevention and early diagnostic strategies are the most important public health interve... more Effective prevention and early diagnostic strategies are the most important public health interventions in gastric cancer, which remains a common malignancy worldwide. Preventive strategies require identification and understanding of environmental risk factors that lead to carcinogenesis. Helicobacter pylori (H. pylori) is the primary carcinogen as this ancient bacterium has a complex ability to interact with its human host. Smoking and salt are strong independent risk factors for gastric cancer whereas alcohol is only a risk when it is heavily consumed. Red meat and high fat increase the risk of gastric cancer however fresh fruits, vegetables (allium family) and certain micronutrients (selenium, vitamin C) reduce the risk, with evidence lacking for fish, coffee and tea. Foods that inhibit H. pylori viability, colonization and infection may reduce cancer risk. Obesity is increasingly recognized as a contributory factor in gastric cardia carcinogenesis. Therefore, modest daily physic...
Background– The main area of Iran affected by relapsing fever (RF) is Ardabil Province, for which... more Background– The main area of Iran affected by relapsing fever (RF) is Ardabil Province, for which Borrelia persica is the most common cause in this country. The aim of this study was to determine the epidemiologic characteristics of the disease, and the frequency of infection among ticks in this region. Method– This clinical epidemiology and entomology study was performed on a total of 391 patients diagnosed with tickborne relapsing fever between 1998 to 2001. The presence of Borrelia with any species as well as the clinical characteristics were observed. Borrelia was identified in blood smears of 1,421 ticks collected from 130 indoor and 14 outdoor sites. The ticks were crushed and the suspension obtained was injected into the peritoneum of two mice and two guinea pigs to determine the frequency of infection among the ticks living in this region. Data including the tick species determination were collected through a questionnaire and analyzed using Chi-square and ANOVA tests. Resul...
Despite all recent treatment advances and the worldwide decline in the incidence rate, gastric ca... more Despite all recent treatment advances and the worldwide decline in the incidence rate, gastric cancer (GC) remains an ongoing global health challenge and one of the major leading causes of cancer-specific deaths, particularly in high-incidence regions including Iran. Since GC is often diagnosed in advanced stages, the best action may be to enable early diagnosis of the disease or even prevent it in the first place through identification and control of the underlying risk factors. Endoscopy, as the gold standard method, is both expensive and invasive, making it an unfavorable device in this regard. Therefore, it is crucial to implement a reliable region-specific screening and surveillance program to identify high-risk individuals with more efficient screening modalities. Here, in addition to a review of current GC knowledge, we presented the data of newly-established Population-based Cancer Registries (PBCRs) in Iran. Our assessment confirmed earlier reports of a very high GC inciden...
1. The Authors state that they aimed at evaluating the usefulness of HA for discrimination of &qu... more 1. The Authors state that they aimed at evaluating the usefulness of HA for discrimination of "levels of fibrosis". On the basis of the typology of patients studied and of the obtained results, I would suggest that the aim should be "to evaluate the presence of extensive fibrosis in patients with chronic hepatitis B". 2. Methods. The Authors should report in the text that their pathologist was unable to differentiate fibrosis stage 5 and 6. 3. I would be glad to see a scattergram of the HA serum levels plotted against fibrosis scores. 4. Discussion, page 9, second paragraph (HA cut-offs): The Authors should add that the cut-off value for a given variable depends upon the sample in which it has been identified. In order to be reproducible, a cut-off value should be obtained in a sample representative of the population with the disease. 5. Discussion, page 9, third paragraph (HA predictive values): Fifty-four out of 65 patients had extensive fibrosis, and 54 out of...
2Now, the central role of H. pylori infection in the pathogenesis of gastric cancer, including bo... more 2Now, the central role of H. pylori infection in the pathogenesis of gastric cancer, including both the intestinal and diffuse histological subtypes, is not to be ignored. Although gastric cancer is the outcome of a multi-factorial pathway, the crucial role of an infectious agent involved in its pathogenesis makes it potentially preventable through eradication therapy that utilizes effective antibiotics. Successful clinical recovery from the peptic ulcer disease model following eradication of H. pylori has prompted researchers to investigate whether this would be applicable for the gastric can\�
ObjectivesExtra-articular manifestations (EAMs) are important systemic features of axial spondylo... more ObjectivesExtra-articular manifestations (EAMs) are important systemic features of axial spondyloarthritis (axSpA), which may influence the choice of tumour necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and predictors of EAMs and the influence of these on first TNFi choice in a ‘real-world’ cohort of patients with axSpA.MethodsClinical and patient-reported outcomes of 2420 patients with axSpA from 83 centres were collected by the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), inflammatory bowel diseases (IBD), psoriasis) were compared with those without EAMs. Also, the association between pretreatment EAMs and choice of first TNFi (adalimumab, etanercept, certolizumab) was analysed.ResultsAAU was directly associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 95% CI 0...
ObjectivesTo determine the frequency, severity and natural history of neutropaenia in early rheum... more ObjectivesTo determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management.MethodsThe Scottish Early Rheumatoid Arthritis inception cohort prospectively recruited patients with newly diagnosed RA and followed them up every 6 months. Patients with RA who developed at least one episode of neutropaenia (grade 1: <2.0×10^9/L; grade 2: <1.5×10^9/L; grade 3: <1.0×10^9/L; grade 4: <0.5×10^9/L) were compared with those who did not. Comparisons were also made between patients who experienced one or more episodes of neutropaenia and between patients with different neutropaenia grades.Results77 neutropaenia episodes were recorded in 58 of 771 (7.5%) patients with RA, who were followed up for a median (range) of 18 (6–48) months. Neutropaenia occurred at a median (range) of 12 (0–120) months after RA diagnosis. The majority had mild neutropaenia (g...
Background: A few studies have indicated inverse relationships between serum ghrelin and gastric ... more Background: A few studies have indicated inverse relationships between serum ghrelin and gastric and esophageal cancers but those associations have been restricted to specific populations, including smokers and overweight individuals. We examined the association between ghrelin and gastroesophageal cancers and atrophic gastritis in a population-based setting. Methods: In total 220 gastroesophageal cancers, comprising non-cardia and cardia gastric cancer, esophageal adenocarcinoma, esophageal squamous cell carcinoma (SCC) and age and gender-matched controls were recruited. Serum ghrelin, pepsinogen I/II ratio (PGI/II) and anti-H.pylori IgG antibodies were measured. Relationships between ghrelin and gastroesophageal cancers, after adjustment for PGI/II ratio, H.pylori status and smoking, were tested using logistic regression. Furthermore, in 125 endoscopically normal volunteers, with and without histological atrophic gastritis, the relationship with ghrelin was compared. Results: Seru...
BACKGROUND Nonalcoholic steatohepatitis is a common cause of chronic liver disease. It is importa... more BACKGROUND Nonalcoholic steatohepatitis is a common cause of chronic liver disease. It is important to have a uniform and validated method for scoring liver histology in these patients. Therefore, we propose a modification of the Brunt system by scoring the four histologic features separately and reporting their sums as the nonalcoholic steatohepatitis activity index. METHODS A nonalcoholic steatohepatitis activity index was defined which scored the grade of disease activity between 0 and 12 according to four histologic features: steatosis, hepatocyte ballooning, portal inflammation, and lobular inflammation. Fibrosis was separately scored between 0 and 4. A total of 60 liver specimens collected from nonalcoholic steatohepatitis patients were scored by two pathologists at the time of biopsy and after three months. Liver enzyme levels were also correlated with the histologic score. RESULTS The intra-rater agreement (weighted kappa) for various variables of the scoring system was betw...
Effective prevention and early diagnostic strategies are the most important public health interve... more Effective prevention and early diagnostic strategies are the most important public health interventions in gastric cancer, which remains a common malignancy worldwide. Preventive strategies require identification and understanding of environmental risk factors that lead to carcinogenesis. Helicobacter pylori (H. pylori) is the primary carcinogen as this ancient bacterium has a complex ability to interact with its human host. Smoking and salt are strong independent risk factors for gastric cancer whereas alcohol is only a risk when it is heavily consumed. Red meat and high fat increase the risk of gastric cancer however fresh fruits, vegetables (allium family) and certain micronutrients (selenium, vitamin C) reduce the risk, with evidence lacking for fish, coffee and tea. Foods that inhibit H. pylori viability, colonization and infection may reduce cancer risk. Obesity is increasingly recognized as a contributory factor in gastric cardia carcinogenesis. Therefore, modest daily physic...
Background– The main area of Iran affected by relapsing fever (RF) is Ardabil Province, for which... more Background– The main area of Iran affected by relapsing fever (RF) is Ardabil Province, for which Borrelia persica is the most common cause in this country. The aim of this study was to determine the epidemiologic characteristics of the disease, and the frequency of infection among ticks in this region. Method– This clinical epidemiology and entomology study was performed on a total of 391 patients diagnosed with tickborne relapsing fever between 1998 to 2001. The presence of Borrelia with any species as well as the clinical characteristics were observed. Borrelia was identified in blood smears of 1,421 ticks collected from 130 indoor and 14 outdoor sites. The ticks were crushed and the suspension obtained was injected into the peritoneum of two mice and two guinea pigs to determine the frequency of infection among the ticks living in this region. Data including the tick species determination were collected through a questionnaire and analyzed using Chi-square and ANOVA tests. Resul...
Despite all recent treatment advances and the worldwide decline in the incidence rate, gastric ca... more Despite all recent treatment advances and the worldwide decline in the incidence rate, gastric cancer (GC) remains an ongoing global health challenge and one of the major leading causes of cancer-specific deaths, particularly in high-incidence regions including Iran. Since GC is often diagnosed in advanced stages, the best action may be to enable early diagnosis of the disease or even prevent it in the first place through identification and control of the underlying risk factors. Endoscopy, as the gold standard method, is both expensive and invasive, making it an unfavorable device in this regard. Therefore, it is crucial to implement a reliable region-specific screening and surveillance program to identify high-risk individuals with more efficient screening modalities. Here, in addition to a review of current GC knowledge, we presented the data of newly-established Population-based Cancer Registries (PBCRs) in Iran. Our assessment confirmed earlier reports of a very high GC inciden...
1. The Authors state that they aimed at evaluating the usefulness of HA for discrimination of &qu... more 1. The Authors state that they aimed at evaluating the usefulness of HA for discrimination of "levels of fibrosis". On the basis of the typology of patients studied and of the obtained results, I would suggest that the aim should be "to evaluate the presence of extensive fibrosis in patients with chronic hepatitis B". 2. Methods. The Authors should report in the text that their pathologist was unable to differentiate fibrosis stage 5 and 6. 3. I would be glad to see a scattergram of the HA serum levels plotted against fibrosis scores. 4. Discussion, page 9, second paragraph (HA cut-offs): The Authors should add that the cut-off value for a given variable depends upon the sample in which it has been identified. In order to be reproducible, a cut-off value should be obtained in a sample representative of the population with the disease. 5. Discussion, page 9, third paragraph (HA predictive values): Fifty-four out of 65 patients had extensive fibrosis, and 54 out of...
2Now, the central role of H. pylori infection in the pathogenesis of gastric cancer, including bo... more 2Now, the central role of H. pylori infection in the pathogenesis of gastric cancer, including both the intestinal and diffuse histological subtypes, is not to be ignored. Although gastric cancer is the outcome of a multi-factorial pathway, the crucial role of an infectious agent involved in its pathogenesis makes it potentially preventable through eradication therapy that utilizes effective antibiotics. Successful clinical recovery from the peptic ulcer disease model following eradication of H. pylori has prompted researchers to investigate whether this would be applicable for the gastric can\�
ObjectivesExtra-articular manifestations (EAMs) are important systemic features of axial spondylo... more ObjectivesExtra-articular manifestations (EAMs) are important systemic features of axial spondyloarthritis (axSpA), which may influence the choice of tumour necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and predictors of EAMs and the influence of these on first TNFi choice in a ‘real-world’ cohort of patients with axSpA.MethodsClinical and patient-reported outcomes of 2420 patients with axSpA from 83 centres were collected by the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), inflammatory bowel diseases (IBD), psoriasis) were compared with those without EAMs. Also, the association between pretreatment EAMs and choice of first TNFi (adalimumab, etanercept, certolizumab) was analysed.ResultsAAU was directly associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 95% CI 0...
ObjectivesTo determine the frequency, severity and natural history of neutropaenia in early rheum... more ObjectivesTo determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management.MethodsThe Scottish Early Rheumatoid Arthritis inception cohort prospectively recruited patients with newly diagnosed RA and followed them up every 6 months. Patients with RA who developed at least one episode of neutropaenia (grade 1: <2.0×10^9/L; grade 2: <1.5×10^9/L; grade 3: <1.0×10^9/L; grade 4: <0.5×10^9/L) were compared with those who did not. Comparisons were also made between patients who experienced one or more episodes of neutropaenia and between patients with different neutropaenia grades.Results77 neutropaenia episodes were recorded in 58 of 771 (7.5%) patients with RA, who were followed up for a median (range) of 18 (6–48) months. Neutropaenia occurred at a median (range) of 12 (0–120) months after RA diagnosis. The majority had mild neutropaenia (g...
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Papers by Mohammad Derakhshan