Afshin Shafaghi

Guilan University of Medical Sciences, Rasht, Ostan-e Gilan, Iran

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Publications (15)15.14 Total impact

  • Indian Journal of Rheumatology 01/2014;
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    ABSTRACT: Portal hypertension is a common consequence of hepatic cirrhosis, which causes esophageal varices. Bleeding from varices has a high mortality rate. The present gold standard for diagnosing varices is endoscopy. Considering endoscopy side effects and patients' low acceptance, there have been always efforts for finding alternative diagnostic methods including Doppler ultrasonography (US). The aim of the present study was to evaluate changes of Doppler indices in cirrhotic patients with and without esophageal varices. Sixty six patients with known cirrhosis entered this cross-sectional study. Gastroscopy was performed for patients, and the first questionnaire was filled based on the Japanese Portal Hypertension Society guidelines. Then patients were referred for Doppler US of splenoportal system, and information was documented in the second questionnaire. Forty-four patients were male and 22 female. Forty six patients had esophageal varices, and 20 did not. There were no significant associations between splenoportal indices found by Doppler US, and presence of esophageal varices in patients. However, we found a negative association between platelet ratio to spleen diameter, and to splenic vein diameter. Neither of studied variables was perfect to differentiate cirrhotic patients with and without EVs. Endoscopy is still the gold standard diagnostic method for diagnosing esophageal varices in patients with cirrhosis. It seems that some of the splenoportal Doppler indices are promising, but more research and evaluation is necessary.
    Hepatitis Monthly 01/2014; 14(1):e11237. · 1.25 Impact Factor
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    ABSTRACT: Background: Iran is a country with very high incidences of stomach cancer, especially in Northern parts. Here we assessed prognostic value of serum screening biomarkers among people >50 years old for early detection of precancerous lesions in a hot spot for gastric carcinoma in Guilan Province, North Iran. Methods: A cross- sectional population-based survey was conducted on 1,390 residents of Lashtenasha city with the mean age (SD) of 61.8 (9.02) years old (50.8% females) to assess the association of gastrin and the pepsinogen (PG) I/II ratio with premalignant gastric lesions. Blood samples were taken for CBC, blood group, and serologic exams (PGI, PGII, and gastrin 17) from each subject. Expert gastroenterologists performed upper GI endoscopy and ROC curves were generated to determine appropriate cutoff points. Results: Mean values of PGI, PGII, PGI/PGII and gastrin were significantly different between patients with and without atrophy or metaplasia (P<0.05). To diagnose atrophy and intestinal metaplasia, a significantly higher AUC was observed for the PGI/PGII ratio (70 and 72%, respectively) compared to the PGI (56, 55%), PGII (63, 64%) and gastrin (59, 61%) (all p<0.001). Conclusions: Biomarker tests such as the PGI/II ratio can be used in the screening and diagnosis of subjects at high gastric cancer risk in our region.
    Asian Pacific journal of cancer prevention: APJCP 01/2013; 14(6):3931-6. · 1.50 Impact Factor
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    ABSTRACT: Background. In this study, we evaluated the association between diastolic dysfunction severity and severity of cirrhosis in nonalcoholic cirrhotic patients. Methods. This cross-sectional study was conducted on all nonalcoholic cirrhotic patients who were admitted in Rasht Razi hospital the Cancer of Guilan Province, north of Iran, from January 2011 to March 2012. Severity of cirrhosis was evaluated by Child-Pugh score. A 12-lead surface ECG and echocardiographic studies were performed. We used a HDI 3000 (Philips ATL, Bothell, WA, USA) equipped with 2 to 4 MHz probes. Diastolic function was determined by an expert cardiac sonographer. Data were analyzed by SPSS for win (version16). A P value less than 0.05 was considered significant. Results. Sixty-tree percent of patients were male. The mean age of patients was 52.78 ± 15.2 years. 22%, 38%, and 40% of patients were considered as child class A, B, and C, respectively. There was a significant relation between diastolic dysfunction and disease duration (P = 0.001), female gender (P = 0.004), age > 60 years (P = 0.045), and severity of cirrhosis (P = 0.048). On multivariate analysis, decreased E/A ratio (P = 0.03) and disease duration (P = 0.02) showed an independent significant relation. Conclusion. According to the relation between severity of cirrhosis and diastolic dysfunction, we recommend cardiac assessment in all child B and C cirrhotic patients.
    International journal of hepatology. 01/2013; 2013:892876.
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    ABSTRACT: Adenosquamous carcinoma of the colon consisting of both glandular and squamous histopathologic features is a rare colorectal neoplasm. Metastasis commonly occurs in right and transverse colon. A 71-year-old Caucasian man presented with a four-month history of intermittent rectal bleeding. Pathologic analysis of biopsy specimen revealed an adenosquamous carcinoma of sigmoid colon. Sigmoid resection with a proximal and distal resection was performed. Early detection and radical operation with other available therapeutic modalities may improve clinical outcome.
    International journal of clinical and experimental medicine 01/2013; 6(5):390-2.
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    ABSTRACT: Here we report a rare case of living Fasciola hepatica in biliary tract. The patient was in acute phase of infection and treated successfully with 10 mg/kg oral triclabendazole after the fluke was extracted using endoscopic retrograde cholangiopancreatography (ERCP).
    Annals of hepatology: official journal of the Mexican Association of Hepatology 05/2012; 11(3):395-8. · 1.67 Impact Factor
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    ABSTRACT: Strongyloidiasis, a common intestinal parasitic infection, is endemic in tropical and subtropical regions and occurs sporadically in temperate areas. It is endemic in Guilan province, Iran, and especially affects the rural population. We report the case of a 43-year-old woman living in Anzali (in the north of Iran), with dyspepsia and epigastric pain for 2 years, unresponsive to H2 receptor antagonists and proton pump inhibitors. Upper gastrointestinal endoscopy was done and showed multiple small nodules at the stomach. The pathologist reported Strongyloides. Treatment with Ivermectin and antibiotic triple therapy was done. She responded well to treatment and 6 months later an upper gastrointestinal endoscopy revealed no significant lesions and all nodules had disappeared. Strongyloidiasis is usually not severe and frequently is nonspecific. For this reason, the infection is easily ignored by both the patients and physicians. Although gastric involvement shows nonspecific symptoms, the possibility should be carefully considered by clinicians who practice in endemic areas.
    The American journal of case reports. 01/2012; 13:7-10.
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    ABSTRACT: BACKGROUND AND OBJECTIVES : Gastric cancer is a leading cause of cancer-related deaths in both sexes in Iran. This study was designed to assess upper GI endoscopic findings among people>50 years targeted in a mass screening program in a hot-point region. Based on the pilot results in Guilan Cancer Registry study(GCRS), one of the high point regions for GC - Lashtenesha - was selected. The target population was called mainly using two methods: in rural regions, by house-house direct referral and in urban areas using public media. Upper GI endoscopy was performed by trained endoscopists. All participants underwent biopsies for rapid urea test (RUT) from the antrum and also further biopsies from five defined points of stomach for detection of precancerous lesions. In cases of visible gross lesions, more diagnostic biopsies were taken and submitted for histopathologic evaluation. Of 1,394 initial participants, finally 1,382 persons (702 women, 680 men) with a mean age of 61.7 ± 9.0 years (range:50-87 years) underwent upper GI endoscopy. H.pylori infection based on the RUT was positive in 66.6%. Gastric adenocarcinoma and squamous cell carcinoma of esophagus were detected in seven (0.5%) and one(0.07%) persons, respectively. A remarkable proportion of studied participants were found to have esophageal hiatal hernia(38.4%). Asymptomatic gastric masses found in 1.1% (15) of cases which were mostly located in antrum (33.3%), cardia (20.0%) and prepyloric area (20.0%). Gastric and duodenal ulcers were found in 5.9% (82) and 6.9% (96) of the screened population. Upper endoscopy screening is an effective technique for early detection of GC especially in high risk populations. Further studies are required to evaluate cost effectiveness, cost benefit and mortality and morbidity of this method among high and moderate risk population before recommending this method for GC surveillance program at the national level.
    Asian Pacific journal of cancer prevention: APJCP 01/2012; 13(4):1407-12. · 1.50 Impact Factor
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    ABSTRACT: Furazolidone has been introduced as an effective drug against Helicobacter pylori infection in Iran, but intolerable side effects may limit its use. The aim of this study was to compare quadruple and triple furazolidone-based regimens to achieve an economically affordable regimen with acceptable success rate and fewer side effects. Patients with Helicobacter pylori positive peptic ulcer disease were randomly allocated into two groups: amoxicillin 1 g b.i.d., furazolidone 200 mg b.i.d. and omeprazole 20 mg b.i.d. with or without bismuth subcitrate 240 mg b.i.d. for two weeks (amoxicillin, furazolidone, omeprazole, bismuth and amoxicillin, furazolidone, omeprazole regimens, respectively). Helicobacter pylori eradication was confirmed by 13C-urea breath test 12 weeks after the end of therapy. Eighty-six patients were enrolled, but 16 patients discontinued their therapy or follow-up. The eradication rates with amoxicillin, furazolidone, omeprazole, bismuth and amoxicillin, furazolidone, omeprazole were 85.3% and 61.1% by per-protocol analysis, respectively (p=0.02) and 67.4% and 51.2% by intention-to-treat analysis, respectively (p<0.05). The most frequent adverse effects in the two study groups were weakness, nausea, anorexia, and dizziness, and no significant differences between the groups were shown. Based on the results in this study, furazolidone-based triple therapy (without bismuth) is not recommended for Helicobacter pylori eradication because of the lower eradication rate and unchanged frequency of adverse effects. Thus, we recommend furazolidone, amoxicillin and omeprazole in combination with bismuth for treatment of Helicobacter pylori.
    The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 02/2011; 22(1):1-5. · 0.48 Impact Factor
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    ABSTRACT: Background: Propofol is used as a sedative drug during colonoscopy. In this study we analyzed the adverse effects of propofol (i.e., hemodynamic and respiratory) on patients who underwent colonoscopies. Methods: This study was performed in Qom Province, Iran. In this study, 125 patients (63 females, 62 males) were enrolled. Study patients were administered (0.5-1.5 mg/kg) intravenous propofol by an anesthesiologist. Oxygen saturation and blood pressure were recorded at three minute intervals. We used the American Society of Anesthesiology (ASA) classification to stratify patients by risk prior to the procedure. For statistical analysis, the chi-square and paired t-tests were used. A p-value less than 0.05 was considered significant. Resultsts: Patients’ mean age was 45.36 ± 16.19 years. ASA-I comprised 25.6% of study patients and 74.4% were categorized as ASA-II. Hypopnea occurred in 56.8% of patients and was prolonged in 32.4%. Of the study patients, 5.6% developed hypoxemia which was successfully controlled by the administration of nasal oxygen and no need for mechanical ventilation. The mean arterial blood pressure (p < 0.0001), oxygen saturation (p < 0.0001) and heart rate (p < 0.0001) significantly decreased during colonoscopy. The occurrence of hypopnea significantly increased in patients with pre-procedure oxygen saturation levels ≤ 95% (p < 0.02), age ≥50 years (p < 0.0001) and ASA class II (p < 0.0001) Agitation, hypotension and cough were seen in 1.6%, 1.6% and 0.8% of patients, respectively. Conclusion: Propofol has a short half life that enables faster recovery of normal neurologic and social functions we recommend the use of propofol under supervision of anesthesiologist or a trained gastroenterologist. Keywords: Propofol; Conscious sedation; Colonoscopy; Adverse effect
    Middle East Journal of Digestive Diseases. 01/2011; 3:74-78.
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    ABSTRACT: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran). Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled in the study. Serum and ascitic fluid albumin levels were determined by biochemical reactions. The serum-ascitic albumin gradient (SAAG) less than 1.1 g/dL was considered low. Statistical analysis was performed with SPSS 9.0 software and P<0.05 was considered statistically significant. Of the 148 patients enrolled in the study, 72 (48.6%) were males and 76 (51.4%) were females with a mean age of 59.03+/-13.54 years. Tuberculous peritonitis was the most frequent cause of low gradient ascites in 68 (45.9%). Other most frequent causes were cancer in 62 (41.9%), nephrotic syndrome in 9 (6%), pancreatitis in 6 (4%). Peritoneal cancer was found in 22 (35%), ovarian and gastric cancers were found in 14 (22.5%) and 12 (19.3%), respectively. All of which were the causes of ascites. The mean SAAG was 0.68+/-0.19 g/dL. The mean serum and ascitic fluid albumin concentrations were higher in tuberculous patients (P<0.006), but lactate dehydrogenase (LDH) level was higher in cancer patients (P<0.0001). In peritoneal tuberculosis, mean ascitic glucose concentration was significantly lower than other patients (P<0.0001). Tuberculosis should be considered in all patients with low gradient ascites especially in developing countries (like Iran), as the first cause of ascites. In the approach to patients with low gradient ascites, ascitic fluid glucose, and LDH level are useful indicators for decision making.
    World Journal of Gastroenterology 04/2005; 11(15):2337-9. · 2.55 Impact Factor
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    ABSTRACT: The aim of this study was to determine the effect of metronidazole in patients who did not cure after treatment with triclabendazole, in Guilan (Northern Province of Iran). Patients, who passed fasciola egg in stool and had positive serum anti fasciola antibody (ELISA), at least three months after treatment with triclabendazole, were enrolled and received 1.5 g/day metronidazole orally for three weeks. Two months and 12 months after end of therapy, stool examination in 3 consecutive days and serum anti fasciola antibody were performed. Frequency of patients with negative serology for fasciola and/or absence of fasciola egg in stool were determined. Chi-square test was used and P value <0.05 was considered significant. Forty-six patients, 26 females and 20 males, were enrolled with mean (+/-SD) age of 34.6(+/-9.8) years. Three patients excluded because of drug side effect and poor compliance. Two months after end of therapy, stool exam became negative in 35 patients and in 31 patients became negative both in serology and stool examination. (Difference in response to treat between age groups and genders was not significant). All patients with abdominal pain became pain free after therapy. Most frequent side effects were metallic taste in 14 (30.4%), headache in 8 (17.4%) and nausea in 6 (13%). 12 months after end of therapy, 28 out of 35 patients were examined again and all were negative both in serology and egg in stool examination. Metronidazole, 1.5 g/day for 3 weeks, seems to be an effective, available, well-tolerated alternative for treatment of human fascioliasis.
    Medical science monitor: international medical journal of experimental and clinical research 10/2003; 9(10):PI127-30. · 1.22 Impact Factor
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    ABSTRACT: To compare the efficacy of antibiotics therapy alone with antibiotics and saccharomyces boulardii in treatment of acute amebiasis. In a double blind, random clinical trial on patients with acute intestinal amoebiasis, 57 adult patients with acute amoebiasis, diagnosed with clinical manifestations (acute mucous bloody diarrhea) and amebic trophozoites engulfing RBCs found in stool were enrolled in the study. Regimen 1 included metronidazole (750 mg Tid) and iodoquinol (630 mg Tid) for 10 days. Regimen 2 contained capsules of lyophilized saccharomyces boulardii (250 mg Tid) orally in addition to regimen 1. Patients were re-examined at two and four weeks after the treatment, and stool examination was performed at the end of week 4. Student's t-test, chi(2) and McNemar's tests were used for statistical analysis. Three patients refused to participate. The other 54 patients were randomized to receive either regimen 1 or regimen 2 (Groups 1 and 2 respectively, each with 27 patients). The two groups were similar regarding their age, sex and clinical manifestations. In Group 1, diarrhea lasted 48.0+/-18.5 hours and in Group 2, 12.0+/-3.7 hours (P<0.0001). In Group 1, the durations of fever and abdominal pain were 24.0+/-8.8 and 24.0+/-7.3 hours and in Group 2 they were 12.0+/-5.3 and 12.0+/-3.2 hours, respectively (P<0.001). Duration of headache was similar in both groups. At week 4, amebic cysts were detected in 5 cases (18.5 %) of Group 1 but in none of the Group 2 (P<0.02). Adding saccharomyces boulardii to antibiotics in the treatment of acute amebiasis seems to decrease the duration of clinical symptoms and cyst passage.
    World Journal of Gastroenterology 08/2003; 9(8):1832-3. · 2.55 Impact Factor
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    ABSTRACT: The aim of this study was to determine the seroprevalence of hepatitis B and C viruses and abnormal liver function tests among hemophiliacs in Guilan province, Iran. Patients registered with Guilan Hemophilia Society (GHS) were enrolled in this study, and evaluated for the presence of hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (HCV-Ab) and liver function tests. One hundred and one patients (100 males, 1 female, mean age 19.7 years, range 3-71 years) from 110 registered hemophiliacs were enrolled in this study. 29 patients (28.7%) had elevated Alanine aminotransferase (ALT), 27 (26.7%) and 72 (71.3%) were positive for HBsAg and HCV-Ab, respectively. Seropositivity for HCV-Ab correlated with the duration of treatment with clotting factor until 1997 (P=0.01). There was also an inverse correlation between factor VIII & IX activity and seropositivity for HCV-Ab (P<0.001) and HBsAg (P<0.04). HCV-Ab was more likely to be positive among those received lyophilized factor VIII and cryoprecipitate than lyophilized factor VIII alone (P<0.01). In addition HCV-Ab seropositivity was more common among those received factor IX concentrate and fresh frozen plasma (FFP) than those received only FFP (P<0.01). Based upon our finding, prevalence of HBsAg positive cases in Guilan province was higher than other studies. Although frequency of HCV-Ab was similar to other studies, frequency of increased ALT was less. Upon the results emerged from this study, we recommend that all hemophiliacs should be vaccinated against HBV and should have regular program for checking HCV.
    Medical science monitor: international medical journal of experimental and clinical research 12/2002; 8(12):CR797-800. · 1.22 Impact Factor
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    ABSTRACT: The object of the study was to study the efficacy and safety of furazolidone and tetracycline compared to metronidazole and amoxicillin in an omeprazole based triple therapy in a prospective randomized-blind-clinical trial. Patients with endoscopically verified active duodenal ulcer disease in the presence of Helicobacter pylori infection were eligible to enter the study. Endoscopy was performed a day before and 6-8 weeks after the cessation of treatment. H. pylori status was assessed by histologic examination (Giemsa stain) of biopsy specimens were taken from the antrum and corpus. H. pylori eradication was defined as absence in histology of the biopsy specimens at the second endoscopy. Ulcer healing was considered as decrease in ulcer size to less than 20% of its primary size. Patients were randomly assigned to receive omeprazole 20 mg, amoxicillin 1000 mg and metronidazole 500 mg (OAM group) or omeprazole 20 mg, tetracycline 500 mg and furazolidone 200 mg (OTF group). All medications were taken twice daily, for 2 weeks. Out of 111 patients enrolled in the study, 108 completed a course of treatment and underwent a follow-up endoscopy, with 54 patients in each group. H. pylori eradication was achieved in 52 patients (96.3% - 95% CI: 91.27-100) in OTF group and 45 patients (83.3% - 95% CI: 73.35-93.25) in OAM group (P=0.015). Our study showed the superiority of OTF vs. OAM regimen with a 13% increment in eradication rate, with only occasional severe side effect. In conclusion OTF regimen is a safe, cheaper and effective alternative for OTF regimen and we recommend it to be used especially in developing countries.
    Medical science monitor: international medical journal of experimental and clinical research 04/2002; 8(3):PI27-30. · 1.22 Impact Factor