Sima Besharat

Golestan University of Medical Sciences, Asterābād, Golestān, Iran

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Publications (65)97.68 Total impact

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    ABSTRACT: Background: It has been reported that 15-20% of parous female have experienced at least one miscarriage, while 3% of them have experienced two miscarriages. The goal of this study was to evaluate the plasma level of coagulation factors in women with a history of spontaneous abortions. Materials and methods: In this case-control study, 82 women with a history of two or more abortions referred to the six private gynecologic clinics in Gorgan city without any structural abnormality were recruited during 2011-2012. Plasma levels of antithrombin III (ATIII) using colorimetric assay, protein C, protein S, factor V Leiden and lupus anticoagulant (LAC) using coagulation method were measured. The control group was women with a history of normal delivery and no abortions. Those under anti-coagulant therapy were excluded from the study. Data were entered into the computer using the Statistical Package for the Social Sciences (SPSS, SPSS Inc., Chicago, IL, USA) version 16 and analyzed by Chi-square, t test and non-parametric tests. Results: At least one abnormality was reported in 35 cases (42.7%). Among them, protein C deficiency was the most prevalent (30.5%). ATIII was abnormal in 17.1% and lupus anti-coagulant was abnormal in 8.5%. Factor V Leiden was normal in all cases and protein S deficiency was only seen in one case. Conclusion: We suggest to perform these tests in regards to the thrombophilia in cases with spontaneous abortions in order to find an early cure for this treatable disorder.
    Preview · Article · Dec 2015 · International journal of fertility & sterility
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    ABSTRACT: Chronic infection with the hepatitis B virus and obesity may both contribute synergistically to liver disease, although relatively few studies have investigated this hypothesis. Therefore, in this study, we evaluated the relationship between central obesity and the liver stiffness in the Golestan Hepatitis B cohort study (GHBCS). Our study included 304 chronic hepatitis B (CHB) patients enrolled from GHBCS. Liver stiffness measurement (LSM) and laboratory tests were performed after a follow-up of 4 years (2012). The hepatitis B viral load was measured at the baseline and follow-up using the real-time PCR method. Waist circumference ≥ 102 cm in men and ≥ 89 cm in women (central obesity) was considered to be abnormal. Advanced liver stiffness (ALS) was defined as LSM ≥ 8 KPa. Statistical analysis was performed using SPSS-V17. Logistic regression was used to test predictors of advanced liver stiffness (LSM ≥ 8 KPa). Linear regression was used to test the predictive value of variables in ALT (as a continuous variable). P-value of less than 0.05 was considered statistically significant. Among these CHB patients, 19 (7.4%) cases with a mean (±SD) age of 49.5 (±6.3) developed ALS after 4 years of follow-up. Multivariate analysis showed a significant predictive role of central obesity and viral load in ALS. Central obesity is related to the liver stiffness in chronic hepatitis B patients.
    Full-text · Article · Sep 2015
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    ABSTRACT: Hepatitis B virus (HBV) infection is a major global health problem. Chronically infected people are at risk for progressive hepatic fibrosis and consequent cirrhosis. Hepatitis B surface antigen (HBsAg) level in serum is a complementary marker for intrahepatic HBV DNA and covalently closed circular DNA (cccDNA). Sortilin-1 (SORT1) has been reported to be involved in the post-Golgi vesicle trafficking of Apo lipoproteins degradation pathways. This study was designed to evaluate the hepatic and serum expression of HBsAg and its association with hepatic SORT1 gene expression in patients with chronic HBV. Thirty chronic hepatitis B patients with histological examination results were enrolled in this study. Liver biopsies were analyzed for hepatic HBsAg and SORT1 gene expression by immunohistochemistry and quantitative real time PCR (qRT-PCR), respectively. Twenty seven out of 30 (90%) liver biopsies had positive staining for HBsAg and showed a significant inverse association with hepatic SORT1 fold change gene expression (β = -0.5, P = 0.042). There was significant association between HBV DNA levels and HBsAg expression in hepatocyte or serum titer of HBsAg (r = 0.39, P = 0.029; r = 0.39, P = 0.032 respectively). Serum ALT was also correlated with hepatic activity index (HAI) score (β = 0.6, P = 0.001). Inverse association between hepatic SORT1 gene expression and hepatic HBsAg expression indicates the possible role of sortilin in HBsAg particle formation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Medical Virology
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    ABSTRACT: Although certain HBV mutations are known to affect the expression of Hepatitis e antigen, their association with HBV viral level or clinical outcomes is less clear. We evaluated associations between different mutations in the Basal Core promoter (BCP) and Pre-core (PC) regions of HBV genome and subsequent changes in HBV viral DNA level over seven years in a population of untreated HBeAg negative chronic hepatitis B (CHB) participants in Northeast of Iran. Participants in the current study were drawn from the Golestan Hepatitis B Cohort Study (GHBCS), a cohort of approximately 2590 HBsAg positive subjects (living in Gonbad city) embedded in the Golestan Cohort Study (GCS). At baseline, HBsAg was measured in all participants and revealed 2590 HBsAg positive cases. We randomly selected 304 participants who their blood sample were taken at both baseline and seven years later in follow-up and had not been treated for HBV during this time. HBV viral load were assessed at baseline and at year 7. The BCP and PC regions of the HBV DNA, at baseline, were amplified via hemi-nested PCR and sequenced by cycle sequencing. At year 7, liver stiffness was assessed by fibroscan; also, other parameters of liver disease were assessed following standard clinical protocols. Associations were assessed via tabulation, chi-square, t-tests and logistic regression. P values < 0.05 were considered statistically significant and all tests were two-sided. Among 304 HBsAg positive participants, 99 had detectable HBV DNA at study baseline. Of these, 61.6% had PC mutations (48.5% A1896 and 25.2% G1899). In contrast to other mutations, A1896 was associated with a higher proportion of detectable HBV DNA at year 7 (39.6%) compared to patients with the wild type (13.7%) (OR: 4.36, CI95% = 1.63-11.70; P Value = 0.002). Although participants with the A1896 mutation had higher year-7 HBV viral load than participants with G1896 (2.30 ± 1.66 IU/mL vs. 1.76 ± 1 IU/mL among patients with detectable HBV; P value = 0.052), no association was observed with either serum level ALT or liver stiffness. Interestingly, mutations in the basal core promoter (BCP) region had no significant effect on virus DNA detection. In this population with chronic HBeAg negative hepatitis B, an association was observed between the G1896A mutation in the Pre-core region of HBV and subsequent level of HBV DNA seven years later, which indicated that mutations in this region of HBV genome may contribute to disease progression in these patients and play an important role in HBV natural course of disease.
    Full-text · Article · Mar 2015 · Hepatitis Monthly

  • No preview · Article · Mar 2015 · Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
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    ABSTRACT: BACKGROUND Different clinical and epidemiological studies using dual-energy X-ray absorptiometry have shown an increased prevalence of low bone mineral density in patients with inflammatory bowel diseases. The aim of this study was to assess the correlation between bone density and the disease activity in patients with ulcerative colitis. METHODS In this cross-sectional study, 52 patients with ulcerative colitis (duration of the disease less than 5 years) were invited to our research center, Golestan province, northeast of Iran, during February 2012 up to August 2012. A demographic checklist and Simple Clinical Colitis Activity Index was completed for each patients and 5 cc of blood sample was taken after obtaining the informed consent. We used colorimetry method for measuring serum calcium, UV method for serum phosphorus and ELISA for serum vitamin D. Dual-energy X-ray absorptiometry was done to evaluate the bone density. Data analysis was done using SPSS software version 16. Normality of data was assessed using Kolmogorov- Smirnov test. T and ANOVA tests were used if data had normal distribution. Mann-Whitney U or Kruskal-Wallis tests were used for the remaining data. Correlation between qualitative variables was evaluated by Chi-square test. RESULTS The mean (±SD) age and disease activity of the patients were 37.72 (±12.18) years and 4.78 (±1.98), respectively. There were no correlation between disease activity and mean age. Low bone density was seen in 30.8%, 11.5%, and 15.4% in spine, femur neck, and hip, respectively. There was no relationship between Z-score of total hip, spine, and femur neck with disease activity, age, and duration of disease (p>0.05). CONCLUSION Our results showed an acceptable rate of low bone density in patients with ulcerative colitis without any correlation with the disease activity index.
    Full-text · Article · Jan 2015 · Middle East journal of digestive diseases
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    ABSTRACT: BACKGROUND Different clinical and epidemiological studies using dual-energy X-ray absorptiometry have shown an increased prevalence of low bone mineral density in patients with inflammatory bowel diseases. The aim of this study was to assess the correlation between bone density and the disease activity in patients with ulcerative colitis. METHODS In this cross-sectional study, 52 patients with ulcerative colitis (duration of the disease less than 5 years) were invited to our research center, Golestan province, northeast of Iran, during February 2012 up to August 2012. A demographic checklist and Simple Clinical Colitis Activity Index was completed for each patients and 5 cc of blood sample was taken after obtaining the informed consent. We used colorimetry method for measuring serum calcium, UV method for serum phosphorus and ELISA for serum vitamin D. Dual-energy X-ray absorptiometry was done to evaluate the bone density. Data analysis was done using SPSS software version 16. Normality of data was assessed using Kolmogorov– Smirnov test. T and ANOVA tests were used if data had normal distribution. Mann-Whitney U or Kruskal-Wallis tests were used for the remaining data. Correlation between qualitative variables was evaluated by Chi-square test. RESULTS The mean (±SD) age and disease activity of the patients were 37.72 (±12.18) years and 4.78 (±1.98), respectively. There were no correlation between disease activity and mean age. Low bone density was seen in 30.8%, 11.5%, and 15.4% in spine, femur neck, and hip, respectively. There was no relationship between Z-score of total hip, spine, and femur neck with disease activity, age, and duration of disease (p>0.05). CONCLUSION Our results showed an acceptable rate of low bone density in patients with ulcerative colitis without any correlation with the disease activity index.
    Full-text · Article · Dec 2014 · Middle East journal of digestive diseases
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    ABSTRACT: Hepatitis B virus (HBV) infection is the most common cause of end stage liver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand the natural course of HBV infection. To date, several studies of HBV epidemiology, natural history, progression to cirrhosis and as-sociation with HCC have been reported from other countries. However, few of these are prospective and fewer still are population-based. Moreover, the underlying molecular mechanisms and immunogenetic determinants of the outcome of HBV infection especially in low and middle income countries re-mains largely unknown. Therefore, the hepatitis B cohort study (HBCS), nest-ed as part of the Golestan Cohort Study (GCS), Golestan, Iran was established in 2008 with the objective to prospectively investigate the natural course of chronic hepatitis B with reference to its epidemiology, viral/host genetic in-teractions, clinical features and outcome in the Middle East where genotype D HBV accounts for >90% of infections. In 2008, a baseline measurement of HBV surface antigen (HBsAg) was performed on stored serum samples of all GCS participants. A sub-cohort of 3,505 individuals were found to be HBsAg positive and were enrolled in the Golestan HBCS. In 2011, all first degree rela-tives of HBsAg positive subjects including their children and spouses were invited for HBV serology screening and those who were positive for HBsAg were also included in the Golestan HBCS.
    Full-text · Article · Oct 2014
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    ABSTRACT: Hepatitis B virus (HBV) infection is the most common cause of end stage liver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand the natural course of HBV infection. To date, several studies of HBV epidemiology, natural history, progression to cirrhosis and association with HCC have been reported from other countries. However, few of these are prospective and fewer still are population-based. Moreover, the underlying molecular mechanisms and immunogenetic determinants of the outcome of HBV infection especially in low and middle income countries remains largely unknown. Therefore, the hepatitis B cohort study (HBCS), nested as part of the Golestan Cohort Study (GCS), Golestan, Iran was established in 2008 with the objective to prospectively investigate the natural course of chronic hepatitis B with reference to its epidemiology, viral/host genetic interactions, clinical features and outcome in the Middle East where genotype D HBV accounts for >90% of infections. In 2008, a baseline measurement of HBV surface antigen (HBsAg) was performed on stored serum samples of all GCS participants. A sub-cohort of 3,505 individuals were found to be HBsAg positive and were enrolled in the Golestan HBCS. In 2011, all first degree relatives of HBsAg positive subjects including their children and spouses were invited for HBV serology screening and those who were positive for HBsAg were also included in the Golestan HBCS.
    Full-text · Article · Oct 2014 · Middle East journal of digestive diseases
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    ABSTRACT: Background: Gastric cancer (GC) is the second cause of cancer related death in the world. It may develop by progression from its precancerous condition, called gastric atrophy (GA) due to gastritis. The aim of this study was to evaluate the accuracy of serum levels of pepsinogens (Pg) and gastrin-17 (G17) as non-invasive methods to discriminate GA or GC (GA/GC) patients. Materials and methods: Subjects referred to gastrointestinal clinics of Golestan province of Iran during 2010 and 2011 were invited to participate. Serum levels of PgI, PgII and G17 were measured using a GastroPanel kit. Based on the pathological examination of endoscopic biopsy samples, subjects were classified into four groups: normal, non-atrophic gastritis, GA, and GC. Receiver operating curve (ROC) analysis was used to determine cut-off values. Indices of validity were calculated for serum markers. Results: Study groups were normal individuals (n=74), non-atrophic gastritis (n=90), GA (n=31) and GC patients (n=30). The best cut-off points for PgI, PgI/II ratio, G17 and HP were 80 μg/L, 10, 6 pmol/L, and 20 EIU, respectively. PgI could differentiate GA/GC with high accuracy (AUC=0.83; 95%CI: 0.76-0.89). The accuracy of a combination of PgI and PgI/II ratio for detecting GA/GC was also relatively high (AUC=0.78; 95%CI: 0.70-0.86). Conclusions: Our findings suggested PgI alone as well as a combination of PgI and PgI/II ratio are valid markers to differentiate GA/GC. Therefore, Pgs may be considered in conducting GC screening programs in high-risk areas.
    Full-text · Article · Sep 2014 · Asian Pacific journal of cancer prevention: APJCP
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    ABSTRACT: Fetuin-A, a hepatic glycoprotein present in the circulation, is a potential inhibitor for systemic calcification. The main aim of this study was to evaluate the association between fetuin-A and other biochemical parameters as facilitator factors for developing atherosclerosis in hemodialysis (HD) patients. This case-control study was conducted on 44 HD patients undergoing treatment in 2012. Parathormone (i-PTH) and fetuin levels were performed by the enzyme-linked immunosorbent assay method, high-sensitivity C-reactive protein (hs-CRP) by chemiluminescence, low-density lipoprotein by direct enzymatic, calcium and albumin by colorimetric and phosphorous by ultraviolet (UV) methods. Chi-square was used for evaluating the association between variables and t-test was used for comparing the mean of the quantitative variables for the two groups. SPSS-16 software was used for data analysis and P-value less than 5% was considered as significant. Mean of serum fetuin level was 23.25 ± 4.90 ng/mL in HD patients and 32.92 ± 5.21 in the control group. Median of hs-CRP was 2.45 mg/dL in the patients and 1.00 mg/dL in the control group and i-PTH was 74.3 pg/mL in the patients and 7.30 pg/mL in the control group. The calcium-phosphorous product was 46.77 ± 14.22 mg/dL in the patient and 31.73 ± 6.48 mg/dL in the control group. A reverse significant association was found between fetuin-A and hs-CRP in this study. In this study, serum fetuin-A level in HD patients was lower than controls. Therefore, a low level of fetuin-A seems to be associated with atherosclerosis, inflammation and malnutrition.
    No preview · Article · Jul 2014 · Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
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    ABSTRACT: Occult hepatitis B virus (HBV) status (OHBS) is simply defined as the presence of HBV DNA in the liver (with or without detectable HBV DNA in the serum), in the absence of serum HBV surface antigen (HBsAg). Importance of OHBS is mostly clinical, related to its possible role in spreading through blood transfusion and liver transplantation; causing classic forms of HBV. Mechanisms underlying this entity are poorly defined. Several possibilities have been suggested, with major classification into two groups: defective host immune response and viral replication activity through mutations of HBV DNA sequence. Mutations are extensively investigated in all four overlapping open reading frames (ORFs) of HBV genome, to define their possible role in the pathogenesis of OHBS. Some of these mutations like S-escape mutants could not be detected by the routine available assays, making them difficult to diagnosis. Therefore, trying to detect this covert condition could be more helpful for defining better preventive and therapeutic strategies. In the present study we provided an in-depth review of the most important new data available on different mutations in HBV genome of patients with OHBS, which may play a role in the pathogenesis of OHBS. The data were collected through reviewing the full-text articles, identified by the PubMed search, using the following keywords and their different combinations: occult hepatitis B, HBV genome, "a" determinant, HBV open reading frames, S mutations, X mutations, P mutations and C mutations. Variants within the major hydrophilic region (MHR) of the HBsAg, deletions in the pre-S1region, codon stop in the S open reading frames (ORF), sporadic non common mutations, some mutations affecting the posttranslational production of HBV proteins in the S ORF like deletion mutations, mutations in start codon and nucleotide changes in the X ORF, deletion and point mutations in P ORF and sometimes, nucleotide substitution in the C ORF are among the assumed mutations detected to have a role in OHBS appearance. Studies mostly lacked a control group and the whole-length HBV sequencing was scant with conflicting results, suggesting that OHBS is often a result of multiple mechanisms. Additional studies on full-length HBV genomes from occult and non-occult HBV cases may shed more light on the interplay between different mechanisms involved in the pathogenesis of OHBS.
    Preview · Article · May 2014 · Hepatitis Monthly

  • No preview · Article · May 2014 · Gastroenterology

  • No preview · Article · Apr 2014 · Journal of global infectious diseases
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    ABSTRACT: The clinical significance of pentavalent technetium-99m dimercaptosuccinic acid ((99m)Tc(V)-DMSA) scintigraphy in diagnosing inflammatory bowel disease (IBD) has not yet been fully elucidated. The aim of this prospective paper was to study the above. This study included 54 patients, 22 females and 32 males (mean age: 36.68±11.49; range: 18-63 years) with IBD who came to our clinics for follow-up and were examined clinically by colonoscopy and (99m)Tc(V)-DMSA scintigraphy. On the follow-up studies, five patients (9.25%) relapsed, and 49 (90.74%) remained at a steady condition. There was a good correlation between the scintigraphic results and the clinical and colonoscopy data of the patients (P<0.05). In conclusion, our results indicated that (99m)Tc(V)DMSA scintigraphy can be complementary to colonoscopy for the diagnostic evaluation of IBD.
    No preview · Article · Nov 2013 · Hellenic journal of nuclear medicine

  • No preview · Article · May 2013 · Gastroenterology

  • No preview · Article · Apr 2013 · Saudi medical journal
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    ABSTRACT: Hepatocellular carcinoma (HCC) is very rare during pregnancy and has a worse prognosis in pregnant women compared to those who are not pregnant. We present a case of HCC in a 41- year-old pregnant patient who was referred to our academic hospital.The patient presented with chief complaints of abdominal pain, jaundice, edema and hypertension. Laboratory results were notable for elevated liver enzymes and features of microangiopathic hemolytic anemia with normal alpha fetoprotein (AFP) and elevated cancer antigen 125 (CA125). At laparotomy for termination of pregnancy, multiple massive lesions were detected in the liver. Histologic evaluation showed features of HCC.HCC must be included in the differential diagnosis of any pregnant patient who presents with elevated liver enzymes and hemolysis.
    Full-text · Article · Oct 2012 · Middle East journal of digestive diseases
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    ABSTRACT: Introduction: Northeastern Iran is known as a high risk area of upper gastrointestinal cancers. Recent reports have suggested a declining trend for these cancers as well as an increase in the incidence of other malignancies including breast cancer. Our present aim was to describe the epidemiological pattern of breast cancer in this region during 2004-2009. Methods: All new cancer cases from public and private diagnostic and therapeutic centers of Golestan province were registered. A structured questionnaire was prepared and used based on the standards of the International Association of Cancer Registries. The international classification of diseases for oncology was considered for coding. Age standardized incidence rates (ASR) of breast cancer were calculated. Results: A total of 11,038 new cancer cases were registered during 2004-2009, of which, 1,101 (10%) were females with breast cancer. The median age of the breast cancer patients was 46 years. The ASR for breast cancer was 28 per 100,000 person-years. We found an unusual rapid increase in breast cancer rate at the age of 25 years. The ASR of breast cancer was significantly lower in females from Turkmen ethnicity and those from rural areas (P value <0.01). Conclusion: Our study showed high rate of breast cancer in Golestan province of Iran. We found an unusual peak of breast cancer in young women. So, the age of starting screening programs may need to be revised in this area. The rate of breast cancer was significantly lower in women from Turkmen ethnicity. Further studies are warranted to clarify the role of important determinants, especially regarding the ethnic disparity, on breast cancer in this region.
    Full-text · Article · Sep 2012 · Asian Pacific journal of cancer prevention: APJCP
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    ABSTRACT: Some mood disorders are more prevalent in chronic medical conditions compared with the general population. The relationship between inflammatory bowel disease (IBD) and psychiatric disorders has been raised as an area of interest for investigation. In this study, we aimed to assess the probable relationship between depression and disease activity in IBD patients in Golestan province, northeast of Iran. During February 2008 to February 2010, 50 patients recently diagnosed as IBD cases attended the Golestan Research Center of Gastroenterology and Hepatology (GRCGH), northeast of Iran. The Simple Clinical Colitis Activity Index (SCCAI) was used to evaluate the disease activity. The Beck Depression Inventory (BDI) was used to assess the severity of depressive symptoms. Depression was assumed when the BDI score was 13 points or higher. Sixteen cases (32%) had depressive characteristics. SCCAI and the Beck score were not significantly different between the two sexes. There was a non-significant correlation between SCCAI, Beck score, age and body mass index (BMI). We reported a relatively high percent of depression in IBD patients, although no significant relationship was seen.
    No preview · Article · Sep 2012 · Arab Journal of Gastroenterology

Publication Stats

240 Citations
97.68 Total Impact Points

Institutions

  • 2005-2015
    • Golestan University of Medical Sciences
      • • Gastroenterology and Hepatology Research Center
      • • School of Medicine
      Asterābād, Golestān, Iran
  • 2014
    • Shariati Hospital
      Teheran, Tehrān, Iran
  • 2011-2014
    • Tehran University of Medical Sciences
      • Digestive Disease Research Institute (DDRI)
      Teheran, Tehrān, Iran