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Schwannomas or neurilemmomas are benign and slow-growing tumors that arise exclusively from Schwann cells in peripheral nerve sheaths. These neoplasms theoretically can occur anywhere in the body, but they most frequently affect extremities, as well as head and neck region. However, their presentation in the abdominal wall is extremely rare and only few cases have been reported in the literature. Subcutaneous lesions may be asymptomatic and only incidentally discovered upon physical examination or imaging. However, occasionally they induce mass effects on surrounding large nerves. We present the case of a 34-year-old man with abdominal wall pain localized in the right iliac fossa and palpable subcutaneous mass. Ultrasound and CT scan revealed a solid well-defined mass of the abdominal wall. Following surgical excision under general anesthesia, histological examination was consistent with the diagnosis of benign schwannoma. ©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.Patients with a stoma have 5% chance of developing parastomal varices, which tend to repetitive massive and life-threatening hemorrhages. Treatment of choice in parastomal varices have not been established, while Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been revealed as the most successful measure. We report a hemodynamically unstable patient with a history of Ulcerative Colitis (UC) and Primary Sclerosing Cholangitis (PSC) with colostomy, because of colon cancer who presented with massive parastomal bleeding. Non-operative treatments and TIPS failed to control the symptoms. Color Doppler ultrasound showed a hepato-fugal flow. The direct antegrade technique, using Sodium Tetradecyl Sulfate (STS 1%) and glue-Lipiodol, was applied under ultrasonography guidance, and complete stoppage of bleeding was achieved. No immediate or late complication or follow-up recurrence were noted after 8 months. In case of hepatofugal flow, direct percutaneous mesenteric parastomal venous access and sclerotherapy is a rapid and relatively safe procedure for parastomal variceal bleeding. ©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.Glutamine has been considered as a dietary supplement with a non-essential amino acid structure. Some studies have found that liver failure may be associated with a high plasma glutamine level. Consumption of this product may be linked to potential adverse effects. This report describes the first case of glutamine-induced hepatotoxicity. A 35-year-old female athlete with severe abdominal pain and scleral icterus was referred to the hospital. She had been taking glutamine powder for the past three weeks. Impaired liver function test and imaging evaluation suggested hepatotoxicity. Glutamine consumption was discontinued and the patient was closely monitored. Finally, after two weeks, the patient recovered successfully. This novel case was the first report regarding glutamine-induced hepatotoxicity. Health care providers must know that consumption of dietary supplements such as glutamine may be associated with serious side effects. Liver damage is a possible side effect of glutamine. Hence it is necessary to consider hepatotoxicity as an adverse reaction in case of glutamine supplement consumption. ©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.Aim This study aimed to investigate the frequency and molecular epidemiology of class A ESBLs producing Enteroinvasive Escherichia coli (EIEC) isolates among patients with diarrhea. Background Antibiotic resistance is widespread among diarrheagenic Escherichia coli (DEC) in developing countries. Information regarding Extended-Spectrum β-Lactamases (ESBLs) in diarrheagenic pathogens should be considered in clinical management when an optimal treatment is required. Methods A total of 581 stool samples were collected from patients with diarrhea in Ahvaz, Iran. PCR was used for the presence of the ipaH gene to confirm EIEC strains. The antibiotic resistance pattern of all EIEC isolates was determined by the disk diffusion method. EIEC isolates were screened for class A β-lactamase genes. Genotyping of harboring β-lactamase genes was performed by Multi-Locus VNTR Analysis (MLVA). Results Among 13 EIEC isolates, 9 isolates (69.2%) were found ESBL positive by double-disk synergy test (DDST) and PCR. Furthermore, bla CTX-M-15 and bla CTX-M-1 genes were detected in 77.8% (n=7) and 44.5% (n=4) of the bla CTX-M-1 group. On the other hand, the bla TEM-1 gene was detected in 66.6% (n=6). None of the isolates had bla SHV-1, bla KPC, or bla GES genes. Six MLVA genotypes were identified. Conclusion The current study revealed that the presence of ESBLs genes mediates the resistance of EIEC isolates to the majority of antibiotics in this region. The presence of ESBLs genes in different MLVA types showed that one specific clone was not responsible for spreading the EIEC isolates. ©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.Aim This study aimed to compare the effects of synbiotic soymilk fortified with whey protein concentrate and zinc sulfate with lactulose on bile duct ligated-induced HE. Background Hepatic encephalopathy (HE) is seriously associated with neuromuscular and cognitive alterations. Methods Eighty-two Sprague Dawley rats were randomly assigned into seven groups (sham, bile duct ligation (BDL), BDL + lactulose, BDL + soymilk (SM), BDL + Synbiotic soymilk (SSM), BDL + SSM + whey protein concentrate (WPC), BDL + SSM + WPC + ZnSO4). Different SM products, lactulose, and normal saline were administered via oral gavage (2 mL/rat/day). The serum and liver markers as well as liver histopathology were assessed after 28 days. Results The SM products significantly reduced the serum alanine aminotransferase, albumin, and ammonia (P less then 0.05). The levels of aspartate aminotransferase, endotoxin, and liver interleukin-6 improved significantly in all treatments, except for those receiving SM. SSM and SSM + WPC + ZnSO4 were the only effective products in reducing serum alkaline phosphatase (P less then 0.05). Furthermore, the liver total antioxidant capacity was greater (P less then 0.05) in the SSM + WPC and SSM + WPC + ZnSO4 groups. The histopathological examinations confirmed the efficiency of all SM products in reducing liver fibrosis. Liver bile duct proliferation diminished only in the SSM + WPC and SSM + WPC+ ZnSO4 groups (P less then 0.05). Conclusion This study showed the positive effects of different SM products, especially SSM + WPC and SSM + WPC + ZnSO4, on HE. Further studies are required to confirm our findings. ©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.Aim To investigate the potential effects of carboxyl and amino termini of HCV core protein on the HSCs activation. Background The core protein is recognized as the most important fibrosis inducer of Hepatitis C virus (HCV). While the exogenous fibrotic effect of HCV core protein has been reported earlier, the endogenous effect and the role of two termini must still be investigated. Methods Plasmids expressing full length, carboxyl-truncated (T1), or amino-truncated (T3) versions of the core were transfected into LX&nbsp;2 cells. MTT assay was performed to evaluate the cytotoxicity of the endogenous expression of different regions of core protein on these cells. Afterwards, the total RNA was reversely transcribed and introduced into quantitative polymerase chain reaction (qPCR) to measure the expression level of collagen type I (COL1A1), α-smooth muscle actin (-SMA), tissue metalloproteinase inhibitor&nbsp;1 (TIMP-1), and transforming growth factor-β1 (TGF-β1). In addition, TGF-β1 as a fibrotic factor, was also assessed in the supernatant of LX-2 cells using ELISA method. Results The full and T1 versions of the core exhibited a measurable proliferative effect on LX&nbsp;2 cells (P less then 0.05). Analysis of the gene expression was also showed that, in spite of amino-truncated version, these constructs represented a significant activation impact compared to the empty plasmid. Moreover, the result of TGF&nbsp;β assay was in agreement with the results of mRNA expression analysis. Conclusion The endogenous expression of the full and carboxyl-truncated versions of the core exhibited a significant activator effect on HSCs. Therefore, it can be concluded that, amino domain of HCV core protein performs a stellate cell activation role. ©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.Aim This study aimed to evaluate the impact of two different reperfusion techniques on outcomes of LT patients. Background Post-reperfusion syndrome (PRS) during liver transplantation (LT) remains a serious issue for both the surgeon and anesthetist. Methods In this prospective study, all liver transplant recipients referred to the liver transplantation department of Imam Khomeini Hospital, Tehran, Iran, from January 2016 to June 2017 were enrolled in the study and were divided into two groups of vented (reperfusion with 300cc blood venting) and non-vented (reperfusion without blood venting) cases. Then, 30-minute intraoperative hemodynamic and biochemical changes, as well as 2-month complications and 6-month mortality, were compared between the groups. Results 57 LT cases (31 vented and 26 non-vented) were studied (50.9% female). The two groups had a similar age (p = 0.107), sex (p = 0.885), MELD score (p = 0.61), donor warm ischemic time (p = 0.85), recipient warm ischemic time (p = 0.36), cold ischemic time (p = 0.99), comorbid disease (p = 0.502), and etiology of end-stage liver disease (p = 0.281). PRS occurred in 3 (11.5%) patients in the vented group and 4 (12.9%) in the non-vented group (p = 0.69). One (3.8%) patient in the non-vented group and 4 (12.9%) patients in vented group died (p = 0.229). Conclusion Reperfusion with and without blood venting had the same outcome regarding intraoperative hemodynamic and biochemical changes, PRS rate, and postoperative complications, as well as 6-month survival. Thus, it seems that blood venting is not a necessary method for decreasing post-reperfusion complications following LT. ©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases.Aim This study aimed to investigate the prevalence of thyroid disease (TD) in untreated CD patients and to evaluate the effect of gender and age on its prevalence. Background Celiac disease (CD) is a form of intestinal malabsorption syndrome which is closely related to endocrine disorders, especially autoimmune thyroid disease and diabetes. The prevalence of TD is possibly high among patients with CD which necessitates the need for screening for TD among them. Methods This comparative cross-sectional study was conducted on 288 consecutive untreated patients with CD (mean age, 27.9±14) and 250 controls (mean age, 29.01±13.15) referred for endoscopy in a hospital located in Iran. Thyroid function was evaluated by measuring T3, T4, and TSH levels using ELISA technique, and testing anti-thyroperoxidase (anti-TPO) antibodies through electrochemiluminescence method. Data analysis was conducted in SPSS v.22 software using descriptive statistics and chi-squared test. Results Thyroid disease prevalence was 4-fold higher in patients than in controls (13.