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According to our results, sequential regimen does not seem to be an appropriate therapy for H. pylori eradication in the Iranian population, whereas hybrid therapy showed to be more effective. However, considering the high cost of clarithromycin in Iran, we recommend further studies to compare hybrid therapy with bismuth-containing regimens or to assess the effects of hybrid therapies with periods shorter than 14 days.

Background: One of the most critical health issues in the world is the COVID-19 pandemic from the Coronaviridae family. There is a lack of knowledge regarding the disease, and liver involvement is controversial.Objectives: We aimed to analyze the laboratory investigations of COVID-19 patients focusing on liver enzymes and association with outcomes. Methods: We enrolled 93 patients with COVID-19 referring to the Mazandaran University of Medical Sciences' hospitals and 186 people from the normal population of Tabari Cohort. The laboratory tests included CBC, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), direct bilirubin, and total bilirubin. The lengths of hospital stay, critical care transfers, and deaths were the outcome measures investigated with lab results. Results:The counts of lymphocytes (833.3 ± 564.4 vs. 2465.1 ± 796.6 per mm 3 , P < 0.001) and platelets (209.4 ± 62.7 vs. 255.2 ± 63.8 per mm 3 , P < 0.001) were significantly lower in patients than in controls. Also, AST (39.5 ± 34.9 vs. 19.9 ± 7.5 U/L, P < 0.001), ALT (40.4 ± 46.5 vs. 21.6 ± 12.7 U/L, P < 0.001), and ALP (192.6 ± 91.2 vs. 222.2 ± 70.6 U/L, P = 0.004) were higher in patients than in controls.The most common hepatic impairment events were increased direct bilirubin (45.8%), ALT (30.3%), AST (29.2%), ALP (17%), and total bilirubin (10.2%), in sequence. The risk of transfer to intensive and critical care units was strongly associated with elevated levels of AST and direct bilirubin, and AST = 30.5 (U/L) had a sensitivity of 71.4% and specificity of 68.5% for critical and intensive care transfer. The mortality rate significantly increased with increased AST levels (P = 0.023). Conclusions: Abnormal liver enzymes are frequent in COVID-19 patients. As AST is not specific for liver damage, the systemic inflammation induced by the virus might be responsible for these findings.

Ginger, the rhizome of Zingiber officinale, which is used as a spice globally has a long history of medicinal use that stimulates investigators to assess its potential roles as an adjuvant therapy or alternative medicine in a range of diseases. Anti‐inflammatory, antioxidant, antitumor, and antiulcer effects of ginger have been proven in many scientific studies, and some of the ancient applications of ginger as a home remedy has been confirmed in human. In this review, we summarized the current evidence on the effects of ginger consumption on gastrointestinal disorders based on clinical trials. Our data indicate that divided lower daily dosage of 1500 mg ginger is beneficial for nausea relief. Because of limited number of studies on some other gastrointestinal disorders, the results may not be as much powered as to find significant results. Therefore, more extensive and well‐controlled human studies of ginger or its standard extracts are required to demonstrate its efficacy as a gastroprotective agent. Dose‐finding studies should be undertaken to accurately determine the effective dose and preparation of ginger in further clinical trials protocol.

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Background/Aims A recent study revealed increasing incidence and prevalence of inflammatory bowel disease (IBD) in Iran. The Iranian Registry of Crohn’s and Colitis (IRCC) was designed recently to answer the needs. We reported the design, methods of data collection, and aims of IRCC in this paper. Methods IRCC is a multicenter prospective registry, which is established with collaboration of more than 100 gastroenterologists from different provinces of Iran. Minimum data set for IRCC was defined according to an international consensus on standard set of outcomes for IBD. A pilot feasibility study was performed on 553 IBD patients with a web-based questionnaire. The reliability of questionnaire evaluated by Cronbach’s α. Results All sections of questionnaire had Cronbach’s α of more than 0.6. In pilot study, 312 of participants (56.4%) were male and mean age was 38 years (standard deviation=12.8) and 378 patients (68.35%) had ulcerative colitis, 303 subjects (54,7%) had college education and 358 patients (64.74%) were of Fars ethnicity. We found that 68 (12.3%), 44 (7.9%), and 13 (2.3%) of participants were smokers, hookah and opium users, respectively. History of appendectomy was reported in 58 of patients (10.48%). The most common medication was 5-aminosalicylate (94.39%). Conclusions To the best of our knowledge, IRCC is the first national IBD registry in the Middle East and could become a reliable infrastructure for national and international research on IBD. IRCC will improve the quality of care of IBD patients and provide national information for policy makers to better plan for controlling IBD in Iran.

Regulatory T (Treg) cells take part in immune homeostasis and play a pivotal role in maintaining peripheral tolerance. The aim of this study was to evaluate the frequency and function of Treg cells in active and untreated ulcerative colitis (UC) patients. Thirty-two subjects with newly diagnosed UC and 31 age-matched healthy controls were included in this survey. The frequency of Tregs was analyzed with flow cytometry using CD4, CD25, CD127 and FoxP3 markers. We used surface expression of CD4(+), CD25(+) and CD127(low) markers for isolation of a relatively pure Treg population. Suppressive activity of Tregs was determined by measuring their ability to inhibit the proliferation of T responder cells. UC patients had a lower frequency of CD4(+) CD25(+) CD127(low) FoxP3(+) Treg cells. Additionally, Treg cell-mediated suppression was lower in UC patients compared to controls. The frequency and suppressive capacity of Tregs and MFI of FoxP3 were inversely correlated with disease activity. These results suggest that CD4(+) CD25(+) CD127(low) FoxP3(+) Treg cells may contribute to immunopathogenesis of UC, and assessment of Treg cell frequency and function may have clinical value.

Ten-day hybrid regimen could not achieve acceptable eradication rate. However, 14-day hybrid regimen seems to be an acceptable option for H. pylori eradication in Iran.