Background and aim: Noroviruses are the most common known cause of non-bacterial acute gastroenteritis in worldwide. Norovirus gastroenteritis most often occurs in the winter with vomiting and diarrhea. Materials and Methods: This cross sectional study was done to evaluate the outbreak of gastroenteritis in one of the villages of Kurdistan province, 1-12 February 2019. During this period, 149 people developed joint illness and symptoms of diarrhea, vomiting, abdominal cramps, and their information was recorded. Data analysis was done with Stata7 software. Results: Attack rate of the total population in the village was 31.17%. Also, Attack rate in rural men and women was 26.5 percent and 36.24 percent, respectively. The median age of the patients was 26.5 years. The mean and standard deviation of patients' age in the first days of outbreak were less than other days that this relationship was statistically meaningful (P = 0.003). The most common symptoms were non-bloody diarrhea (57.71%), vomiting (52.34%), abdominal cramp (26.17%) and nausea (24.83%). According to the shape of the epidemic curve, the outbreak was a community-wide outbreak caused by the norovirus virus. Conclusion: Based on clinical evidence, epidemiological examination, results of human and water samples analysis, outbreaks occurred due to the consumption of drinking water contaminated with norovirus. To prevent similar outbreaks, it is recommended to fix the bugs observed in the water supply system and implement the water safety program.

Background: The projection studies are imperative to optimize the future need for health care systems and proper response to the public health problems such as inflammatory bowel disease (IBD). Methods: To accomplish this, we established an illness-death model based on available data to project the future prevalence of IBD in Asia regions and Iran separately from 2017 to 2035. We applied two deterministic and stochastic approaches. Results: For 2035 compared to 2020, we projected a 2.5-fold increase in prevalent cases for Iran with 69 thousand cases, a 2.3-fold increment for North Africa and the Middle East with 220 thousand cases, quadrupling of the prevalence for India with 2.2 million cases, a 1.5-fold increment for East Asia region with 4.5 million cases and a 1.6-fold increase in prevalence for High‐income Asia‐Pacific and Southeast Asia regions with 183 and 199 thousand cases respectively. Conclusions: Our results showed an emerging epidemic for the prevalence of IBD in Asia regions or/and countries. Hence, we suggest the need for emergency action to control this increasing trend in Asia and Iran.

Introduction: As two biological agents, infliximab (IFX) and biosimilar adalimumab (CinnoRA®) are routinely used in the clinical management of ulcerative colitis (UC) in Iran. Objectives: This study was done to evaluate the cost-effectiveness of IFX versus CinnoRA for the treatment of moderate-to-severe UC patients. Patients and Methods: To accomplish this, we developed a hybrid decision-tree/microsimulation (MS) approach for modeling UC’s natural history. We populated our model with available data on probabilities, costs, utilities / disutilities, and emergent adverse effects. Costs were reported in Iranian Rial (IRR) and in April 2021 US dollars ($). One-way and multiple sensitivity analyses were used to determine the uncertainty of the model’s parameters. Results: For five, 10, and lifetime horizon times, patients on IFX received slightly more quality-adjusted life-year (QALY) per year in remission and experienced about 3 to 5 times less surgery than CinnoRA patients. With willingness-to-pay (WTP) thresholds of 1800 ($7826.08), 820($3565.21), and 520 ($2260.86) million IRR for these horizon times, IFX was cost-effective with 100% certainty. Our findings were highly sensitive to the number of adverse effects. Conclusion: Our results demonstrated that IFX is more effective and more costly than CinnoRA, and if we ignore the predicted surgeries, CinnoRA is nearly as effective as IFX. However, these findings should be cautiously interpreted without a robust clinical trial of CinnoRA in UC patients. Since the impact of CinnoRA may have been over/underestimated.

Background: Toll-like receptor (TLR) signaling has been implicated in colorectal cancer (CRC) development. Intestinal microbiota can affect the expression of TLRs, which may induce inflammatory responses and impair the gut homeostasis. Here, we aimed to evaluate certain intestinal microbiota related to TLRs expression in colonic tissues of adenomatous polyposis and CRC patients. Results: Fecal and colonic tissue samples were collected from normal controls (NC), adenomatous (AP) cases and (CRC) patients via colonoscopy for CRC screening during 2016 to 2018. Fecal samples were collected to analyze intestinal bacteria including Streptococcus bovis , Enterococcus faecalis , Bacteroides fragilis , enterotoxigenic Bacteroides fragilis (ETBF) , Fusobacterium nucleatum , Porphyromonas gingivalis, Porphyromonas spp . and Roseburia spp . by real-time PCR. Gene expression of TLR2, TLR4 and TLR5 was examined in colonic tissues by qRT-PCR. Different abundant of gut bacteria were achieved in NC, AP and CRC groups. The genes expression of TLR2, TLR4 and TLR5 were significantly different in AP and CRC cases vs. normal group (P value <0.05). There was a significant relationship between TLR2, TLR4, TLR5 genes expression and Roseburia spp., P. gingivalis and ETBF quantity in normal group. Also significant association between TLR2, TLR4 genes expression levels and the quantity of S.bovis , ETBF, Roseburia spp. and E. faecalis in AP and CRC cases were achieved. Conclusion : Intestinal expression of TLR2, TLR4 and TLR5 is dynamic and depends on gut microbiota. Hence, altered immune activation in response to dysbiotic microbiota may promote intestinal inflammation in a group of patients with AP and CRC. Keyword: Adenomatous polyposis; colorectal cancer; gut microbiota; Toll-like receptors; intestinal inflammation