GOVARESH JOURNAL
Year:2021 | Volume:25 | Issue:4|Papers Count:8

Celiac disease (CD) is a systemic disease that is triggered by gluten consumption in genetically susceptible patients, with a predominance approximating nearly 1% of the overall community. Although CD primarily involves the small intestine, it may also affect other bodily systems and present as a disease outside of the gastrointestinal tract. Therefore, individuals who have CD might visit a physician for appraisal of several hematological issues before reaching the diagnosis of CD. Secondary anemia due to vitamin B12 and folic acid deficiency or due to malabsorption of iron are frequent problems in CD. In addition, individuals may reveal thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and thrombocytosis. These hematological changes may represent the distinctive features of the disease and should cue the physician to test for CD in a suggestive clinical setting. Identification of non-typical extraintestinal manifestations, including hematologic ones, could provide a significant chance to increase the rate of CD diagnosis, as this disease is grouped with the most underdiagnosed chronic intestinal disorders throughout the world. This review summarizes new evidence concerning the hematological manifestations of CD, and concentrates on applicable recommendations for physicians.

Background: Lead is a widely distributed metal in the environment and can be toxic to the human body. Lead poisoning has different clinical features. Recently, there have been increasing reports about lead poisoning following oral opium use. We report on a series of patients presented with abdominal pain attributable to lead-contaminated opium. Materials and Methods: We recruited all patients presented with abdominal pain and opium addiction, referring to the emergency room of a universityaffiliated hospital. Demographic, clinical, and laboratory data, as well as abdominal imaging and blood lead level, were collected for all patients. Results: Of 208 patients enrolled, 183 were male (88%), and the mean age was 51. 2 ± 14. 1 years. They all had a minimum of one-year history of oral opium consumption. 112 (53. 8%) patients had a blood lead level of more than 20 μ g/dL, and 22 patients (10. 5%) had a blood lead level of more than 100 μ g/dL. Half of the patients had a history of several hospital admissions for abdominal pain. Among patients with a lead level of more than 20 μ g/dL, 87 (78%) had anemia with a hemoglobin level of less than 13 g/dL (mean hemoglobin 11. 1 ± 2. 5 g/dL). Conclusion: Our case series highlights the role of opium administration as a possible emerging cause of acute abdominal pain of unknown cause.

Background: The aim of this study was to examine the prevalence of restless legs syndrome amongst patients with inflammatory bowel disease. Materials and Methods: Participants were 384 patients aged more than 18 years who had a history of admission with a diagnosis of inflammatory bowel disease (IBD) in the gastroenterology hospital in Guilan, Iran. The diagnosis of restless legs syndrome (RLS) was confirmed based on DSM-V, and its severity was identified using the International Restless Legs Scale (IRLS) questionnaire. The participants were assigned into two groups; patients with a history of IBD and RLS (n = 61) and IBD without RLS (n = 323). The prevalence of RLS, as well as demographic variables, have been analyzed between groups using the Chi-square test. Results: The prevalence of RLS was 15. 9%. It was significantly higher in; women (p = 0. 042), primary/secondary, and high school graduates (p < 0. 0001), married (p = 0. 011), and retired (p = 0. 021) patients. The prevalence of RLS in patients affected with anemia was significantly more (p = 0. 043). Increasing age (OR = 1. 06) and the duration of IBD (OR = 1. 08) were associated with increased risk of RLS. Conclusion: Our findings indicate RLS frequently happens in patients with IBD. As RLS can affect sleep quality, it should be considered as one of the causes of sleep disturbance in patients with IBD.

Background: Helicobacter pylori (H. pylori) is located in the digestive tract. This bacterium has a tendency to attack the stomach surface layer, mucosal changing, and eventually may involve in developing gastric cancer. In this regard, the main remaining issue is antibiotic resistance, which influences the efficacy of eradication regimens. To assess the efficacy of two frequent anti-H. Pylori quadruple treatments consisting of omeprazole, bismuth, amoxicillin, and clarithromycin (OBAC) or tetracycline (OBMT). Materials and Methods: Patients infected with H. pylori were assigned to receive omeprazole 20 mg, bismuth subcitrate 240 mg, metronidazole 500 mg, and tetracycline 500 mg twice a day versus omeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1000 mg, and bismuth subcitrate 240 mg twice a day. Non-inferiority analyses were conducted according to both intention-to-treat and per-protocol principles. Results: 100 patients in each group were enrolled. The intention-to-treat eradication rate was 82% (82/100) in the group receiving OBMT and 85% (85/100) in the OBAC group. Per protocol, eradication rates were 88. 1% (82/93) for the group receiving OBMT and 89. 4% (85/95) for patients in the OBAC group. When considering non-inferiority analysis, there were no differences between the two groups in both methods of analysis. Conclusion: The eradication rate of OBMT is not inferior to OABC, and both are effective in eradicating H. pylori in areas with high metronidazole resistance. OBMT is a good alternative against the increasing resistance to clarithromycin.

Coronavirus disease 2019 (Covid-19) is expanding worldwide. Although it seems to be a purely respiratory disease, occasional reports of lesions in other organs have been published. We report here an asymptomatic child with Covid-19 and with the main symptom of abdominal pain distension and without any respiratory symptoms. A 14-year-old male patient with main complaints of fever, malaise, anorexia, and severe abdominal pain was admitted to a hospital in Mashhad, Iran. Laparotomy revealed distension of the small intestine and an adhesive ileocaecal band that had produced ileum herniation without free fluid in the abdomen. Chest radiography and high-resolution computed tomography of the lungs showed bilateral and diffuse, peripheral dense areas of ground-glass appearance. A nasopharyngeal swab for diagnosis of Covid-19, was ordered due to lymphopenia together with these diffuse lung infiltrations, which showed a positive result. This led to drug treatment with lopinavir/ ritonavir, hydroxychloroquine, ribavirin/oseltamivir, and meropenem. The patient was febrile and developed tachycardia on the third day, accompanied by a respiratory rate of 44/min. At this point, tracheal intubation was done, but the patient died after 3 hours due to cardiac arrest. The case report brings forth the hypothesis that the gastrointestinal manifestation may be an atypical symptom of Covid-19 infection and highlights the importance of the diagnosis based on combined laboratory-based data and scanning imagery.

Background: Prediction for diseases and health issues using Web information diffusion is the main aim in infodemiology studies. This study’ s goal is to give a raw estimation of people with inflammatory bowel diseases (IBDs) for all provinces in Iran. Materials and Methods: The data for this analytical cross-sectional study was collected using Google Trends (GTr). Three keywords of “ Inflammatory Bowel Disease” , “ Crohn’ s Disease” , and “ Ulcerous Colit” were searched through. The results were limited to the geographical region of Iran from 1/1/2010 to 12/31/2018. The retrieved data saved to a local drive in Excel and analyzed through SPSS software version 23. Results: Overall searches for IBDs showed a significant (p = 0. 0) trend during the studied course of time. There was no significant relationship between the number of searches, applied keywords, and various seasons. The largest number of searches for IBDs keywords came from Ardebil, Gilan, and East-Azarbaijan provinces. Conclusion: This study revealed an increasing search rate for IBDs among Iranian clients from 2010 to 2018. The increased number of searches for Crohn’ s disease compared with ulcerous colitis from 2016 onward is likely a wise estimation of disease spread in the country.

Background: According to previous studies, a number of executive functions are impaired in people with bulimia nervosa. Accordingly, the aim of this study was to identify the most function impairments involved in patients with bulimia nervosa. Materials and Methods: The present study is a descriptive survey, and according to the method of implementation, is a systematic review study. A literature search was conducted by using the following electronic databases including scientific information databases )SID), CINAHL, Scopus, Web of Science, google scholar, PubMed, ScienceDirect, Medlib, Magiran, and Medline from 1991 through 2017. With executive actions involved in patients with bulimia nervosa, a search was done using the keywords of executive actions, working memory, attention, inhibition, reasoning and planning, organizing, self-regulation, inhibition, retention and conversion, self-regulation, cognitive flexibility, inhibitory control, speed processing, repositioning, decision-making, self-control, anorexia nervosa, and their combination with bulimia nervosa and similar terms )emotional eating). The content of all articles, after extraction from the databases, was evaluated by the PRISMA checklist, and the content analysis was used to examine data. Results: After the search and evaluation of the studies, the final analysis was carried out on 63 articles. The findings of this study showed that the executive actions involved in bulimia nervosa fall into five categories: attention, decision-making, inhibition, working memory, and set-shifting. Conclusion: Based on the results, drawing on the areas identified in the field of executive functions involved in patients with bulimia nervosa can be used as a conceptual map for more coherent studies and the design of extensive interventions.

Laryngeal cysts are rare lesions and makeup about 5% of benign laryngeal lesions. These cysts are often asymptomatic in adults but they can present with dysphonia, dyspnea, dysphagia, odynophagia, stridor, cough, foreign body sensation, airway obstruction, and even hemoptysis. A 17-year-old girl complained of dysphagia a month earlier, and also a foreign body sensation in her throat, and of mild intermittent dysphonia. The patient underwent laryngoscopy, and a large cystic-like lesion measuring approximately 3. 3 cm was observed on the lingual surface of the epiglottis extending to the vulva. Computed tomography of the neck was requested without contrast, in which a cystic lesion measuring 27 × 31 × 34 (Mm) was found in the hypopharynx connected to the epiglottis and extending to the vulva. The patient underwent oxygenated lesions, after which the patient's symptoms greatly improved. Laryngeal cysts in adults are often asymptomatic and are accidentally detected, but in any case with dysphagia, dysphonia, cough, odynophagia, and foreign body sensation in the throat, epiglottis cysts and the laryngeal area should be considered. Such a diagnosis should be considered among differential diagnoses.