GOVARESH JOURNAL
Year:2020 | Volume:25 | Issue:2|Papers Count:8

A 77-year-old man with a history of gastric lymphoma developed fever 7 days after total gastrectomy. His medical history was unremarkable, and no cardiac abnormality was noted in the perioperative cardiologic consultation. On his physical examination, the oral temperature was 38. 8 ° C. Other physical exams, including the chest and abdomen, were not significant...

Esophageal cancer (EC) is categorized histologically to two common groups; adenocarcinomas and squamous cell carcinomas, with high incidence and mortality worldwide. Esophageal squamous cell carcinoma (ESCC) is the most prevalent (more than 90%) form of all EC cases in Golestan province. Golestan province, as the high-risk province for ESCC, is located in the eastern part of the Caspian littoral area of Iran, although in the last decades, the occurrence rates have decreased in this area. Tobacco smoking, opium consumption, low oral hygiene, drinking hot liquids, insufficient intake of fresh fruits and vegetables, and poor socioeconomic status increase the risk of ESCC in Golestan, although exposure to infections and toxic chemical compounds are also reported. Here, we summarize the previous epidemiological studies from 1970 to 2019 that have investigated the risk factors involved in ESCC in this high-risk area. More prospective cohort studies are required to assess the risk factors, categorize highrisk peoples, and evaluate early detection and involved mechanisms.

Background: Many trials studied green tea extract for its flavonoid antioxidant effects on the liver function (liver enzymes) and fatty liver status (serum lipid levels) in patients suffering from non-alcoholic fatty liver disease (NAFLD). Therefore, the effects of pure epigallocatechin gallate (EGCG) was assessed here as the most potent flavonoid of green tea in such patients. Materials and Methods: This was a pilot study in which 33 patients with NAFLD were assigned to consume EGCG capsules (390 mg) daily for 12 weeks. Fasting blood sugar, liver enzymes, and lipid profiles were monitored at baseline a nd at the end of the trial. Results: The studied group showed significant decreases in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at the end of trial (p < 0. 01). The women showed more significant decreases in these enzymes (ALT: p < 0. 01, AST: p < 0. 001). No statistically significant differences were observed in total cholesterol, High-density lipoproteins C (HDL-C), Low-density lipoproteins C (LDL-C), Very low-density lipoprotein (VLDL), and Triglyceride (TG) levels at the end of the trial (p > 0. 05). Conclusion: According to our results and also recent reports about the positive impact of green tea polyphenol EGCG on liver function and fatty liver status in patients with NAFLD, the daily use of pure EGCG may improve the level of liver enzymes in such patients.

Placement of prophylactic pancreatic duct (PD) stents is a strategy to reduce the rate and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients. However, PD stents do not completely eliminate the risk of PEP. Most previous studies have shown the positive effects of PD stents on PEP reduction, especially in high-risk ERCP procedures. Here, we report seven cases of severe post-ERCP pancreatitis associated with PD stents. Needle knife cannulation technique following PD stenting was used for all cases. The PD stent that was used was a polytetrafluoroethylene, 5-Fr polyethylene single pigtail unflanged plastic PD stent (Endo-Flex GmbH, Voerde). The PD stent was inserted successfully with the first attempt and the least trauma to the pancreatic duct. In fact, the present article describes our experience of the successful placement of PD stent, but post-ERCP pancreatitis was diagnosed according to Cotton’ s criteria in all the patients. Because of the long hospitalization more than 10 days for each case, the intensity of pancreatitis in all cases was considered severe.

Background: Considering the prevalence of COVID-19 worldwide, the present study aimed to determine the prevalence of gastrointestinal problems (anorexia, diarrhea, nausea, and vomiting) in patients with COVID-19. Materials and Methods: The purpose of this study was to determine the prevalence of gastrointestinal problems in patients with COVID-19 using Systematic Review and Meta-analysis methodology. The search was conducted independently by two researchers on international databases, including Web of Science (ISI), Scopus, Embase, Science Direct, PubMed/Medline, and Google Scholar Search Engine. Keywords included “ Vomiting” , “ Anorexia” , “ Diarrhea” , “ Nausea” , “ SARS-CoV-2” , and “ COVID-19” . Data were analyzed using STATA statistic software. Results: The total sample size was 3602 patients. Initially, 1456 studies were included in the study, which reached 33 articles after the final screening. Regarding the prevalence of gastrointestinal problems in patients, the prevalence rate of diarrhea was 6% (95% CI: 0. 06 [0. 04, 0. 08]), anorexia was13% (95% CI: 0. 13 [0. 03, 0. 24]), nausea and vomiting was 4% (95% CI: 0. 04 [0. 03, 0. 05]), and pharyngalgia was 16% (95% CI: 0. 16 [0. 02, 0. 30]). Conclusion: The results of this study can be used as a guideline for clinical professionals.

Background: Liver cancer is one of the common cancers. Despite many advances in medical sciences, it continues to be one of the main problems in the care systems. Diagnosis of the disease and its treatments result in many problems for affected patients. The purpose of this study was to assess the consequences of transcatheter arterial chemoembolization. Materials and Methods: The study was performed on 84 patients at Imam Khomeini Hospital in Tehran, using available sampling methods. Questionnaires on cancer treatments, Fatigue Severity Scales, Hospital Anxiety and Depression Scales, Edmonton Symptoms Scales, and demographic characteristics were filled before and after treatment. Data were analyzed using SPSS software version 21. Descriptive statistics, t test, and correlation test were used as appropriated. Results: The study showed many consequences such as anxiety, pain, and fatigue. Mean physical and psychological outcomes after treatment showed a significant increase (p ˂ 0. 05), which led to a significant decrease in FACT. Conclusion: Consequences have an inverse and significant relationship with patients’ performances and their quality of life. Due to the direct effects of consequences on life, they should be reduced or eliminated.

Background: Campylobacter species are among foodborne pathogens that are known as the main cause of inflammatory diarrhea in humans. In this cross-sectional study, we investigated the prevalence of Campylobacter spp. and their drug resistance status in fecal samples of patients with community-acquired gastroenteritis in Tehran. Materials and Methods: In this survey, infection with Campylobacter spp. was evaluated in 400 stool samples of patients with diarrhea. Accordingly, microscopic examination to show the presence of exudative diarrhea, rejection of fungi and parasitic infections, enrichment and culture in a specific medium under microaerophilic conditions, determination of biochemical identity, and molecular confirmation at genus and species levels for C. jejuni, C. coli, C. lari, and C. upsaliensis were performed. Antibiotic resistance patterns were determined by E-test and disk diffusion methods, and the presence of the dominant gyrA gene mutations in the quinolone-resistance domain of C. jejuni isolates was determined by using Mismatch Amplification Mutation Assay-polymerase chain reaction (MAMA-PCR)i 1. Results: A total of 28 strains of Campylobacter were isolated from the samples obtained from the patients with diarrhea. The most common species were C. jejuni (6%), C. coli (0. 5%), C. lari (0. 25%), and other unknown species (0. 25%). The highest antibiotic resistance rate was observed against tetracycline and ampicillin (53. 5% and 50%, respectively), and the lowest rate was detected for nalidixic acid and ciprofloxacin (28. 5% and 28. 5%). Multiple drug resistance (MDR) phenotype was detected among 51. 8% of the strains. Conclusion: Results of this study indicated C. jejuni as the main Campylobacter species responsible for community-acquired diarrhea among the studied patients. The high rate of resistance to antibiotics and MDR phenotype in these strains compared with other countries is considered a risk, especially in the treatment of invasive infections.

Background: Nowadays, gastroenterologists work a wide variety of areas and in this field a lot of new trends have been set up worldwide. According to our nation’ s goals in science production and being a leader in innovation and technology, and also creating several cohorts in digestive and liver diseases, we need to calculate and predict the workforce needed. Materials and Methods: Among the 51 medical universities in Iran, 12 train adult and 5 train pediatric gastroenterologists and hepatologists. About 33 to 35 adult and 8 to 10 pediatric gastroenterologists are trained every year. Currently we have about 650 adult and pediatric gastroenterologists working in Iran, meaning one gastroenterologist per 124, 000 population, which 30% are practicing in Tehran. Results: Each year 40-45 fellows of gastroenterology will be trained, leading to 950 adult and pediatric gastroenterologists by 2025. Our population is estimated to be about 90 million persons by then, leading to one gastroenterologist per every 95-100. 000 population. Conclusion: Estimating the need for gastroenterologists depends on the per capita income, governmental funds and insurance policies. Distribution of gastroenterologists is centralized in large cities and capitals of each province. Every year about 45 gastroenterologists enter Iran’ s workforce, along with this increase we need necessary equipment for diagnostic and therapeutic endoscopic procedures. Proper distribution of graduates can facilitate and improve services in this field. Till 2025, our population is estimated to be about 90 million and we will have about 950 gastroenterologists, meaning 1 per every 95-100. 000 population. Therefore, the estimates given by Strategic Planning Committee seems reasonable and justifiable.