GOVARESH Journal
Year:2019 | Volume:24 | Issue:2|Papers Count:7

Background: Many studies have clearly reported the advantages of colonoscopy screening in terms of reducing the mortality rate of colorectal cancers in general population. However, the importance of colonoscopy screening in improving the survival rate of kidney transplant recipients is still unclear. So, the aim of this study is to survey the importance and feasibility of colonoscopy screening in kidney transplant recipients. Materials and Methods: This clinical study was conducted from February 2015 to November 2016. All participants received polyethylene glycolelectrolyte solution (PEG-ES) or magnesium hydroxide for bowel preparation. Colonoscopy was done and the location and the size of any lesions were recorded in all participants. Results: Among 247 post-kidney transplant patients who were visited routinely in Labbafi-Nejad Hospital in Tehran, 30 individuals with any signs or symptoms of malignant or non-malignant colorectal diseases and patients who had a colonoscopy during the previous year or had a failed transplant procedure and subsequent return to dialysis were excluded. Finally, 217 kidney transplant recipients were enrolled in this study, of which 121 patients completed the study. Conclusion: The results of this study, for the first time, confirm the safety and efficiency of colonoscopy as a routine gastrointestinal screening method among post-kidney transplant recipients in Iran, and suggest that it can be highly proficient in detecting gastrointestinal lesions and its implementation is without significant adverse effects in such patients.

Background: Liver fibrosis is the main prognostic factor for chronic hepatitis B (CHB). Change of inactive hepatitis B to active one is usually done silently. In this setting accurate estimation of fibrosis is an important step in the management of affected patients. The aim of this study was to determine the impact of fibroscan to evaluate liver fibrosis in inactive chronic hepatitis B. Materials and Methods: In a prospective study between February 2016 and June 2018, we evaluated liver fibrosis among patients with inactive CHB by fibroscan assessment. The inclusion criteria were the presence of serum HBsAg more than 6 months, persistence normal liver enzymes during the last 6 months, and HBV– DNA viral load < 20000 IU/mL. All other liver diseases were excluded. All patients underwent liver fibroscan. The factors affecting fibroscan results such as severe obesity, cardiac and renal failure, decompensate cirrhosis, and ascites were excluded. The patients were visited every 6 months. The eligible patients were followed up for one year. Results: 210 patients were enrolled in this study. The mean age was 37. 49 ± 12. 8 years and of them132 patients were male. Regarding the HBV DNA load, 48 (22. 9%), 84 (40%), and 78 (37. 1%) patient had viral load undetectable, under, and more than 2000 IU/mL, respectively. The mean transit elastography (TE) value among these patients was 5. 8 ± 1. 26 kPa. TE value more than 7. 2 kp was seen in 25 (11. 9%) patients with mean of 8. 1 ± 1. 4 kPa. There was no significant association between TE results and viral load levels in general. Moreover, we did not observe a significant association between age and viral load and TE. Conclusion: We showed that inactive hepatitis B is not a benign condition, which needed regular follow-up by evaluating liver enzymes, vial load, and TE. Hepatic fibrosis has prognostic significance because afflicted patients are at higher risk of developing cirrhosis; although liver biopsy is considered as the best available gold standard for assessing hepatic fibrosis.

Background: Irritable bowel syndrome (IBS) is a functional disorder with an unknown etiology. Some recent studies report the presence of a microscopic inflammation in people with IBS. This micro-inflammation can be due to an alteration in the pattern of recognition receptors especially in Toll-like receptors (TLRs). In this systematic review, we reviewed an evaluated existing studies related to TLRs and their changes in patients with IBS. Materials and Methods: Three science citation index databases including Web of Science, Pubmed and Embase were searched for related keywords from September 2000 to September 2018. There was no language restriction. Two reviewers screened and extracted data independently. Results: A total of 178 records were retrieved and eight eligible studies (265 patients) were included for data extraction and analysis. The results showed that, compared with the healthy group, the expression of some of the TLRs such as TLR2, TLR3, TLR4 and TLR5 increased whereas the expression of some others including TLR7 and TLR8 decreased significantly. Conclusion: Alteration of TLRs in patients with IBS can be due to changes in microbiota causing a micro-inflammation. This alteration can have a potential role in pathophysiology of IBS.

Occult hepatitis B virus (HBV) infection (OBI); the presence of HBV DNA in the absence of HBsAg, has been recognized as one of the possible phases in the natural history of chronic HBV infection. OBI is a known clinical entity in some clinical settings including blood transfusion, cryptogenic cirrhosis, dialysis patients, solid transplantation, etc. The molecular basis of OBI is closely related to the peculiar life cycle of the HBV, and in particular to the long-lasting persistence of HBV covalently closed circular DNA (cccDNA) organized as a minichromosome into the nucleus of the infected hepatocytes. This feature together with the long half-life of liver cells imply that HBV infection, once occurred may continue for life, even in condition of strong inhibition of viral transcription and replication. In addition to cccDNA stability, other factors such as immune responses, viral mutations, epigenetic mechanisms, and co-infection are associated with occult infection. Importantly, all the conditions inducing host immunosuppression (i. e., hematological malignancies, chemo-or immunotherapies, etc. ) can cause the reactivation of OBI with the development of a typical overt hepatitis B infection.

Background: Gastroesophageal reflux disease (GERD) is a common disorder, which is associated with mental disorders. Therefore, it is essential to study mental health and strategies for coping with stress, in such individuals. This study was performed to compare Profile of Mental Health and Strategies for Coping with Stress in Women with and without Gastroesophageal Reflux Disease. Materials and Methods: The design of this study was descriptive-causal comparative. The population included all women with and without Gastroesophageal Reflux Disease, from Zahedan province in year 2018. 46 women who were detected as having GERD and were advised to receive gluten-free products from the relevant centers and gastrointestinal clinic were selected and 47 healthy individual who were matched with respect to demographic characteristics with the patients with GERD were selected by purposive sampling method. The participants answered SCL-90-R and Andler & Parker coping strategies questionnaires. Results: The results of multivariate analysis of variance showed that the mean scores of somatic symptoms (F = 17. 41), interpersonal sensitivity (F = 3. 8), depression (F = 10. 59), anxiety (F = 16. 68), phobia (F = 4/97), psychosis (F = 4/34), and avoidance style (F = 20/20) were significantly more in patients with GERD compared with healthy people. Conclusion: Mental health in patients with GERD is significantly worse than healthy people and the use of avoidant coping strategies in such patients is more common than healthy individuals. Therefore, it is essential to pay attention to the psychological status of such patients.

Background: Acute upper gastrointestinal bleeding (UGIB) is a common and life-threatening problem. The identification of high-risk patients with regard to the need for urgent endoscopy and immediate intervention in patients with acute UGIB is a challenge for emergency physicians. The use of Rockall and Blatchford scoring systems has diminished this challenge to some extent. Therefore, the aim of this study was to investigate the role of Blatchford and Rockall systems in the outcomes of patients with UGIB referred to Emergency Department of Shahid Beheshti Hospital in Qom. Materials and Methods: In this retrospective analytic study, using a checklist of Blatchford and Rockall Scoring Systems and an easy sampling method, the clinical records of 194 patients with UGIB who aged over 18 years and had no trauma referring from 2013 to 2016 to the Emergency Department of Shahid Beheshti Hospital were studied. The role of Blatchford and Rockall Scoring Systems was investigated by Statistical tests regard to the significance level of p = 0. 05. Results: This study showed a significant relationship between the interventions for patients with UGIB in Shahid Beheshti Hospital with predicted interventions by the Blatchford Scoring System (p = 0. 000, kappa = 0. 294). Also, there was a significant relationship between the place of admission of patients in Shahid Beheshti Hospital with predicted place of hospitalization determined by Rockall (p = 0. 000, kappa = 0. 182). Also, there was a significant relationship between age and Rockall Scoring System (p < 0. 00001). Conclusion: The Blatchford Scoring System can be used as a clinical guide to determine the type of treatment intervention immediately and in the emergency department as a clinical guide to determine the type of patient's care.

Cancer is one of the most important causes of mortality in the world after cardiovascular disease. Currently, one of the most common cancers in the gastrointestinal tract in Iran and the whole world is colorectal cancer, which is ranked third in Iranian men and ranked fourth in Iranian women. Colorectal cancer manifestations include lower gastrointestinal bleeding, abdominal pain, changes in bowel habit, symptoms of iron deficiency anemia, obstruction, and intestinal perforation, and in rare cases upper gastrointestinal bleeding. The upper gastrointestinal bleeding is a rare manifestation of colonic cancer but it may exist. A few case reports have been published in this regard. Our case is a transverse colon invasive adenocarcinoma with extension to the second part of the duodenum, which was referred to with the complaint of hematemesis.