GOVARESH JOURNAL
Year:2007 | Volume:11 | Issue:4 (SN 57)|Papers Count:14

Background: There is evidence that pulmonary function abnormalities are present in patients with inflammatory bowel disease (IBD). The aim of this case-control study was to assess the frequency of pulmonary dysfunction in patients with IBD.Materials and Methods: Pulmonary function of 37 patients with IBD (8 with CD and 29 with UC) without any known pulmonary disease was tested by body-box plethysmograph. As control 30 healthy subjects who were adjusted with patient group for age, sex, cigarette smoking and body mass index were also tested. Disease activity in IBD patients was assessed by the CD activity index for CD and the Truelove index for UC, respectively. Extension of gastrointestinal tract involvement was determined by endoscopic and radiograghic findings which had been documented before.Results: A total of 19% of patients with IBD had restrictive, obstructive or mixed pattern of pulmonary dysfunction in compare with 3% in control group. Forced expiratory flow 25-75% (FEF25-75%) and forced expiratory volume in 1s (FEV1) mean were significantly lower in inflammatory bowel disease compared with control group (p=0.02 and p=0.036, respectively). Inverse correlation between extension of involvement of colon in patients with ulcerative colitis and FEV1 (R= -0.528, p= 0.003) and FEF25-75% (R= 0.532, p= 0.003) was observed.There was also inverse correlation between duration of inflammatory bowel disease and FEF25-75% (R= -0.336, p= 0.042).Conclusion: Pulmonary involvement is a relatively frequent extraintestinal manifestation of inflammatory bowel disease, it's not known whether it is due to disease process itself or other factors such as drugs.

Background: Caustic ingestion can result in severe gastrointestinal tract burns and important complications such as esophageal stricture. Early diagnostic endoscopy is usually recommended routinely in all children after caustic ingestion. The aim of this study was to determine the predictive value of clinical symptoms and ingested material types and quantity as markers of severe esophagogastric lesions and eventual complications.Materials and Methods: 72 children were admitted after accidental caustic ingestion. The clinical symptoms; ingested product type and quantities, endoscopic data and outcome were prospectively analyzed.Results: 36 patients had no symptoms (group B), others presented with one or more early symptoms (vomiting, hematemesis, drooling, respiratory distress) and/or oropharyngeal burns (group A). In group A, stronger substances were ingested in higher quantities. In group B, 23 patients ingested <20cc and 13 patients ≥20cc and in group A, one patient <20cc and 35 patients ingested ≥20cc. The proportion between patients who ingested >20cc was 2.7 more in group A to B (35/13=2.7). In group A the relationship between the amount of the caustic agent and degree of GI damage was pvalue=0.036, but it was pvalue=0.492 in group B. Severe GI injuries in endosocpy were seen in 32 cases (77.8%), and 17 of them developed complications (47.2%). 3 patients had esophageal perforation in acute phase, in one case of them perforation was in both esophageal and gastric. 17 patients had stenosis (16 cases had esophageal stenosis and one case was associated with gastric inlet obstruction and in another one with esophago-pleural fistula) and one case had gastric outlet obstruction. In group B no severe burn and complication were seen. Between substance property and quantity, early symptoms with GI burn and complication was coherence (p<0.05).Conclusion: In conclusion, diagnostic endoscopy is not necessary in asymptomatic children after accidental caustic ingestion.

Background: Narcotic addiction is one of the most important problems in human communities that unfortunately its prevalence has been increased in our country inconveniently. Opium has various effects on the parts of body. Many Studies has been performed about these effects, but opium effect on common bile duct has allocated only small quantity.Materials and Methods: This study is a cross-sectional study which carried out during 9 months (2004-2005). 50 opium addicts were selected from patients with non-ulcer dyspepsia who referred to Fatemiye hospital with opium addiction. Opium addiction was defined as daily use for at least 2 years. Common bile duct diameter was measured by a sonographist. Finally, mean of common bile duct diameter in both groups was calculated and the effect of opium consumption, duration and type of opiate on common bile duct was analyzed.Results: Mean of common bile duct diameter was obtained 4.1±1.8 mm in opium addicted group and 2.8±0.6 mm in control group. By considering p<0.0001 in t-test and p=0.003 in Mann-Whitney test. There was significant difference between the common bile duct diameters in two groups. There is no difference between oral or inhalation route or type of opium in common bile duct diameter but by using the linear regression model the diameter increases 0.17 mm per 1 yr consumption (p<0.0001).Conclusion: The opium addicted persons have more dilated common bile duct than the normal population.

Background: Nowadays colonoscopy has a very important role in screening colorectal cancers. In addition, adequate bowel preparation is critical to colonoscopy, as a poor preparation may obscure pathology or prevents full colonoscopy. As it is estimated that unsuccessful colonoscopy leads to second procedures in up to 20% of patients, we sought to compare the effects of different doses of polyethylene glycol (PEG) versus castor oil based lavage preparation for colonoscopy.Materials and Methods: In this double blind, randomized clinical trial 117 patients who were supposed to undergo colonoscopy, were allocated randomly into 4 groups in order to receive different lavage preparation protocols: 29 patients under 2 sachets of PEG (group A), 30 patients under 3 sachets of PEG (group B), 32 patients under 4 sachets of PEG (group C) and 26 patients under castor oil (group D). All the used PEG were Macrogol 4000 produced by Sepidaj pharmacy. The quality of bowel preparation was assessed using a scale of 1 to 8 and the higher the grade was, the poorer the bowel was prepared.Results: The highest and lowest mean grade of colonoscopy preparation were seen in groups A (2.79, SEM=0.36)-the worst preparation-and D (2.46, SEM=0.35)-the best preparation-respectively. However, the difference was not statically significant (p=0.224).The highest and lowest number of patients who were needed to repeat colonoscopy because of poor preparation were also seen in groups A (24.1%) and D (7.7%), respectively.Conclusion: It seems that usage of PEG may accompany with less gastrointestinal complications such as nausea and vomiting, compared with castor oil; although, no significant difference in quality of bowel preparation was seen in our study.

Background: Ultrasonography is an imaging method which, due to its relative economy, is becoming more widely available in regions of the world where fasciola hepatica infection occurs most frequently. In this report, we describe the sonographic findings of hepatic lesions in patients with fascioliasis to help confirmation of the sonographic characteristics of this disease and thus aid in its diagnosis. Materials and Methods: In this cross-sectional study 248 patients with confirmed hepatic fascioliasis of Guilan province were referred by internists and infectious disease specialists to private sonographic offices. Abdominal sonography was performed in supine and left decubitus positions using ALOKA 288 scanner and a 3.5 MHz transducer. Data was analyzed by SPSS 10. Results: 112 cases (45.2%) had liver parenchyma involvement. Sonography showed lesions in gallbladder and biliary tracts in 34 (13.7%) and 17 (7%) cases respectively. There was coincident involvement of liver and biliary tracts in 13 cases (5.2%). It was shown that liver parenchyma is the place of the most involvement seen mainly in posterior segment of right lobe and periportal area. Conclusion: Sonography can be useful in the detection and follow up of hepatic lesions in human fascioliasis and can facilitate the diagnosis of this condition, particularlyin areas where it is endemic.

Background: Safety of Blood products and plasma derivates is one of main concerns in transfusion sector. Screening of donated blood became an emerging item to large extent because of Hepatitis C and B virus, (HCV, HBV) and HIV epidemics especially in blood donation campaign following disasters. In this study we aim to evaluate the pattern of variation of viral infection markers donated at three consecutive years and during Bam earthquake disaster.Materials and Methods: Using donors' electronic information system in Qazvin province of Iran, all data about demographic characteristics and HCV, HBV markers were assessed and analyzed with SPSS software. Time period of 11 days after Bam disaster in 2003 was compared with similar period in 2002.Results: Prevalence of HBV and HCV contamination in donated bloods were 0.45 and 0.15 percent respectively and there was no differences regarding gender and marital status. Consecutive blood donors (45.3 percent of subjects) had lower rate of infection compared with others (p<0.05). HBV infection had a significant descending rate in three years but there was no similar pattern regarding HCV. Despite 3.6 times increase in blood donation rate the contamination rate during Bam disaster had no differences with similar time period in previous year.Conclusion: Decrease in HBV infection prevalence may be the result of installation of donors' electronic information system in second year of study. Despite the fact of no increase in prevalence of blood contamination, it is necessary to close monitoring of blood donation during disaster to ensure blood safety.

Background: Although Irritable bowel syndrome is a common problem in Europian countries, it’s prevalence in Asian countries is unclear. The aim of present study was to determine the prevalence of IBS and to assess the symptom subgroups based on the predominant bowel habit in a young adult population of Iran.Materials and Methods: A cross-sectional study on medical students at the Golestan University of Medical Sciences was conducted. A valid self-report questionnaries based on ROME II criteria was administered to all medical students. Comparison between groups was assessed using the Chi-square and Fisher’s exact analytical tests.Results: Of 708 questionnaires, 513 complete responses were received (response rate of 87.4%). Fifty (10.6%) subjects reported symptoms consistent with the diagnosis of IBS, predominantly in women. Forty (77.4%) and three (7.1%) were of the constipation-predominant and diarrhea-predominant subgroups, respectively. Seven (12.2%) subjects fell into the non-specific IBS subgroup. 57.1% (n=28) of the medical students had consulted their healthcare practitoners for their symptoms, and 55.1% reported self-medication.Conclusion: The prevalence and impact of IBS in young Iranian population is higher than previously expected that deserves greater care and further investigation.

Background: Ascitic fluid infection is presumptively diagnosed when the fluid polymorph nuclear (PMN) concentration equals or exceeds 250 cells /mic,l. The leukocyte esterase (lE) test has been shown to be a good predictor of the presence of PMNs in urine and other body fluids. This study examines of value of multistix 8SG dipstick test for rapid diagnosis of infected ascitic fluid.Materials and Methods: Seventy three ascitic fluid samples were evaluated by PMN count and LE dipstick testing. LE dipstick values of small or greater were considered positive. For each samples the LE test result was compared to the corresponding PMN count.Results: From 73 total patient (mean age: 55.1) they were 38 female (mean age: 46.4) & 35 male (mean age: 64.4). The causes of cirrhosis were HBV infection (39.7%), HCV infection (12.3%), Autoimmune hepatitis (9.6%), Cryptogenic (15%), other (4%) and Under evaluation (13%).The most finding in SBP negative group was asymptomatic (79%) but abdominal pain (77%) in SBP positive group.Eight of ten LE positive samples has PMN>=250 cells/mic,l while eight of nine samples with PMN>=250 cells/mic,l were also LE positive.Of 63 LE negative samples, 62 were also negative by PMN count. Sixty two of 64 samples with PMN<250 cells/mic,l had negative LE test.The sensitivity and specificity of the LE test for detecting ascitic fluid PMN>=250 cells/mic,l were 88.8% (95% CI: 52-100%) and 97% (95% CI: 89-100%) respectively with a positive predictive value of 80%, a negative predictive value of 98.5%, and an accuracy of 95%.Conclusion: The multistix leukocyte esterase test is useful for prompt detection of an elevated ascitic fluid PMN count, and recommended as a conveniant new method for the rapid diagnosis of infected ascitic fluid.

Chronic hepatitis B is caused by persistent infection with the hepatitis B virus (HBV). Chronic infection has a variable course after several decades resulting in cirrhosis in up to  one-third of patients and liver cancer in a proportion of those with cirrhosis. Currently, there are six approved therapies for hepatitis B: interferon alpha, pegylated interferon alpha, and four nucleos (t) ide analogues: lamivudine, adefovir (Hepsera), entecavir (Baraclude) and telbivudine (Tyzeka). These drugs can not eradicate HBV. Thus, clinical benefit is dependent upon the ability to maintain sustained suppression of HBV replication. However, long-term treatment with nucleos(t)ide analogues is associated with increasing rates of drug resistance, and the newer anti-HBV drugs are very expensive in Iran, and most patients can not afford to pay for the newer drugs. Given the difficulties on the management of HBV infection, and diverse practices of the physicians on this management in the country, the development of a guideline for the management of chronic hepatitis B in Iran was urgently needed. This guideline is based on the best available evidences as well as expert recommendations on the management of chronic hepatitis B in Iran, and is approved by the Iranian Association of astroenterology and Hepatology.