GOVARESH JOURNAL
Year:2009 | Volume:14 | Issue:1 (SN 66)|Papers Count:11

Background: The incidence rate of Esophageal Squamouse Cell Cancer (ESCC) in eastern part of Golestan province in Iran is among the highest ones in the world. In order to discover the factors interplay in high rate of ESCC incidence, several case-control and cross-sectional studies were established in this area. As a cohort study has priority in detecting risk factors of a disease, a 10-year prospective cohort study was conducted in this area.Materials and Methods: 68,024 individuals of residents in eastern part of Golestan province in the range of 40-75 year-old were invited to participate in the study. In rural areas, all the eligibled subjects were invited while in Gonbad city; a randomized systematic clustering sampling was conducted based on family numbers. Results: Of 50045 subjects, recruited in the study, 21,241 (42%) and 28,804 (58%) individuals were male and female, respectively. The mean age of participants was 52.12±9.1 years. About 23.9% and 76.1% of participants were residents of Gonbad city and rural areas, respectively.Conclusion: Eastern part of Golestan province has one of the highest incidence rates of ESCC in the world. A 10-year cohort study could lower the incidence rate of ESCC by identifying and controlling the related risk factors.

Background: Non-ulcer dyspepsia (NUD) is one of the common gastrointestinal disorders considered as a psychosomatic disorder. The effectiveness of psychological intervention in improving symptoms of this disease remains unclear. The objective of this study was to assess the effects of add-on stress management training on symptoms of NUD.Materials and Methods: In a randomized clinical trial, 28 consecutive patients with treatment-resistant NUD were selected from referrals to Noor Hospital, Isfahan and they were randomly assigned to the intervention group or the control group. The intervention group received a usual care plus a 7-session stress management training while the control group received a usual care plus psychological placebo. All patients were assessed by the Global Overall Symptoms (GDS) scale, Cooper Stress Inventory, Beck Depression Inventory and Cattell Anxiety Inventory at pretreatment and three weeks after treatment. Analysis of covariance was used to analyze the data.Results: The results of covariance showed significant differences between the two groups in the Global Overall Symptoms (GDS) scale (F=8.39, p<0.0007), Cooper Stress Inventory (F=10.8, p<0.003), Beck Depression Inventory (F=12.87, p<0.001) and Cattell Anxiety Inventory (F=11.031, p<0.003). Conclusion: Globally, the findings proved that combination of psychological intervention-based stress reduction plus routine medical care would be the successful approach in treating symptoms of NUD.

Introduction: Helicobacter pylori infection is likely acquired was in childhood. Helicobacter pylori is recognized as a cause of gastritis and peptic ulcer. Our objective to investigate some noninvasive tests, particularly serum Hpylori IgG, for the diagnosis of H pylori infection in comparison with the gold-standard invasive test, esophagogastroduodenoscopy with biopsy (histology and rapid urease test). Materials and Methods: We studied 100 patients (age range: 6-18 years) who underwent esophagogastroduodenoscopy with biopsy (histologic examination) for a suspicious upper gastrointestinal disease, in all of them serum Hpylori immunoglobulin G was measured and result of this were compared with those of the gold standard esopahgogastrodudenoscopy with biopsy.Results: Of 100 patients (60 males, 40 females), 91% had history of gastrointestinal disease and 29% had positive family history for gastrointestinal disease. gastritis, ulcer and erosion were found respectively in 94%, 31%, 34% of patients.Rapid urease test, serology and histology were positive respectively in 57%, 23%, and 29% of patients. In comparison with histology sensitivity of serology was 45% and its specificity was 71%.Conclusion: serum Hpylori IgG test has a low sensitivity and specificity in children in comparison with the gold standard invasive test.

Background: In order to extend HBV immunization to twenty-five-year old adolescents, Ministry of Health and Medical Education (MOH & ME) in Iran has decided to implement HBV mass vaccination campaign for adolescents who were born nom 1989 to 1992. The first three-round campaign covering 1989 born adolescents was implemented in 2007 in Iran. This study was conducted for cost estimation and analysis of HBV vaccination campaign for adolescents implemented in 2007 in Iran. Materials and Methods: This cost analysis study was conducted applying health system perspective. The cost variables considered in this study were recurrent costs, personnel costs, publicity costs, transportation costs and overhead cost. We gathered the required data to estimate recurrent costs, national-level supervision and publicity from existing data and through interview with experts in MOH & ME. To estimate vaccine administration cost, provincial supervision cost and outreach teams' costs, we gathered the data from one or some of the provinces, then, we expanded the results to the country. We used recommended proportions by WHO to estimate transportation and overhead costs. We used administrative data reported from universities of medical sciences to estimate vaccination coverage. Sensitivity analysis was applied. Results: Total cost for three rounds of the campaign was estimated as 83615 billion IR Rials including 24% for recurrent costs, 42% for personnel costs, 31% for transportation costs, 0.1% for publicity costs and 3% for overhead costs. Total cost was estimated as 21000 IR Rials per dose administered. Sensitivity analysis indicated that increasing campaign coverage and using under 20 year-old vaccine dosage will decrease the cost to 17500 IR Rials per dose administered. On the other hand, decreasing campaign coverage and using above 20 year-old vaccine dosage will increase the cost to 23000 IR Rials. Conclusion: The costs in this campaign are much lower than that in similar programs in developed countries and will be even decreased if some revisions, particularly in vaccine dosage are considered. Publicity costs have been too low and needs more attention in future campaigns. The findings in this study provided evidence to support the resource value, which MOH & ME will be requested for future campaigns.

Helicobacter pylorus (HP) is a common infection in Iran. Inappropriate laboratory tests for its diagnosis such as serology and irrational drug prescription for HP treatment in patients with non-ulcer dyspepsia is a drastic obstacle in our country. Treating every patient with dyspepsia without peptic ulcer or precancerous lesions, not only results in high economic burden on health system, but also causes antimicrobial resistance and undesirable clinical outcomes. The Iranian Society of Gastroenterology and Hepatology discussed this topic in a meeting and suggested preparing a guideline for approach to dyspepsia in Iran. Then, the literatures were reviewed and the published data in our area were searched and a practical guideline was developed. According to the present evidences, we suggest HP treatment only for patients with peptic ulcer, infected gastric cancer patients and their first degree relatives and also for MALT lymphoma. We suggest standardized urea breath test, endoscopicbiopsy or stool antigen test for diagnosis of HP infection and its eradication. Serology is not a suitable diagnostic method for evaluation of HP infection even prior to the treatment. Because of ineffectiveness, we don't suggest HP eradication treatment for non-ulcer dyspepsia.

Lead poisoning has several clinical manifestations so the diagnosis may be troublesome. These manifestations consist of anemia, neurologic abnormalities, liver and biliary tract problems and abdominal pain. Not only opium addiction, but also lead toxicity can cause biliary tract problems. When both etiologies occur at the same time, the diagnosis is difficult.A 46 year old opium addicted man with colicky abdominal pain was referred for more evaluation. In the first hospitalization, he complained of abdominal pain, constipation and weakness. Laboratory data revealed anemia and elevation of ALP. Sonographic exam revealed dilatation of CBD. ERCP revealed also dilation of CBD without concomitant CBD stone. Sphincterotomy was done. After 2 weeks, he came back with the same presentation, but some neurologic abnormalities such as gait disturbance, tremor and proximal weakness were added to his problems. Blood lead level was checked that revealed severe elevation (90 mcg/dl) and the patient was managed properly with lead toxicity diagnosis. Although opium can lead to common bile duct disease, our case, indicated that lead poisoning must be considered even in opium addicted patients, who come with symptoms and signs of common bile duct problems.

Adenocarcinoma of the stomach was the leading cause of cancer-related death worldwide through most of the 20th century. Usual presentations of gastric cancer include anorexia, epigastric pain or discomfort and weakness. Rarely, patients present with unusual clinical manifestations. In this article, we report two cases with uncommon presentations of gastric adenocarcinoma.The first patient was a 52-year-old male presented with testicular mass, and the second case was a 51- year-old female presenting with diffuse bone pain, petechiae and purpura on the skin of abdomen. In the first case, the initial pathologic specimen was provided from testicular mass (orchiectomy) and for the second case, bone marrow biopsy was done. The initial reports for these cases were seminoma and metastatic signet ring carcinoma, respectively. Chemotherapy was done for both.Gastric adenocarcinoma rarely presents with unusual clinical manifestations. Chemotherapy in one out of two cases showed good palliative results.

Cystic fibrosis is an inheritant autosomal recessive disease. It is associated with mutations in Cystic Fibrosis Trans Regulator gene (CFTR) and has different presentations. We report two 2 month old female patients, products of a twin delivery presented with anemia, edema, hypoalbuminemia and pneumonia. After some work ups, diagnosis of cystic fibrosis was confirmed. This is an uncommon and interesting presentation of cystic fibrosis, which occurred simultaneously in one twin.