GOVARESH JOURNAL
Year:2010 | Volume:15 | Issue:1 (70)|Papers Count:11

Background: Hepatitis C virus (HCV) is one of the main causative factors of liver disease which can lead to chronic hepatitis C infection in 80% of cases. HCV genotypes have a special worldwide geographic distribution. The goal of the present study was to detect HCV genotypes in patients with anti-HCV positive titers in Golestan Province, Iran.Materials and Methods: In this cross-sectional study, 95 positive HCV samples as detected by RIBA were evaluated. Viral RNA was extracted with a Roche extraction kit and the Fermentase cDNA kit Random hexamer primers was used for viral genomic cDNA synthesis. PCR was performed on all samples by a general pair of primers. Second-step PCR was done with specific primers, and the results were obtained following electrophoresis in 1.5% agarose gel and ethidium bromide staining in documentation gel.Results: General primer PCR revealed 91 positive samples. Assessment of 77 samples determined that the following genotypes were present: 1 and 3 [1a (19.5%), 1b (19.5%), 3a (15.6%), 3b (24.7%)], 2a (2.6%), 4 (7.8%). The remaining samples were a mixture of genotypes 1 and 3 (6.5%).Conclusion: The ingmost prevalent genotypes found were types 1 and 3 in Golestan Province. This distribution pattern differed from other areas in Iran, however genotype 4 was in accordance with other studies. Genotype 2 was only reported in this study and a study in Tehran. Thus, additional, larger studies of HCV genotypes should be performed for further analysis of genotypic distribution patterns.

Background: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with irritable bowel syndrome (IBS) versus healthy subjects with the use of a glucose breath test (GBT) in our geographical area.Materials and Methods: This study included a total of 80 consecutive patients; 40 with IBS based on Rome III criteria and 40 healthy controls with similar age and sex distribution. Patients and controls underwent 50g GBT for the diagnosis of SIBO. The test was considered positive if the hydrogen concentrations in the expired air increased more than 20 ppm over basal values within 90 minutes or there were two distinct peaks during the test.Results: Of the 40 patients with IBS and 40 healthy controls, there were 14 males and 26 females in each group. Patients ages ranged from 22 to 66 years (mean 34 years). The majority of patients with IBS had either constipation predominant (42.5%) or mixed type IBS (30%) and 17.5% were diarrhea predominant.The prevalence of an abnormal GBT result was higher in patients diagnosed with IBS (47.5%) with respect to controls (20%, p=0.009). A positive GBT was seen in 47% of IBS constipation predominant patients, 42.9% of diarrhea predominant and in 50% of the mixed group IBS patients (p=0.85).Conclusion: This study showed that approximately half of the IBS patients had SIBO. A significant difference of SIBO, however, was not detected amongst IBS subgroups. Therefore, SIBO should be suspected in patients diagnosed with IBS and in these patients GBT might be requested.

Introduction: Constipation is one of the most prevalent causes of abdominal pain in pediatrics, with no underlying pathology. It is defined as functional constipation in 95% of cases evaluated. This study was designed to compare the therapeutic effect of polyethylene glycol (PEG) and lactulose in treating chronic functional constipation in children.Materials and Methods: In this randomized, double blind clinical trial, patients were classified into two groups: lactulose (n=65) and PEG (n=63). During an eight week period, patients were either treated with an average of 3.5 g/day (PEG) or 7 g/day (lactulose). Successful treatment was defined as defecation (painless and soft, or normal) three times or more per week. Analysis was performed by calculation and comparison of the success rate in both groups, followed by reporting the relative risk and number needed to treat (NNT).Results: Response to treatment in the second week was significantly higher in the PEG group when compared with the lactulose group (P<0.0001). There was a significant difference in the response rate between both groups in the 4th and 6th weeks (P<0.0001). In the 8th week all patients in the PEG group were treated successfully, whereas there were five (7.7%) cases who did not respond in the lactulose group.Conclusion: These results have shown that a four week treatment period with PEG (3 g/day) lead to a response rate of 87% in children, in comparison with lactulose (7 g/day) which needed at least eight weeks of treatment.

Background: Colorectal adenocarcinoma is one of the most prevalent and treatable malignancies of the gastrointestinal tract. Recent in vitro studies have demonstrated the anticancer effect of Calendula officinalis extract on a tumor cell line derived from colorectal cancers. The inhibitory effect of this extract ranges from 70-100% and an in vitro study has demonstrated that Calendula officinalis extract inhibits expression of nuclear b-catenin protein on dysplastic colonic aberrant cryptal cells. The aim of present study was to evaluate in vivo the effect of Calendula officinalis extract on the expression of b-catenin protein in dysplastic colonic aberrant cryptal.Materials and Methods: In this study 20 male Wistar rats with an approximate age of 12 weeks that weighed 200-300g were assigned to two equal groups (treatment and control). For the induction of colorectal carcinoma these two groups were given two subcutaneous injections of 1, 2-dimethylhydrazine (40mg/kg) twice a week for eight weeks. Thereafter, the treatment group received Calendula officinalis extract (200mg/kg) daily for ten weeks through gavage. The control group received normal saline by the same manner. After ten weeks of treatment with Calendula officinalis extract, distal parts of colonic tissue were sampled in both groups. Expression of b-catenin was assessed semi-quantitatively by four scales through immunohistochemical analysis. Significant difference between the groups was determined by the Mann-Whitney U test. Statistical significance was considered at p<0.05.Results: Immunohistochemical studies revealed that the expression of nuclear b-catenin protein in dysplastic colonic aberrant cryptal cells was lower in the treatment group compared to the control group. The mean difference between the treatment and control groups was significant (p<0.01).Conclusion: The results of this in vivo study indicated that Calendula officinalis extract has an inhibitory potential on the expression of nuclear b-catenin protein in dysplastic colonic aberrant cryptal cells in experimental colorectal carcinoma of rats.

Acute liver failure (ALF) is an uncommon, devastating syndrome of which over 2000 cases occur annually in the USA, with a mortality rate of about 80%. ALF is defined by the sudden onset of hepatic encephalopathy and coagulopathy (INR³1.5) in an otherwise healthy person. The most common etiologies are acute viral hepatitis A and B, medication overdose (e.g., acetaminophen) and idiosyncratic drug reactions. The outcome of ALF is determined by its etiology, the degree of hepatic encephalopathy present on admission and by complications, particularly infection.In the era of orthotopic liver transplantation and with improvements in the intensive care of patients with ALF, spontaneous recovery and overall survival now exceed 40% and 65%, respectively. Increased information about the etiologies and treatment options of this syndrome will improve the survival rate of our patients. In this study, we have decided to discuss the main issues of ALF by reviewing the literature and recent papers.

Ulcerative colitis is a mucosal-inflammatory disease that usually involves the rectum and extends proximally to involve all or part of the colon. Medications for treatment include anti-inflammatory agents such as 5-ASA compounds, systemic and topical corticosteroids and immunomodulators.A 33 year-old female and 52 year-old male both diagnosed with severe active ulcerative colitis who were resistant to intravenous hydrocortisone therapy (400 mg/day) were admitted to our clinic. Respectively, the patients were treated with pulsed steroid therapy at doses of 500 and 1000 mg/day methylprednisolone intravenously, for three consecutive days. After the treatment, the patients potentially achieved complete clinical remission.In conclusion, pulsed steroid therapy may induce complete clinical remission in patients with severe, active ulcerative colitis who have resistance to intravenous conventional steroid therapy.

Background: Cystic fibrosis (CF) is a common genetic disorder chiefly characterized by respiratory and gastrointestinal symptoms. The purpose of this study was to evaluate the clinical presentation and growth status in CF patients at the time of diagnosis and following conventional treatment.Materials and Methods: A cross-sectional study was conducted on 67 CF patients who enrolled for at least a two-year follow up period in the CF Clinic of Sarvar Pediatric Hospital. Disease diagnosis was based on a positive sweat test. Growth indicators and initial clinical presentations of patients were registered at the time of diagnosis. Weight and height was measured at each clinical visit during follow up. All patients were treated with enzyme replacement, vitamin and mineral supplements. Other medications were prescribed as clinically indicated. Statistical analyses were performed by SPSS 16.0 for MS Windows.Results: The mean age of patients was 24.9±37.7 months at the time of diagnosis, whereas it was 3.1±2.1 months at the onset of CF symptoms. At diagnosis, the majority of CF patients suffered from malnutrition, growth failure, and presented with pulmonary and gastrointestinal symptoms. After conventional and nutritional treatments, significant improvements were seen in weight and height.Conclusion: A delay in the diagnosis of CF as seen in our country causes patients to further suffer from malnutrition and growth failure in comparison to developed countries. This emphasizes the necessity of neonatal screening. The results of this study show the dramatic effects of nutritional treatment on growth status.

Allgrove syndrome also known as triple-A syndrome is an autosomal recessive disorder characterized by alacremia, achalasia and ACTH-resistant adrenal insufficiency. Although this syndrome is rare, herein we report four cases with different clinical manifestations. They were referred to the gastrointestinal ward during a one year period with complaints of vomiting and dysphagia. The diagnosis of triple-A syndrome was confirmed after careful evaluations for vomiting.