GOVARESH JOURNAL
Year:2018 | Volume:22 | Issue:4 |Papers Count:9

Gastric cancer (GC) is the fourth most common disease worldwide and approximately one million people are diagnosed as havinggastric adenocarcinoma. Each year, nearly 700,000 people lose their lives because of GC. Several altered molecular pathwaysare involved in the pathogenesis of GC, which can be targeted by specific monoclonal antibodies (mAbs). In recent years, the useof mAbs has provided considerable success in the treatment of cancer. Such mAbs are laboratory-produced molecules that incurchanges to precisely bind to specific sites. These drugs are similar to naturally produced antibodies as part of our immune system’sresponse. They play an important role in the treatment of many diseases, such as the different types of cancer. In cancer therapy,bispecific antibodies are used for targeting immune effector cells to destruct tumor cells (cancer immunotherapy) or neutralize twodifferent pathways through inactivation on the level of either receptors or ligands. It seems that the development of this type oftherapeutic agents to effectively treat a variety of cancers such as GC, is inevitable. The aim of the present study was to describemolecular-targeted therapy by using new-generation mAbs and inhibitors for the treatment of GC.

Background:The aim of this study was to evaluate the psychological characteristics of negative affect, social inhibition, and ambiguity tolerancein prediction of quality of life in patients suffering from irritable bowel syndrome (IBS).Materials and Methods:In this cross-sectional study, 62 patients suffering from IBS who were referred to the Digestion Clinic of Shadid Beheshti Hospitalin Qom city were selected with available sampling method. For data gathering, quality of life questionnaire in irritable bowelsyndrome (IBS QOL), D personality type scale (DS - 14), and ambiguity tolerance questionnaire were used Lin. Research datawere analyzed using Pearson correlation and regression tests.Results:This study showed that psychological characteristics of negative affect, social inhibition and ambiguity tolerance are factors predictionof quality of life in IBS suffering.Conclusion:For the recovery of the quality of life in patients suffering from IBS, appropriate interventions, training, counseling, and referralto psychologist to make positive changes in the mentioned psychological factors are recommended.

Background:One of the most stressful situations in clinical environments is exposure to invasive diagnostic methods, one of which is theendoscopy of the digestive tract. Endoscopy related anxiety can prevent achieving optimal results. Aromatherapy is one ofcomplementary treatments that can reduce anxiety. The aim of this study was to determine the effect of inhalation of matricariachamomile essential oil on the anxiety before Esophagogastroduodenoscopy.Materials and Methods:This study is a randomized clinical trial that was carried out in May 2014 among patients referred to the Endoscopy Department ofImam Reza Hospital in Mashhad. The population of the study included 152 participants who were randomly divided into interventionand control groups. Anxiety was measured by using State-Trait Anxiety Inventory (STAI) questionnaire. Then for 20 minutes, theintervention group inhaled matricaria chamomile essential oil and the control group inhaled placebo (sesame oil). 10 minutes afterinhalation, anxiety was again measured and compared between the groups. Data analysis was done using SPSS software version 21.Results:The mean age of the participants was 42.05 ± 4.5 years and 41.33% of them were male. Mean level of anxiety after inhalation in theintervention group was 35.89 ± 8.40 and in the control group was 39.88 ± 8.40, which decreased in both groups but in the interventiongroup the decrease was significant.Conclusion:The findings showed that matricaria chamomile essential oil inhalation was effective in decreasing the anxiety of patients whowere candidate for endoscopy. It is recommended to reduce anxiety in stressful situations.

A 40-year-old woman was referred to our health center with a bulky rectorrhagia. The patient was treated with meropenem andvancomycin for an enterococcal meningitis one week earlier. A colonoscopy was performed at a different center, which wasunsuccessful due to high blood volume in the colon and poor vision. The patient underwent angiography of the superior and inferiormesenteric arteries and the rectum artery, but the origin of the bleeding was not known. A polypoid mass with ulcer and bleeding fromthe site was seen in repeated colonoscopy of the left colon reagion. Due to the severity of the bleeding, the patient was transferred tothe operating room and a large uterine mass that had transmitted to the lobes of the sigmoid colon was observed. Due to the diagnosisof uterine tumor, hysterectomy and oophorectomy were performed, and the descending colon was removed as a colostomy fromthe abdominal wall. In the pathological examination, diffuse endometriosis was found, which had involved the left ovary, the leftfallopian tube, and both parametrium and sigmoid to the submucosal layer. On the 26th day, the patient was discharged with a goodgeneral condition and full vigilance.

Background:Studies have reported the controversial association between multiple sclerosis (MS) and celiac disease (CD). Thus, we aimed to conducta case control study on patients with MS, CD, and controls to investigate CD in patients with MS by means of comparing CD geneticmarkers in patients with MS and controls. We also evaluated serological markers in patients with MS.Materials and Methods:This is a case control study conducted on 60 patients with MS, 140 patients with CD, and 151 healthy controls in 2015 in Tehran,Iran. HLA typing was done to identify the carriers of the DQB1*02, DQB1*0301, DQA1*05, or DQA1*0201 alleles for HLA-DQ2,DQB1*0302, or DQA1*03 for HLA-DQ8. All data were analyzed using SPSS software (version 23, IBM Corp). Serological markersincluding anti-gliadin antibodies (AGA) (IgA, IgG), anti-tissue trans glutaminase antibodies (Anti tTG) (IgA, IgG), anti-endomysialantibody (EMA) (IgA, IgG), and total IgA were assessed in MS group by enzyme immunoassays.Results:The data of 60 patients with MS (26.7% male, mean age = 34.83 years), 140 patients with CD (33.6% male, mean age = 38.37 years) and 151controls (48.3% male, mean age = 40.43 years) were analyzed. The results of serological markers were not positive in any of the patients withMS. The prevalence of IgA deficiency (IgA ≤ 0.7) was 13.3% in patients with MS. 34 (56.7%) patients with MS, 90 (59.6%) controls, and135 (96.4%) patients with CD had positive results in either or both HLA DQ2 and DQ8. There was a significant difference in the HLA typingresults between the patients with MS and controls with CD group (P < 0.001), while comparing the MS group with the controls there was nota significant difference in the result of HLA typing (P = 0.69). Four (50%) patients with MS and IgA deficiency had positive DQ2 and/or DQ8.Conclusion:Our results did not show any correlation between MS and CD, which was similar to other studies.

Background:Clinical trials and meta-analyses have reported about 20% failure rates in first-line Helicobacter pylori (H. pylori) eradication.This reflects the need for effective second-line eradication regimens.Materials and Methods:61 patients with H. pylori infection who had failed previous non-bismuth clarithromycin-containing first line therapies entered thestudy. They were given a 14-day levofloxacin-containing triple regimen consisted of pantoprazole 40 mg, amoxicillin 1gr, and levofloxacin500mg, each given twice daily. Eight weeks after the treatment, H. pylori eradication was assessed by 14C-urea breath test.Results:All patients completed the study. The eradication rate was 91.8% (95% confidence interval = 84.9% – 98.6%) by both intentionto treat and per-protocol analyses. Side effects of therapy were reported by eight patients (13.1%), but they were severe in onlytwo patients (3.2%).Conclusion:According to the high H. pylori eradication rate and the very low rate of severe adverse effects, levofloxacin-containing tripletherapy seems to be a suitable second-line option in case of previous failure by clarithromycin-containing therapies. We suggestfurther studies with shorter duration of treatment or lower dose of levofloxacin.

Background:This study assessed the causes of infection in cholecystectomy and compared the infection rates between the open and laparoscopiccholecystectomy.Materials and Methods:This was a retrospective cohort study, performed on all patients admitted to Shariati Hospital since February 2017 for cholecystectomy.Initially, the patients were evaluated for infection risk factors, and then surgical site infection rates in these individualswere measured. Infection was assessed at the time of patients discharge (in the first few days after surgery) and again a monthlater, either in clinic or by phone. Information from 81 patients was collected, and SPSS software version 24 was used to analysethe data using appropriate statistical tests. Statistical significance was defined as p value < 0.05.Results:The mean age of the participants was 45.89 ± 13.38. The relationship between surgical site infections (SSI) and age, sex, comorbidities (diabetes,hypertension, ischemic heart disease, malignancy, chronic lung disease, and chronic kidney disease), taking corticosteroids, smoking,and the emergency or elective nature of the surgery was not significant. The mean age of the patients who underwent open cholecystectomywas higher than the laparoscopic group (p = 0.005). Similarly, the average hospitalization period for those underwent open cholecystectomywas higher (p = 0.03). Finally, the infection rates for open cholecystectomy were 6 times higher than laparoscopic surgeries (RR: 6.11).Conclusion:There was no significant relationship between SSIs and the risk factors assessed in this study. However, infection rates werehigher in the open cholecystectomy group. More studies on the various risk factors of infection and the differences between thelaparoscopic and open surgical methods are required.

Achalasia is a medical condition presenting with dysphagia to both liquids and solids. Although it is usually a primary disease,there are cases in which achalasia occurs secondary to other conditions. Despite its presentation as a secondary condition in a numberof diseases, it is very rare for achalasia to be associated with multiple myeloma especially as the presenting symptom when thepatient’s disease has not been diagnosed yet. Initial manifestations of multiple myeloma include array of symptoms such as backpain, bone lesions, and anemia, but as mentioned before it is extremely rare for it to initially present with achalasia.Here we describe a man who initially presented with dysphagia and further studies confirmed the diagnosis of achalasia. Later hewas diagnosed as having multiple myeloma following other presentations of the disease, thus making the dysphagia caused byachalasia his presenting symptom of multiple myeloma.