GOVARESH JOURNAL
Year:2017 | Volume:22 | Issue:1 |Papers Count:9

Celiac disease as an autoimmune disease is predisposes in genetically susceptible subjects due to theconsumption of wheat and other grains containing gluten and as a result of immunological responses,villous atrophy, mucosal hyperplasia, and lymphocytic infiltration will be occurred. The only treatment isa lifelong gluten-free diet. Most patients with celiac disease respond to gluten-free diet (GFD). But in asmall percentage of patients, despite full compliance with gluten-free diet, symptoms and mucosal atrophyare remains. When other causes of mucosal atrophy are rejected, the diagnosis of refractory celiac disease(RCD) is suggested. Based on the abnormality in population of intraepithelial lymphocytes (IEL), RCDis divided into two types 1; (RCD I) and type 2 (RCDII). Prognosis, clinical symptoms and endoscopicfindings of RCD I are better and milder than the RCD II. Treatment of RCD I is based on immunosuppressivetherapy and RCD II is mostly based on nutritional support and chemotherapeutic agents. In this review theclinical characteristics, diagnostic and treatment approach of RCD will be reviewed.

Background:Pancreatic cancer (PC) is classed as the 7th leading cause of cancer-related death in the world. Previous evidence indicates thathyperglycemia, insulin resistance, diabetes, and obesity are implicated in pancreatic carcinogenesis. Thus, evaluation of the dietaryintakes in the etiology of PC can be useful to identify the risk factors of the disease.Materials and Methods:We examined the association between total intake of fruits, vegetables, and dietary fiber and the risk of PC in 50,045 participantsaged 40-75 years within the Golestan Cohort Study. Dietary data were collected using a validated semi-quantitative food-frequencyquestionnaire, which was administered at baseline. Cox proportional hazards models were used to estimate multivariate hazardratio with 95% confidence interval.Results:During 383,630 person-years of follow-up and after excluding the participants with incomplete baseline information, a total of48,676 adults were evaluated. Until October 30, 2014, 54 cases of PC were confirmed based on the exact cause of death usingICD10 criteria. After considering all potential confounding factors, there was only a statistically significant inverse associationbetween the risk of PC for the highest tertile of daily fiber intake compared with the lowest tertile (HR=0.41; 95% CI= 0.15-1.05;P for trend= 0.05). However, the relationship between fruits and vegetables and PC risk was not statistically significant.Conclusion:In summary, based on the findings of this study, increased dietary fiber may reduce the risk of PC. This result highlights theimportance of a diet rich in fiber in order to prevent PC progression. Finally, given the limited number of studies in this field andinconclusive results, there is still a need for new prospective studies with long follow-up.

Background:The quality of life is an important target variable in determining the impact of the illness on the life of patients with ulcerative colitis.The present study aimed to investigate the role of alexithymia, illness perception, and resilience in the quality of life of patients withulcerative colitis.Materials and Methods:This study is descriptive and correlational. 58 patients (34 females, 24 males) who suffered from ulcerative colitis and had referredto gastrointestinal clinics of Isfahan from March to May 2016 were selected. They were examined by using available samplingmethods. The data were collected by three methods: 1. Demographic forms concerning the subjects. 2. Clinical interview done bygastroenterologists based on the evidence of endoscopic, pathological, and colonoscopic findings. 3. Questionnaires that measuredthe variables alexithymia (Bagby, Taylor, & Parker, 1994), illness perception (Brad Benet, and his colleagues, 2006), resilience(Conner & Davidson, 2003), and quality of life (standardized by Gholamrezaei, and his colleagues).Results:Based on regression results, there is a relationship between illness perception and the quality of life of the patients with ulcerative colitis.In addition, the results of correlation have shown that there is a significant relationship between alexithymia, illness perception, andresilience with the quality of life of the patients (p<0.05).Conclusion:It can be concluded that among the variables, illness perception is the most relevant to the quality of life.

Background:Colorectal cancer (CRC) is one of the most common gastrointestinal cancers worldwide. KRAS mutations are found in 20-30% ofthe cases and are associated with poor response to anti-EGFR therapies. Mutations in the KRAS gene induce the constitutive proteinactivity by eliminating the GTPase activity in the signal transduction pathway. Somatic mutations of KRAS are located up to 90%in codons 12 and 13 of exon 2. Therefore, this study evaluated the association between KRAS mutations and clinicopathologicalfeatures of patients with CRC in Isfahan.Materials and Methods:This study was performed on 52 patients with CRC referred to Al-Zahra Hospital in Isfahan. Total DNA was extracted from freshtumor and normal tissues. The exon 2 of KRAS gene was amplified and sequenced for detection of the point mutations. Aftermutation analysis, the clinical and pathological associations of mutant genes were assessed.Results:The prevalence of KRAS gene mutation was 15/4% (8 out of the 52 cases). Six mutations found in codon 12 (75%), were G12Dand G12A, and two mutations found in codon 13 (25%) were G13D. Common tumor sites were rectum and rectosigmoid. Themean age of the patients was 61/2±13/9 years (range: 31-87 years). There was no significant relationship between the mutationsand clinicopathological features of patients with CRC (p>0.05).Conclusion:This paper presents new results on the frequency of KRAS mutations in patients with CRC. KRAS mutations could be used asmolecular biomarkers to predict the lack of response to anti-EGFR monoclonal antibodies.

Background:Providing ways for long-term feeding is essential for those who are not able to ingest. Percutaneous endoscopic gastrostomy(PEG) is a type of enteral feeding methods. The aim of this study was to evaluate the complications, indications, and one-yearsurvival of this method in patients who underwent PEG.Materials and Methods:The cross-sectional study was carried out on 97 patients (census sampling) who had referred to Shahid Sadoughi Hospital in Yazd(Iran) for PEG tube placement in the period of March 2014 to March 2016. Data were collected using a researcher-made questionnaireand were analyzed using SPSS software version 18.Results:Cerebrovascular accident (CVA) was the most reason to refer to the hospital (52 cases, [%53.6]) followed by head and necktrauma (32 cases [33%]), head and neck tumors (6 cases, [6.2%]), ischemic encephalopathy (5 cases, [5.2%]), and burning (headtrauma) (2 cases [1.2%]). Wound infection was observed in eight cases (8.2%), aspiration in three cases (1.3%), bleeding in threecases (3.1%), external leakage in two cases (2.1%), unplanned removal in two cases (2.1%), subcutaneous abscess in one patient(1%), and recurrent vomiting in one patient (1%). One year survival was measured 83.5%.Conclusion:PEG tube is a very convenient feeding method. Its complications are limited compared with its benefits and it is useful for patientswho have trouble in ingestion for a long time. Early discharge from the hospital, especially the intensive care units, reduces costsand length of hospital stay.

Background:Hepatitis delta virus (HDV) is an RNA virus that causes hepatitis. Since HDV is dependent on hepatitis B virus (HBV) for itspathogenesis, two major types of HDV and HBV infection is coinfection with HBV in anti-HBs negative individuals, or superinfectionin chronic HBV carriers. Therefore, the prevalence of HDV depends on the frequency of HBV infection in various populations.In this study, we aimed to systematically review the prevalence of HDV in Iran.Materials and Methods:A systematic literature search was performed in August 2016 in PubMed, Scopus, and Iran Medex using the following keywords(((hepatitis delta virus OR HDV)) AND (prevalence OR frequency OR distribution OR epidemiology)) AND Iran to investigatethe prevalence of HDV in Iran. After literature search and selection of appropriate documents, the desired data were extractedand described.Results:A total of 14 articles with overall 6300 study population with HDV infection were collected. The results of this study showed thatthe prevalence of HDV varied from zero in the north to 19.7% in the south of Iran (in HIV infected patients).Conclusion:The prevalence of HDV was relatively high among Iranian patients with chronic HBV infection. Furthermore, the results of thisstudy showed that the prevalence of HBV/HDV coinfection has increased during the last decade in Iran.

A 48-year-old man was found to have elevated liver enzymes and clinical manifestations of icter, itching, nausea, and vomiting. He had developed a servere hepatotoxic reaction, liver fibrosis, and cirrhosis after treatment with acitretin 25 mg daily (oral retinoid, which is the derivative of etretinate). Elevated serum aminotransferase levels, which are usually reversible, have been reported during treatment with acitretin, however; the present study indicates a warning message that severe hepatotoxic injury may follow such a treatment.

Lower gastrointestinal bleeding refers to bleeding within the lumen of the gastrointestinal tract located below the ligament ofTreitz. In this study, we present a case with bleeding from massive anorectal varices, caused by a congenital high pressure Portosystemicshunt.A 31-year-old man with a prolonged history of painless rectal bleeding was referred to our center. The onset of symptoms was atthe age of two years. Finally, he underwent semi-elective surgery due to severe bleeding and a diagnosis of portosystemic shuntwas made intraoperatively.