GOVARESH JOURNAL
Year:2008 | Volume:12 | Issue:4 (SN 61)|Papers Count:13

Background: Parasitic diseases are among the most important problems of many countries in the world, especially developing ones.Since various parts of Iran have different types of weather, jobs and people, different and separate epidemiological studies for each province will be necessary. We have scarce information on the epidemiology of intestinal parasites in tribal regions of Khuzestan province. Therefore, we conducted this study to determine the prevalence of intestinal parasites in this part of Khuzestan Province.Materials and Methods: In a cross-sectional study, using a cluster random sampling 15 clusters were studied. 15 villages from the Southwest and 13 from the Northeast regions were selected at random.In each village (tribal region) 20-25 families were selected at random (a total of 50 cases in each village). A total of 1494 persons (789 males and 705 females) with different ages were studied for intestinal parasitic infestation using the formalin ether deposit method on all samples, and direct spreading method for those with diarrhea. Fresh samples were collected and sent to the laboratory on the same day.Results: Age of participants ranged from 6 months to 100 years. The participation ratio was 40.4%. 379 (25.4%) of participants were infested with at least one type of intestinal parasites (pathogenic/non-pathogenic protozoa/helmint). 322 (21.6%) participants were infested with intestinal protozoa and 57 (3.8%) with intestinal helmints. The most common intestinal protozoa were Giardia lamblia (10.9%), Entamoeba coli (9.4%), and Blastocystis hominis (2.4%); the most common intestinal helmints were Hymenolepis nana (2.5%), Strongyloides stercoralis (0.6%) and Trichostrongylus species (0.5%).Conclusion: The tribal parts of Khuzestan province have a poor health status. There is an increase in the prevalence rate of Giardiasis.Furthermore, significant differences existed in prevalence rates of infestation with intestinal parasites between the two studied areas.

Background: Chronic hepatitis B virus (HBV) infection represents a major global public health problem. Though there is an effective prophylactic vaccine, more than 370 million people round the globe are chronically infected with HBV.In spite of vaccination, as a therapeutic approach in chronic carriers, some patients are unable to induce an immune response. Such failure is often caused by emergence of mutations in immune epitope of the surface gene.Materials and Methods: 19 consecutive chronic HBsAg carriers with chronic hepatitis and detectable level of serum HBV DNA were given 3 standard injections of the B vaccine at one month interval. Blood samples were collected from each patient before each dose of the vaccine.Nested-PCR was performed on each specimen using specific primers which amplified the S-Ag region. Direct sequencing and alignment of sequences with Iranian species and databases were used for detecting probable mutations.Results: Direct sequencing revealed substitutions in these sequences which were silent and/or amino-acid-changing mutations outside the "a" determinant of surface genes. Most mutations were occurred in the 205-215 regions. The changes included 92 amino acids: 51 in the immune epitope (25 in the CTL epitopes, 21 in the Th cell epitopes and 5 amino acid in the B cell epitopes) and other changes were observed in other regions. The distribution of the mutations could be categorized in 3 groups: The mutation was increased in 3 samples after treatment, was decreased in 6 samples after treatment, and was not different with pretreatment in 7 samples.Conclusion: Mutations occurred outside the "a" determinant.Mutations of the immune epitopes Th and CTL cell could be a type of escape immune response and are responsible for failure in response to immunotherapy.

Background: It is presumed that gastric cancer has several etiologies.First-degree relatives of patients with gastric cancer are suggested to be at higher risk compared to others. This is the first study aimed at estimating this risk, using meta-analysis of case-control studies.Materials and Methods: All records prior to February 2008 in PubMed and EMBASE were searched for case-control studies comparing the frequency of positive family history of gastric cancer in patients with the cancer vs those without gastric cancer. Meta-analysis of pooled odd ratio (random model) was performed by software Review Managerâ, ver 4.2.Results: Fourteen studies out of 113 potential abstracts were included.These included 8,506 patients in gastric cancer group and 53,782 in the control group. 23.5% of the patients and 11.5% of the controls had at least one relative with gastric cancer (p<0.00001). Relative risk for development of gastric cancer in those with a positive family history to controls was 2.86 (95% CI: 2.21-3.70). There was a significant large heterogeneity in the findings of the studies. The heterogeneity was only low in studies with high quality scores. Subgroup analyses of studies in Asian populations, studies with higher quality scores, those with study question as the primary objective and those considering only first-degree relatives were not significantly different from those studies in populations.Conclusion: Patients with a first- or second-degree relative with gastric cancer are almost 3 times more likely to develop gastric cancer compared to other people. Screening guidelines should be developed to early diagnosis and management of gastric cancer in this population.

Background: Food consumption pattern and lack of some nutrients is known as main environmental risk factor of esophageal cancer. We investigated nutritional risk factor and food consumption pattern of people who live in high risk area in Golestan province.Materials and Methods: We investigated food consumption pattern of more than 30 years old Gonbad and Kalale's people who recruited in Golestan cohort study. Assessment carried out with validated 117 items semi quantitative food frequency questionnaire. We also used Iranaian data bank for nutritional analysis. Multiple linear regressions used to compare between sex, Gender, place and ethnicity.Results: From 30463 subjects, aged 52.2 women, Turkmen ethnicity and rural dweller was 57.7%, 75% and 73.6% respectively. Overweight and obesity were common among urban dweller women in compare to other groups. Energy induced from carbohydrate, fat and protein were 65%, 22% and 13% respectively.Conclusion: People in Golestan had lower intake of some nutrients such as Riboflavin, fiber and vitamin A than recommended dietary allowance by FAO/WHO.

Background: Colorectal cancer (CRC) is a common and lethal malignancy worldwide. The incident rate of CRC is different in various geographica regions. CRC is a multifactorial disease; the factors involved included dietary and genetic factors. P53 gene is the most important tumor suppressor gene which involved in many cancers. The mutation rate in exons 7 and 8 of P53 gene in CRC was reported to be different in the world. The objective of this study was to detect the mutations in the exons 7 and 8 of P53 gene and to determine their correlationship with histopathologic parameters in CRC.Materials and Methods: This study was performed on 80 specimens taken from patients with CRC referred to to Isfahan hospitals between 2003 and 2006. DNA was extracted by phenol chloroform isoamil alcohol after tissue processing and making the pathologic diagnosis in the Genetic Department of Isfahan Medical School. Exons 7 and 8 of P53 gene were amplified using specific primers in a PCR assay. After gel electrophoresis, the mutations were detected by SSCP method.Results: From 80 specimens, 9 (11%) were found to have mutations; 4 (5%) had mutations in exon 7 and 5 (6%) in exon 8. The presence of mutations did not have any significant association with stage and level of cell differentiation of tumors and with anatomical region (p>0.05).Conclusion: Although we could not observe any association between the presence of P53 gene mutations and some histopathologic and anatomic presentations of CRC, the pattern of mutations observed in exons 7 and 8 of P53 gene in CRC was different from that reported from many areas of the world.

Background: To perform screening for colonic cancer and to diagnose other colic diseases, colonoscopies are required. Comfort of patient during colonoscopy is very important. Currently, there are two types of sedation used during colonoscopy-the general anesthesia and sedoanalgesia.Sedo-analgesia is the most frequently used type of sedation employed during colonoscopy worldwide.Materials and Methods: In a double-blinded randomized clinical trial, 145 patients underwent colonoscopy were randomly assigned to four treatment arms. Group A patients received 50 mg hydroxyzine orally.Group B patients received 50 mg hydroxyzine orally and 25 mg pethidine intravenously. Group C patients were administered 25 mg pethidine intravenously and patients in group D were given 25 mg pethidine plus 2.5 mg midazolam intravenously. The patient satisfaction was then evaluated using a GHAA-9 questionnaire and measuring the pain by a visual analogue scale.Results: There were differences among the three groups. Sedation with hydroxyzine alone or in combination with pethedine resulted in a significantly better satisfaction (p<0.05). The excellent score for the patient satisfaction was 84.3% in hydroxyzine group, 64.9% in hydroxyzine+pethidine group, 5.7% in pethidine group and 5.7% in pethidine+midazolam group.Conclusion: Oral hydroxyzine is more effective than combinations of a narcotic and benzodiazepine in provision of pain relief and achievement of patient satisfaction in colonoscopy. Hydroxyzine is an excellent alternative to traditional intravenous drugs.

Ascites in the course of Crohn's diseases is rare and is usually a sign of a concomitant malignancy, infection or thrombosis of portal or hepatic vein. Herein, we reported on a 26-year-old man who was initially admitted with severe Crohn's ileocolitis complicated by copious exudative ascites, abdominal pain and sever diarrhea. In our patient, we could not find any of the aforementioned conditions-there was no evidence of malignancy, portal hypertension or inflammation in any organs other than the bowel.The patient got better after treating with 5-ASA and prednisolone during one year of follow-up.

Five years survival for decompensated cryptogenic cirrhosis has been reported less than 14%. The patient is a 70 years old man who had cryptogenic cirrhosis since the last 22 years after splenectomy. He had episodes of upper GI bleeding and ascitis at least for the last 17 years.He is still alive and is doing his daily work appropriately.