Govaresh
Volume:14 Issue: 4, 2010

Tuberculosis continues to be a common health problem worldwide. Rifampin, an antibiotic used routinely for tuberculosis chemotherapy is documented to be a potent hepatotoxicant. The aim of the present study was to assess the antioxidant activity of ethanolic extract of Crocus sativus L. stigma (EECSL.S) against rifampin induced hepatotoxicity in the rats. Male Wistar rats were randomly assigned into 5 groups of 8 animals each. Group I served as normal control and received normal saline (10 ml/kg). Group II served as toxicant control and received rifampin (500 mg/kg). The reference drug silymarin (50 mg/kg), EECSL.S at 40 mg/kg and EECSL.S at 80 mg/kg were administered to the groups III-V, respectively. These three groups received rifampin (500mg/kg) too. All treatments were administered by P.O. route dissolving in 10 ml/kg normal saline daily for 1 month. At the end of experiment, product of lipid peroxidation (MDA), activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX) and glutathione reductase (GR) were assayed in liver homogenates to evaluate antioxidant activity. Significant differences among the groupswere determined by oneway analysis of variance followed by Bonferroni post-test. Statistical significance was considered at p ‹ 0.05. In rifampin-treated rats, EECSL.S (40 and 80 mg/kg) and silymarin significantly decreased the lipid peroxidation and elevated the levels of antioxidant enzymes, in a dose dependent manner. The present findings suggest that the hepatoprotective effect of Crocus sativus L. stigma in rifampin induced oxidative damage may be related to its antioxidant and free radical scavenging activity.

In clinical trials of Irritable Bowel Syndrome (IBS), evaluation of treatment efficacy is still mainly subjective.We compared three outcome measures in reflecting response to treatment in a clinical trial of IBS. Sixty three adult IBS patients participated in a placebo-controlled trial of 10-wk cognitive-behavioral therapy. Patients completed the IBS-quality of Life questionnaire (IBS-QOL),IBS-symptom severity scale (IBS-SSS), extra-intestinal symptom severity scale (EISSS), and HospitalAnxiety and Depression Scale (HADS) before and after the intervention.After the intervention, patients responded to the IBS-Adequate Relied (IBS-AR) and IBS-Global Assessment of Improvement (IBS-GAI) instruments. Patients were categorized into responders and non-responders based on each of the IBS-AR, IBS-GAI, and IBS-SSS instruments. Quality of life, IBS and extra-intestinal symptoms severity, anxiety, and depression scores were compared between the responders and non-responders. Forty six patients (mean age 31.5 ± 6.9 years, 82.6% female) completed the study. After the intervention, significant correlations were found between responder definitions results (r=0.385 to 0.689, P‹0.001). Compared with IBS-AR and IBS-GAI, defining responders based on the IBS-SSS instrument was related to more reduction in severities of IBS and extra-intestinal symptoms, anxiety, and depression scores and to more increase in quality of life scores. The IBS-SSS instrument ismore comprehensive in reflecting changes in symptoms severity, quality of life, and psychological status compared with other outcome measures. IBS-AR is accepted as the current standard for evaluating the efficacy of IBS treatments, however, we recommend IBS-SSS to be applied as well.

Hepatitis B is the most common cause of acute and chronic viral hepatitis in Iran. It is the etiology of 70% of end-stage liver disease and hepatocellular carcinoma in the country. Before the universal neonatal vaccination in Iran (1992), the contact rate with HBV was about 30% and the HBs Ag+ rate was about 3%. In 2009 the contact rate has declined to 18% and HBsAg+ rate decreased to 2%. The estimated total number of death due to HBV is about 5000.Almost 90% of about 2 million carries in Iran are unaware of infection. Early diagnosis and effective therapy of this infection could reduce the morbidity and mortality of infection.

Celiac disease has protean manifestations. In this report, a 24 year-old young female with celiac disease and acute lower extremity deep venous thrombosis (DVT) is presented. The patient was a 24 year-old female who presented with long standing diarrhea, 8 kg weight loss in the recent month, lower extremity edema, petechiae and purpura. Laboratory exam demonstrated very high titers of IgA antiendomysial antibody and IgAanti-tTG plus a positive histology. Doppler sonography revealed the presence of acute DVT in common femoral vein expanding towards distal. Due to increased PT and PTT and protein C deficiency, vitamin K deficiency as a consequence of celiac disease was suggested. With the initiation of gluten free diet, vitamin K replacement and anticoagulant therapy, symptoms resolved in few days. Six months later, she had a weight gain of 20 kg. It is highly recommended to evaluate patients with chronic diarrhea,weight loss and DVT for celiac disease markers.

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the gastrointestinal tract wall (especially stomach and small bowel). Symptoms and signs of this disease depend on the involved layer of gastrointestinal tract. Hereby, we are presenting a patient with abdominal pain since one month ago that aggregated with meals. The patient had 5 kg weight loss. In laboratory testing, he had leukocytosis (13,000) with 6%eosinophilia.Abdominal X-ray showed air-fluid level. Jejunal and rectal wall thickenings were reported in abdominal CT scan. In laparoscopy, bleeding lesions in small bowel were observed and biopsy specimens were taken. Pathologist reported infiltrations of eosinophilic and inflammatory cells in lamina propria.

To determine the colon transit time (CTT) in patients complaining of functional constipation and to evaluate the correlation between abnormal transit times and the types of constipation and the correlation with age and sex.

The signs and symptoms of 84 patients with infrequent or difficult defecation, 33 males and 51 females, with a median age of 33.7 were recorded by means of a questionnaire. After ingestion of radioopaque material, 20 markers per day for 3 days, abdominal X-rays were taken on days 4 and 7. If more than 5 markers remained in the segment of colon, another X-ray was taken in day 10. The numbers of markers in the X-ray and per segment (right and left hemi-colon and rectosigmoid colon) were counted; the CTT in hours was calculated by multiplying this number by 1.2.

The total CTT was normal in 61 patients (72.6%) and prolonged in 23 (27.4%) ones. The CTT was prolonged in the rectosigmoid colon in 8 patients with an average total CTT of 81.3 ± 21.52 h, in 8 patients in the left colon with an average total CTT of 98.5 ± 40.083 h and in 7 patients in the right colon with an average total CTT of 19.94 ± 19.35 h. Of the patients with a normal total CTT, 41 (67.2%) ones had Rome III criteria for IBS. No statistically significant correlation could be demonstrated between CTT and age or sex.

Functional constipationmay be associatedwith a normalCTT.Disorders of colonicmotility and rectal evacuation could be distinguished bymeasuring the total and segmental colonic transit times.

Although plenty of medications have shown promise in the treatment of irritable bowel syndrome (IBS), none have relieved all complaints adequately to be considered as gold standard. Based on previous data regarding the effectiveness of olanzapine in other functional or psychosomatic disorders and clinical experience of the authors on its efficacy and safety, we considered to test this drug in combination with citalopram for IBS. IBS patients who were refractory to conventional treatments were assigned randomly to take placebo or citalopram (C) with either placebo or olanzapine (O) by which, 38, 36 and 38 patients entered in the study in each group, respectively. The patients were evaluated for quality of life (IBS-QOL), severity and frequency of symptoms, depression and anxiety (HADS) before intervention and 4 and 12 weeks after initiation of the treatment. Thirty one of the placebo (P) group versus 13 patients of the control (C+P) and 17 of the case (C+O) completed the full course of study. While there was a trend toward better results in intervention groups compared to placebo alone, no statistically significant difference was observed among the three intervention groups in quality of life (p =0.799); but, there was a significant improvement from pretest scores in both 4 and 12 week observations in all three groups (p‹0.001). Similar findings were detected between the two intervention groups for severity and frequency of symptoms as well as anxiety and depression scores. There was a significant rate of discontinuation of the study in the intervention groups compared to the placebo group. Citalopram neither alone nor in combination with olanzapine added significant benefits to IBS symptoms in this study.

Fecal calprotectin (FC) has been suggested as a noninvasive substitute marker to determine the degree of intestinal inflammation in patients with inflammatory bowel disease (IBD). The aim of this study was to compare FC levels in IBD and irritable bowel syndrome (IBS), to show its discriminative value and relationship with clinical disease activity in patients with IBD.Materials and During the time period betweenMay 2008 andNovember 2009, 41 patientswith newly diagnosed or relapse of IBD and 40 patients with IBS who referred to Gastroenterology Clinic of Firoozgar Hospital, Tehran, Iran, were selected in a consecutive randommanner.Asample of stool was collected fromeach patient before colonoscopy, and fecal calprotectin levels were measured using an ELISA kit (Buhlmann Co.,Switzerland). Differences in FC levels were considered statistically significant where p‹0.05. Mean calprotectin level in IBD cases (newly diagnosed and relapse) was 193.57±147.79μg/gr,which was significantly higher than those in IBS cases (28.25±15.13μg/gr) and the difference wasstatistically significant (p‹0.001). FC levels can be used to differentiate patients with IBD from those with non-inflammatory gastrointestinal disorders such as IBS and can be used as a screening tool for selection of patients who need colonoscopy.