Govaresh
Volume:20 Issue: 3, 2015

The prevalence of bariatric surgery procedures has increased dramatically in recent years and multiple specialties encounter bariatric patients. In this article, we outline the different options in bariatric surgery and summarized the recommendations for gastrointestinal assessment of candidates before and after bariatric surgery. The role of routine endoscopy was controversial in pre surgical evaluation but may alter the operation performed. Comprehensive pre-operative screening conducted by a multidisciplinary team including gastroenterologist was essential to prepare obese patients for successful outcome following surgery. The most commonly performed procedures were Roux-en-Y gastric bypass and adjustable gastric banding. We presented the early and late complications of bariatric surgery and recommendations for post-operative cares by gastroenterologist in this review article.

Celiac disease (CD) has an autoimmune disease in response to ingestion of foods containing gluten sausing damage to the mucosal tissue of small intestine. The disease can severely affect quality of life. This study aims to assess the relationship between behavioral disorders and quality of life (QOL) in patients with celiac disease. 87 celiac patients and 100 healthy individuals are selected and matched for age, sex and education. Patients with Celiac disease were recruited from a subspecialty clinic in Imam Reza (AS) Hospital and clinic in Ghaem in Mashhad. The control group consisted of healthy participants. Participants completed the Beck Depression Inventory, State Anxiety Inventory-Trait Spielberger, Toronto Alexithymia Questionnaire and SF-36 Quality of Life Questionnaire. Research data were analyzed by Pearson correlation and multiple regression analyses.There was no significant difference between the two groups in demographic variables. However significant differences existed between the variables of anxiety, depression and alexithymia. The patient group had higher depression and anxiety levels compared to healthy controls. Multiple regression analysis showed behavioral disorders, explains 43% of the variance in quality of life in patients with CD. Overall, the findings indicate there is a direct link between behavioral disorder and reduced quality of life of celiac patients. Psychotherapy and cognitive behavioral therapy can improve emotional patterns and cognition of celiac patients.

Finding shows that there were several problems in the treatment of Helicobacter pylori infection such as the emergence of resistance to the antibiotics, the risk of recrudescence, and the high cost of treatment. The ineffectiveness of conventional treatment mechanisms against cancer cells reveals the importance of peptides as a novel therapeutic approach. However, the short length of peptides was a restriction factor to realise this approach. As a result, one or more amino acid residues were added during the cloning process that leads to the loss of the original peptide folding. The aim of study was to change the structure of the pCold I vector using site-directed mutagenesis in order to do the directional cloning of each target gene and express/purify the small peptides and native proteins without any additional N terminus amino acids.. Site-directed mutagenesis was performed by plasmid amplification in two individual PCR reactions. Two PCR products were mixed and denatured to separate the nascent strands of plasmid DNA from the parental ones. Slow cooling conditions were used to allow reannealing of PCR products. The products were digested with DpnI that digests methylated parental strands, and then transformed into E.coli DH5α. The mutant plasmid was identified by digestion with NdeI and PceI and sequencing. The mutant plasmids were not digested by NdeI. The presence of mutation was also confirmed by sequencing. In mutant vector the cut sites of both the first restriction enzyme at the multiple cloning site (at the nucleotide level) and factor Xa (at the amino acid level) became the same. The modified vector can be widely used for a fast and more convenient cloning and expression of the native proteins and short peptides, including anti-H.pylori peptides and anti-angiogenesis, gastric anti CSCs and anti-metastatic peptides.

Irritable bowel syndrome (IBS) was one of the most common functional gastrointestinal disorders. Psychological treatments have been effective in reducing symptoms severity and increasing mental health and well-being of these patients to some extent. The aim of this study was to determine the effectiveness of cognitive – behavioral stress management training on symptoms severity and psychological well-being of patients with IBS. The study was an experimental clinical trial with pretest – posttest design with control group. The subjects were 30 patients with IBS who were selected based on convenience sampling and were randomly divided into one experimental (N=15) and one control (N=15) group. there was a significant relation between symptoms severity and psychological wellbeing in two groups(p<0.001). Cognitive – behavioral stress management training can be effective in reducing symptoms severity and improvement of mental health in patients with IBS and attention to the psychological situation of these patients is necessary.

This research aimed to determine the efficacy of emotion focused therapy on quality of life and sleep problems of IBS patients. In this research 52 IBS patients who met this diagnosis, according the Rome II criteria, were selected and assigned to two experimental and control groups with 26 IBS patients in each group. The emotion focused therapy according Greenberg''s manual- was conducted in 8 weekly sessions in the clinic of gastroenterology in Isfahan. The questionnaires of quality of life and sleep problems were completed as the pretest, post-test and follow-up. Results of multivariate analysis of variance s shows that emotion focused therapy has been significant effect in reduction of post-test mean scores of quality of life, beginning of sleep and wake-up and follow-up mean scores of wake-up (p<0. 05). Emotion focused therapy could be useful to improvement of psychological status of IBS patients, but It seems to needs to probing more emotional experiences for more persistent effects.

Vascular endothelial growth factor (VEGF) is a signal protein produced by cells that stimulates angiogenesis and increased vascular permeability. The prognostic value of VEGF expression in colorectal cancer is unclear as shown by the discordant results still reported in the literature. This study was designed for the evaluation of VEGF expression and correlation with clinicopathologic features in colorectal cancer. In this study, 60 paraffin – embedded blocks including colorectal cancer specimens and adjacent non-neoplastic tissues were evaluated for VEGF immunohistochemical expression and their correlation with clinicopathologic features among the patients who admitted in Sari Imam Khomeini hospital. Among the 60 patients (30 males,30 females) 51.7% (31 cases) showed VEGF overexpression (High staining), while it was 1.7% (1 case) in adjacent normal tissue (p=0.004). VEGF expression was correlated with stage(pvalue< 0.001),grade(p-value<0.001), lymph node metastasis(p-value<0.001), recurrence(p value<0.001) and tumor size (p-value<0.001). In other clinicopathologic parameters, no relationship with VEGF expression was seen. These findings provide further evidence for the role of VEGF in colorectal carcinogenesis. Some previous studies showed discordant results, consequently more studies with larger sample size to confirm results are recommended.

This was a case of acute pancreatitis who complicated by left side hemiplegia and dysarthria. It diagnosed as Lacunar infarction and therapy with intravenous heparin started according to neurologist order. In third day of admission, the patient suddenly got dyspnea, tachycardia and tachypnea. Infusion of heparin continued with clinical diagnosis of pulmonary emboli and also warfarin added to his therapeutic regimen. The clinical condition of patient gradually got better and on 7th day of admission, he could tolerate oral regimen without any respiratory difficulty and his hemiplegia improved. On the following day, he discharged from ward with prescription of warfarin.

Annular pancreas (AP) is a rare congenital abnormality in which pancreatic tissue completely surround the duodenum. Presentation of AP in adulthood is very rare and obstructive jaundice is one of the uncommon manifestations of AP in adults. Herein; we reported a 47 years old woman who presented with icterus, mid common bile duct stricture and annular pancreas. She was diagnosed as pancreas cancer three months after surgery. Although AP presenting with jaundice is rare but is indicative of significant relationship with periampullary malignancies and requires a complete investigation of these cancers and close follow up.