Govaresh
Volume:21 Issue: 2, 2016

Approximately 20% of the incidence of cancers are caused by obesity. There have been several studies showing that weight loss, through calorie reduction and increased exercise, can potentially reduce the risk of cancer in obese people. But currently other special methods such as anti-obesity drugs or bariatric surgeries are used for intentional weight loss. Whether such intentional weight loss protect against gastrointestinal malignancies in obese people is a matter of debate. The purpose of the present review was to evaluate the evidence for recommending intentional weight loss as a mean of gastrointestinal cancer prevention.

Interferon-free treatments for hepatitis C have been recently available. They can cure over 95% of patients within 12 weeks without significant side effects. A combination of daclatasvir and sofosbuvir has been particularly useful as it is effective against all genotypes of hepatitis C virus (HCV). The combination of sofosbuvir and daclatasvir in a single pill has been recently manufactured in Iran (Sovodak®). The current paper is a preliminary report on the first patients treated with Sovodak.
100 patients with cirrhosis due to hepatitis C were included. All genotypes of HCV were eligible. All the patients received treatment with daclatasvir and sofosbuvir (Sovodak) in combination with ribavirin for 12 weeks and were evaluated for effectiveness of the treatment 12 weeks after termination of the treatment (SVR12, sustained virological response at 12 week). The results of the first 50 patients are presented here.
Of the first 50 patients enrolled in the study, 47 reached the endpoints. Of them, 17 were infected with HCV genotype 3 and showed 100% response to the treatment (17/17). The remaining 30 patients were infected with genotype 1 and 97% responded (29/30) to the treatment. No adverse effects were reported.
According to international guidelines, the combination of sofosbuvir and daclatasvir is the first line of treatment for all genotypes of HCV infection. For patients with cirrhosis, ribavirin is also added. In our study the efficacy of this combination in patients with cirrhosis was 97% and 100% for genotypes 1 and 3, respectively. Due to its high efficacy and ease of use, we recommend Sovodak for the treatment of all genotypes of HCV in Iran.

Combination antiplatelet therapy is a classic treatment for percutaneous coronary intervention (PCI) but this therapy increases gastrointestinal bleeding (GIB). This study highlights the incidence of related risk factors of GIB and endoscopic findings in patients with GIB after PCI and combination antiplatelet therapy.
A standard check list was used to evaluate the significant risk factors of GIB and upper endoscopic findings in combination antiplatelet treated patients after PCI in the GI center of Rajai Hospital- Karaj, Iran. All statistical tests were performed using SPSS software version 22.0.
During a 12-month period, a total of 103 patients with a mean age of 63 years were included. 64 patients were admitted to hospital and 39 patients were visited in the GI clinic. 54.4 % of the patients were male. The patients’ symptoms were melena (82.5%), hematemesis (28.1%), and hematochezia 3.9%). 6.8% of the patients were admitted with severe GIB and unstable conditions. Findings of upper endoscopy (n=82) were duodenal ulcer (63.4%), gastric ulcer (37.8 %), hiatal hernia (23.2%), Mallory Weiss syndrome (13.4%), gastric tumor (3.7%), and esophageal hematoma (2.4%). Normal endoscopic finding was seen in 14.6% of the patients who had history of GIB. Rapid urease test was positive in 46.3% of the patients. 12.6% of the patients died during hospital admission.
The high prevalence of GIB risk factors were seen among combination antiplatelet treated patients. By identifying and control of such risk factors, GIB in patients receiving combination antiplatelet therapy can be minimized.

Tramadol narcotic drugs or Epoxied artificial categories is weaker than morphine and stronger than ibuprofen and acetaminophen drug. The aim of this study was to investigate the effect of oral tramadol on some liver enzymes in the rat.
In this study, 60 male Wistar rats were randomized into three groups (one control group, and experimental groups of 1, and 2). In the control group adequate serum physiology and in the experimental groups a dose of mercuric chloride was infused into the peritoneal cavity for 30 days. The first experimental group received 50mg/kg tramadol, and the second experimental group received 100mg/kg methadone daily for 30 days
In this study, a significant increase in the amount of alanine and aspartate transaminases were observed in the experimental group compared with the control group.
This study showed that gavage tramadol can cause disruption in the balance of liver enzymes levels.

We report a rare case of congenital foregut cysts (esophageal bronchogenic cyst) in a young woman with history of long term dysphagia. She presented with dysphagia and upper gastrointestinal endoscopy showed bulge submucosal lesion in the distal of the esophagus. Endoscopic ultrasound showed a 3×3 cm cystic lesion suggestive for esophageal duplication or bronchogenic cyst. Computed tomography of chest confirmed a cystic mass located in the same region. Thoracotomy was performed and the large cystic mass was seen between the mucosa and muscular layers of the esophagus, which was successfully resected. Pathological examination of the cyst revealed characteristic findings for esophageal bronchogenic cyst.

Obesity may lead to various morbidity including liver diseases. The present study was done to determine which obesity indices, including body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), and waist to height ratio (WHtR) have the stronger association with rising levels of alanine aminotransferase (ALT).
Material and Of 6143 subjects aged ≥ 10 years of a cohort study in northern Iran, the data of 5052 subjects were analyzed. We performed multivariate logistic regression analyses for data of men and women, separately. In multivariate analyses the obesity measures were separately included in model in addition to other potential confounders. A high value of ALT was considered as outcome. The capability of obesity indices to discriminate an elevated level of ALT was evaluated using receiver operating characteristic (ROC).
Based on our results, men and women with obesity showed significantly higher values of liver enzymes for all obesity indices. In multivariate analysis, while WHtR showed the strongest association with a high value of ALT in men [Wald=91.44; OR=3.348, 95%CI (2.613-4.289); PWHtR in men and WC in women have more independent association with elevated levels of ALT.

There are no data on familial aggregation of colorectal cancer (CRC) in northeastern Iran. The aim of this study was to determine the prevalence of early-onset CRC and patients suspected for hereditary non-polyposis colorectal cancer (HNPCC) based on the clinical criteria in this area.
Documents were collected from two hospitals in Mashhad regarding 326 inpatients during 2013-2015. Demographics, clinical, and tumor-related features were recorded. Interviews were done to identify cancer in the family up to second-degree relatives.
326 patients with CRC (48.5% male) were evaluated. The mean age at diagnosis was 55.44±14.85 years, with 91 patients (27.9%) below 45 years old. Eleven (3.4%) patients fulfilled the Amsterdam II criteria and 136 (41.7%) patients met at least one criterion of the revised Bethesda guideline. There was no difference between early- and late-onset CRC regarding the frequency of CRC in 1st degree relatives or tumor site (p=0.73, p =0.64). However, CRC in second-degree relatives and cases suspected for HNPCC were more common in early-onset of the disease (p =0.022, p =0.024). The patients who fulfilled the Amsterdam II criteria had lower mean age and higher frequency of proximal cancer (p =0.03, p =0.048).
As CRC is common in the young population and CRC clustering and patients suspected for HNPCC are also frequently encountered, measures should be taken to CRC screening policy and genetic studies in this area.

Biliary papillomatosis is a disorder characterized by numerous adenomatous polyps of variable distribution and extent in intrahepatic bile ducts. It should be considered as a premalignant condition because a high proportion of the lesions undergo malignant transformation. In this report, we present a patient with abdominal pain and jaundice.
According to his presenting signs and symptoms, ERCP was done for him and multiple biopsies were taken from the common bile duct. Due to high grade dysplasia in the pathological report, Whipple surgery was performed and specimens were sent for microscopic evaluation. Histological examination showed intraductal biliary papillomatosis.