فهرست مطالب

Middle East Journal of Digestive Diseases
Volume:11 Issue: 1, Jan 2019

  • تاریخ انتشار: 1397/10/22
  • تعداد عناوین: 8
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  • Kamelia Hashemzadeh, Mohammad Hassan Jokar, Sima Sedighi, Maliheh Moradzadeh Pages 5-16
    Therapeutic targeting of phosphatidyl-inositol 3-kinase (PI3K) is considered as a possible strategy in several types of cancer, including gastrointestinal ones. In vitro and in vivo studies indicated the significance of proapoptotic and antiproliferative inhibition of PI3K. Although there are many phase 1 and 2 clinical trials on PI3K inhibitors in patients with gastrointestinal cancer, the molecular mechanism of PI3K targeting PI3K/mTOR pathway is not clear. Pan class I, isoform selective, and dual PI3K/mTOR inhibitors are under investigation. This review aimed to indicate PI3K-dependent targeting mechanisms in gastrointestinal cancer and the evaluation of related clinical data.
    Keywords: Gastrointestinal cancer, PI3K pharmacological inhibitors, Clinical trials
  • Najmeh Aletaha, Zohreh Dadvar, Babak Salehi, Pardis Ketabi Moghadam, Ali Niksirat, Akram Jowkar, Reza Taslimi, Seyed Farshad Allameh, Naser Ebrahimi Daryani Pages 17-23
    BACKGROUND
    A dramatic rise in the rate of clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has been reported in recent years.  
    METHODS
    In this observational case control study, 65 patients were included and were divided into two groups of IBD+CDI as case group and IBD without CDI as control group.  
    RESULTS
    35 patients who had positive test for clostridium difficile were assigned to the case group. The control group consisted of 30 patients with negative test for clostridium difficile. Pancolitis was seen in the cases more statistically significant than the controls and proctitis was seen more among the controls than the cases (p =0.001). The cases were on immunosuppressive (p=0.001) and antibiotic (p =0.02) therapy more than the controls. Colonoscopic findings revealed more severe and extensive inflammation among the cases versus milder inflammation among the controls, but these differences were not statistically significant (p =0.2). Colectomy was seen in 10% of controls and none of the cases and this difference was statistically significant (p value=0.05). More fecal calprotectin were seen among the cases than the controls and this difference was statistically significant (p <0.05)  
    CONCLUSION
    This study showed more clostridium difficile infection among the patients on antibiotic or immunosuppressive therapy. Pathological investigation revealed more severe and extensive inflammation among the cases than the controls. Cases had clinically more severe signs and symptoms with higher mayo scores than the controls. ESR(erythrocyte sedimentation rate) and fecal calprotectin were higher in patients with positive clostridium difficile infection and serum albumin was lower in such patients.
    Keywords: Clostridium Difficile, Ulcerative Colitis, Infection
  • Tarang Taghvaei, Arash Kazemi, Vahid Hosseini, Mehdi Hamidian, Hafez Tirgar Fakheri, Seyyed Abbas Hashemi, Iradj Maleki Pages 24-31
    BACKGROUND
    Gastroesophageal reflux disease (GERD) is a common problem with annoying symptoms. It is associated with negative impact on quality of life. Prokinetic agents may be used in combination with acid suppression agents as an adjunctive in patients with GERD refractory to proton pump inhibitors (PPI) therapy, rather than as sole treatment. This study aimed to evaluate the efficacy of combination of PPI with domperidone (a prokinetic agent) compared with PPI alone in the treatment of patients with refractory GERD.  
    METHODS
    This study was a double blind clinical trial on 29 patients with GERD refractory to PPI during the period of one month. By randomization, the patients were divided into two groups. Group A was treated by pantoprazole 40 mg twice daily and domperidone three times a day for a month, while group B was treated by pantoprazole 40 mg twice daily and placebo three times a day. In this study endoscopy was performed to evaluate the prevalence of erosive esophagitis, non-erosive reflux, and hiatal hernia. Manometry was conducted to study the prevalence of dysmotility. GERD symptom questionnaires including the Gastrointestinal Symptom Rating Scale (GSRS), Carlson Dennett, and the Medical Outcomes Study Short Form-36 health survey (SF36) were used before and after treatment for screening GERD and assessing treatment response.  
    RESULTS
    There were 17 (58.62%) women and 12 (41.37%) men. The prevalence of erosive esophagitis and non-erosive reflux, was 10.34% and 89.66%, respectively. There was a significant difference comparing reflux symptoms before and after treatment between the two groups according to reflux and Carlson Dennett questionnaires. At the end of the study, symptoms of reflux significantly improved by treatment. Although, the quality of life questionnaire scores improved by treatment, there was no statistically significant difference in response to treatment between the two groups.  
    CONCLUSION
    In this research, we showed that adding domperidone to PPI could not make any improvement in patients with refractory reflux regarding the quality of life and improving the symptoms.
    Keywords: Refractory GERD, PPI, Domperidone, Treatment
  • Muhammad Akram, Munawar Hussain Soomro, Mansoor Magsi Pages 32-37
    BACKGROUND
    It is necessity to work more on non-invasive markers like right liver lobe size/albumin concentration ratio for predicting esophageal varices. We aimed to see the right liver lobe/albumin ratio in identifying esophageal varices among patients with cirrhosis caused by hepatitis B and C.  
    METHODS
    A cross-sectional study was conducted among all indoor patients admitted to the Department of Internal Medicine, Pakistan Atomic Energy Commission, General Hospital, Sector H-11/4 Islamabad, Pakistan, during May-December 2016. A non-probability purposive sampling technique was
    used for data collection. Diagnosed cases of cirrhosis caused by hepatitis B and C virus infection aged 25 years or more were included. A pre-designed questionnaire was used for data collection. Statistical analysis was done using SPSS software version 20.  
    RESULTS
    A total number of 160 patients were included. Mean ± SD age was 56.04 ± 10.22 years, while 96 (60%) were men. Child-Turcotte-Pugh grades showed 41.88% of the patients with grade A, followed by grade B (38.12%), and grade C (20%). Esophageal varices were observed in 76.25% of the patients. The sensitivity was 86.89%, while specificity was 78.95%. The positive predictive value was 92.98% (95% confidence interval [CI] = 86.64% - 96.91%) and negative predictive value was 65.22% (CI = 49.75% - 78.64%) with a diagnostic accuracy of 85%.  
    CONCLUSION
    The use of the studied non-invasive markers of portal hypertension particularly the right liver lobe size/albumin concentration ratio, can help physicians to restrict the use of endoscopic screening only to patients presenting a high probability of esophageal varices.
    Keywords: Portal hypertension, Liver cirrhosis, Esophageal varices, Serum albumin
  • Sahar masoudi, Amin Hassanzadeh Nemati, Hamid Reza Fazli, Samira Beygi, Maliheh Moradzadeh, Akram Pourshams, Ashraf Mohamadkhani Pages 38-44
    BACKGROUND
    Aryl-carbon receptor (AhR), a ligand-activated transcription factor, is best known for its ability to mediate the effects of environmental toxins such as 2,3,7,8-tetrachlorodibenzo-p-dioxin. AhR is expressed in several tumor cells and regulates the expression of genes in the signal transduction pathways. In this study, we examined the soluble levels of AhR in patients with pancreatic cancer.  
    METHODS
    123 samples, including 59 (48%) samples of pancreatic ductal adenocarcinoma based on histological evidence and 64 (52%) healthy control samples, were evaluated to determine plasma levels of AhR by Enzyme-linked immunoassay.  
    RESULTS
    The median of AhR among patients was 0.280 ng/mL, which differed considerably from 0.07 ng/mL in the control group (p < 0.001). Significant differences of the AhR were observed between the plasma samples of the patients compared with the healthy group, with respect to male sex (p < 0.001), age groups (p = 0.001), diabetic status (p < 0.001), body mass index (BMI) categories (p = 0.035), and constantly smokers (p < 0.001). We also observed significant differences between the level of AhR expression between men and women (p = 0.01) and ever to never smokers (p = 0.009) in the case group. In addition, the age of 65 and a BMI of 25 or less were significant factors in plasma AhR levels ([1.61 95%CI 1.08-2.38] and [1.84 95%CI 1.22-2.77], respectively).  
    CONCLUSION
    The results of this study can add diagnostic information to pancreatic cancer involving AhR and the potential efficacy of this receptor in therapeutic strategies.
    Keywords: Pancreatic cancer, Aryl hydrocarbon receptor (AhR), Biomarkers
  • Mehdi Mirzaei Alavijeh, Masoumeh Vaezi, farzad jalilian Pages 45-51
    BACKGROUND
    Hepatitis B is the most common occupational disease in health care providers. It can be followed by several complications. The aim of this study was to determine the cognitive determinants of hepatitis B (HB) vaccination Acceptability among nurses based on the Health Belief Model (HBM).  
    METHODS
    This cross-sectional study was conducted among 330 nurses in educational hospitals of Kermanshah city, during 2016. Samples were randomly selected with the proportional to size among different educational hospitals in Kermanshah. A structured questionnaire was applied for collecting data and data were analyzed using SPSS software version 16 by using bivariate correlations and logistic regression statistical tests.  
    RESULTS
    The mean age of the respondents was 30.5 years [SD: 6.62]. About, 58.5% of the participants reported to have completed (three times) vaccination of HB. Female nurses were more likely to be fully vaccinated against HB than male nurses, with adjusted odds ratio estimate of 2.507 [95% CI: 1.523-4.125] and those who had family or friends with a history of HB with odds ratio estimate of 3.706 [95% CI: 1.317-10.425], making these the most influential predictive determinants for full uptake (three time) of HB vaccination. Among the HBM variables: perceived threat with odds ratio estimate of 1.264 [95% CI: 1.160-1.376], perceived self-efficacy with odds ratio estimate of 1.179 [95% CI: 1.020-1.363], and cues to action with odds ratio estimate of 1.335 [95% CI: 1.015-1.756], were the more influential predictors of full uptake (three time) of HB vaccination.  
    CONCLUSION
    To development uptake vaccination programs promotion in addition to focusing on male nurses, using the results of the predictive constructs include; perceived threat perceived self-efficacy suggested. Based on our result, it seems that development and implementation of health promotion programs to increase threat about side effect of HB and self-efficacy regarding HB vaccination uptake may be usefulness of the findings to promotion of vaccination of HB.
    Keywords: Health promotion, Health education, Public health, Behavioral medicine
  • Zamani Farhad, mehran haghighi, Mohammad Roshani, Masoudreza Sohrabi Pages 52-54
    Lichen planus is a dermatologic chronic inflammatory disease that usually involved the skin and mucosa. Esophageal lichen planus with stricture is rare presentation of this disease. It is usually associated with oral mucosal involvement and commonly presenting in middle-age female. In present case, we describe a 48-year-old woman with history of oral lichen planus who referred to us for progressive dysphagia for solid food .She had not history of other causes of dysphagia. Upper endoscopy revealed a benign stricture located in proximal of esophagus that comparable with lichen planus features. The patient underwent three sessions of wireguided bougie dilation that improved her symptoms totally. Lichen planus has to be considered in differential diagnosis in patients with dysphagia.
    Keywords: Dysphagia, Esophageal stricture, Lichen planus
  • Ali Ghavidel, Amirhossein Ghavidel Pages 55-58
    A 58-year-old woman came to clinic suffering from a headache, which started suddenly, and also had right hemiparesis. The patient felt drowsy while being admitted. She had no history of head trauma, but had history of chronic liver dysfunction, with a low blood platelet count. She was also suffering from cirrhosis since 5 years earlier and also suffered from hepatitis B. At that time, her liver disorder was diagnosed as autoimmune hepatitis (AIH).