فهرست مطالب

  • Volume:11 Issue:4, 2019
  • تاریخ انتشار: 1398/08/13
  • تعداد عناوین: 10
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  • Amir Anushiravani *, Sadaf Ghajarieh Sepanlou Pages 189-192

    There has been an increase in the burden of liver diseases in Iran, with an increasing trend from communicable to non-communicable diseases. Almost 5400 deaths were due to chronic liver diseases in 2017. We aim to provide a concise update on the epidemiological trends of liver diseases in Iran. Estimations of deaths, disability-adjusted life years, prevalence of chronic liver diseases and cirrhosis in Iran with its common etiologies have been reported. We investigated the major causes of chronic liver diseases in Iran, we have reported our hepatology research centers, and also we have depicted the future of liver diseases in Iran. In 2017, there was a rising trend in chronic liver diseases in Iran. The most common etiologies for chronic liver disease were chronic hepatitis B, chronic hepatitis C, and non-alcoholic steatohepatitis with highest mortalities due to liver cancer and hepatitis C. The prevalence of HBV infection has decreased from 2.9% to 1.3% with effective vaccination, but new cases are still seen due to perinatal transmission. Treatment of HCV has dramatically changed with new drugs which are being produced by local pharmaceuticals at a low cost. The main obstacle in its elimination is finding patients and linkage to care. More than a third of our population have non-alcoholic fatty liver disease in which central obesity had a stronger association than weight itself. Iran has a high burden of liver diseases. The Ministry of Health has effectively controlled hepatitis B and is working towards the World Health WHO’s goals for hepatitis C by 2030. This being said, non-alcoholic fatty liver disease is becoming a major threat to our nation’s health and quality of life.

    Keywords: Liver diseases, End-stage liver disease, Liver cirrhosis, Non-alcoholic fatty liver disease, Iran
  • Atieh Sadat Fatemian, Neda Abdolvand *, Hamideh Salimzadeh, Alireza Delavari Pages 193-199
    BACKGROUND

     Colorectal cancer is the third common cancer in Iran. In this study we aimed to identify factors associated with the prevalence of advanced colonic neoplasms among a high-risk population.

    METHODS

    Participants were 474 first degree relatives of patients with colon cancer who underwent a screening colonoscopy at Digestive Disease Research Institute, Shariati Hospital affiliated to Tehran University of Medical Sciences. Features examined in this study were age, sex, body mass index, Aspirin use, smoking, and relationship type with patients with cancer in family. Also, patient’s age at the time of cancer diagnosis, number and sex of the patients with colon cancer in the family were assessed. Data analysis was performed by data mining methods using K-Medoid clustering and decision tree C4.5.

    RESULTS

    Results showed that female sex of the patients with colon cancer and their young age (< 60 years old) at the time of cancer diagnosis were important predictive factors for the prevalence of colorectal advanced neoplasms among their family members.

    CONCLUSION

    Data mining methods were found to be applicable in recognizing predictive factors of colorectal advanced neoplasms in each cluster and tree.

    Keywords: Colorectal Cancer, Data Mining, Clustering, Decision Tree, Crisp Methodology
  • Amrollah Sharifi, Homayoon Vahedi*, Mohammad Reza Honarvar, Behnam Alipoor, Zeinab Nikniaz, Hossein Rafiei, Mohammad Javad Hosseinzadeh, Attar Pages 200-205
    BACKGROUND

     Ulcerative colitis (UC) is a chronic inflammatory disorder of the large intestine. Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) is a member of the immunoglobulin superfamily, which binds B7-1 and B7-2 on APCs (antigen-presenting cells), and induces APCs to produce an inhibitory signal to T cells. The aim of this study was to investigate the effect of vitamin D on CTLA-4 gene expression in whole blood samples of patients with UC.

    METHODS

    90 patients with mild to moderate UC were randomized to receive either a single injection of 7.5 mg vitamin D3 or 1 mL normal saline. 90 days following the intervention fold changes in CTLA-4 mRNA expression were determined and statistical comparisons between the two groups were performed.

    RESULTS

    Serum vitamin D increased significantly only in the vitamin D group. CTLA-4 fold changes were significantly higher in the vitamin D group compared with the placebo group (median ± IQR: 1.21 ± 2.3 vs. 1.00 ± 1.5, respectively; p = 0.007).

    CONCLUSION

    The results of this study revealed that vitamin D administration in patients with UC enhances the CTLA-4 gene expression.

    Keywords: Ulcerative Colitis, Inflammatory Bowel Disease, CTLA-4, Vitamin D, Gene Expression
  • Ahmad Hormati, Mohammad Reza Ghadir, Ali Hasanpour Dehkordi, Farshad Yadollahi, Shahriar Salehitali*, Mahboobeh Afifian Pages 206-211
    BACKGROUND

    Although stenting for the treatment of large and multiple common bile duct stones has been acceptable to everyone, its efficacy and outcome have not been studied in comparison with other endoscopic procedures. The purpose of this study was to compare the consequences of stenting and endoscopic papilla balloon dilatation for the treatment of large and multiple common bile duct stones.

    METHODS

    In a double-blind clinical trial, of 431 patients with bile duct stones referred to the treatment center, 64 patients with multiple common bile duct stones ( ≥ 3) and more than 15 cm were selected for the study, then by random allocation rule the participants were allocated in two groups. They were entered into two different endoscopic papillary balloon dilatation (EPBD) and common bile ducts stenting treatments so that both procedures were performed by a person. Both groups were assessed from the point of views therapeutic outcomes such as duct cleaning, pancreatitis, isolated pain, and duct rupture. Data were collected by a self-made questionnaire that was used before and after the procedure to obtain the needed information. Then data were analyzed using SPSS software version 22 and descriptive and analytical tests were used as appropriated.

    RESULTS

    Although the duct cleaning and the complete removal of the stones in the stenting treatment procedure was 93.8%, and in EPBD was 78.3%, no significant difference was observed between the two groups (p = 0.14). Pancreatitis significantly increased after the first and second endoscopic retrograde cholangiopancreatography (ERCP) in the stent group compared with EPBD (p = 0.02). Also, the most frequent cases of isolated pain were in the endoscopic group EPBD (p = 0.0). However, the occurrence of perforation after first ERCP and EPBD was zero, but in the second stage of ERCP, 3.3% of the patients had perforations (p = 0.99). The results indicated that the shape of the stone (circular and angled) was not effective in the result of treatment in the two groups.

    CONCLUSION

    The results of this study indicated that in case of experience and skill in conducting the ERCP, common bile duct stenting is still the first line of treatment for large and multiple stones of the common bile ducts.

    Keywords: CBD Stone, Endoscopic Treatment of EPBD, CBD Stenting, ERCP
  • Tahmine Tavakoli *, Navid Davoodi, Toktam Sadat Jafar Tabatabaee, Zeinab Rostami, Homa Mollaei, Fatemeh Salmani, Sara Ayati, Sanaz Tabrizi Pages 212-218
    BACKGROUND

    Irritable bowel syndrome (IBS) is the most common chronic gastrointestinal (GI) disorder. Patients with IBS usually suffer from anxiety and depression. A combination of psychological approaches and pharmacological treatments can be a significantly effective treatment for IBS. The main objective of the present study was to provide a therapeutic plan based on laughter yoga and anti-anxiety medication, employed for the very first time, and to determine the effectiveness of these treatments on the anxiety and GI symptoms of patients with IBS.

    METHODS

    In this randomized, controlled, clinical trial, the participants were 60 patients selected from those who referred to the GI clinic of Vali-asr Hospital (Birjand, Iran) during the study period (April 2017 to March 2017) and were diagnosed as having IBS based on ROME III criteria. The participants were randomly assigned to either the laughter yoga group, the anti-anxiety medication group, or the symptomatic treatment (control) group. Severity levels of anxiety and GI symptoms before and after intervention were determined and compared among these three groups according to approved protocols.

    RESULTS

    The severity of IBS symptoms after the interventions was more greatly reduced in the laughter yoga group than in the anti-anxiety medication and control groups (p=0.006). The severity of anxiety after interventions decreased in all three groups, especially in the yoga treatment group, but the difference was not statistically significant (p=0.1).

    CONCLUSION

    Laughter yoga is more effective than anti-anxiety medication in reducing the GI symptoms of patients with IBS. Therefore, applying laughter yoga along with common pharmacological therapies for patients with IBS might be strongly advised.

    Keywords: Anxiety, Chronic gastrointestinal disorder, Gastrointestinal symptoms, Irritable bowel syndrome, Laughter yoga
  • Ehsan Zare, Hadi Raeisi, Behnam Honarvar, Kamran B. Lankarani * Pages 219-225
    BACKGROUND

     Gastric outlet obstructions (GOO) is a disabling complication of peptic ulcer disease (PUD). The introduction of endoscopic through the scope balloon dilatation (EBD) has eased the management but there are few reports on the long term results of this modality of treatment on patients’ symptoms.

    METHODS

    Over a period of 4 years from January 2012 to December 2015 in two major referral hospitals affiliated to Shiraz university, medical endoscopy reports were reviewed retrospectively to identify those who received EBD for the treatment of GOO due to PUD .All of these patients were recalled and their current status were evaluated.

    RESULTS

    22 consecutive patients with symptomatic GOO secondary to benign stricture underwent endoscopic balloon dilatation by a single operator. Of them, 14 had balloon dilatation twice and 6 had ballooning three times. The interval between the first referral and the last follow-up was 25.2 ± 10.3 (min: 4.8 max:43.4) months. The averages of maximum balloon size were 14.4 ± 5 mm in the first session, 14.3 ± 3.1mm in the second session, and 16 ± 2.4 mm in the third session. 73% of the patients had a significant improvement in clinical symptom with two sessions of EBD and did not require repeat dilatation.

    CONCLUSION

    EBD is a safe and efficient method in the management of GOO with good long term results.

    Keywords: Duodenal Ulcer, Stomach Ulcer, Gastric Outlet Obstruction, Endoscopy, Helicobacter Pylori
  • Najmeh Aletaha, Hoda Hamid *, Niloofar Ayoobi Yazdi, Reza Taslimi, Bijan Shabazkhani, Pardis Ketabi Moghadam Pages 226-230

    Polycythemia vera (PV) is classified as a myeloproliferative disorder (MPD). Such patients are prone to both thrombotic and hemorrhagic events. Although gastrointestinal (GI) bleeding is not a prominent manifestation of PV, it would be life threatening and necessitating hospital admission and blood transfusion if it occurs. GI hemorrhage in these patients may be due to Aspirin usage, peptic ulcer disease (PUD), acquired VonWillbrand disease, Dieulafoy lesion (DL), Mallory Weiss tear, and esophageal and gastric varices. DL is an enlarged, thick-walled artery in the muscularis mucosa with a small submucosal defect. In this case report, we describe a 65-year-old man with history of PV presented with a massive upper GI bleeding. After a therapeutic endoscopic hemostasis failure and reoccurrence of bleeding during hospital admission, an abdominal computed tomography (CT) was ordered, which revealed an aberrant artery originated from aorta directly into the stomach. An angiographic embolization was considered for the patient, which was successfully performed. Our patient was complicated by splenic infarction due to splenic collateral arteries embolization and the overwhelming thrombotic tendency of the patient himself due to the history of PV. Fortunately, our patient’s signs and symptoms responded to supportive therapies and eventually he discharged well.

    Keywords: Gastrointestinal bleeding, Polycythemia vera, Angioembolization, Dieulafoy lesion, Splenic infarct
  • Maryam Jameshorani, Akram Pourshams, Anahita Sadeghi*, Hiva Saffar, Reza Malekzadeh Pages 231-234

    Celiac crisis is a rare, acute, and life-threatening presentation of celiac disease. Its clinical presentations consist of severe watery non-bloody diarrhea, electrolyte disturbances (i.e. hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, and metabolic acidosis), hypoproteinemia, and dehydration. Here we present a 33-year-old woman who referred with profuse diarrhea, weight loss, hemodynamic instability, hypokalemia, hypoproteinemia, ascites, pancytopenia, and iron deficiency anemia. She used herbal medicines for constipation and had severe weakness after her childbirth. The patient was diagnosed as having celiac disease through pathological and serological evaluations 10 months earlier. Diagnosis of celiac crisis after ruling out the other causes of resistant celiac was made and she was treated with steroids.

    Keywords: Celiac crisis, Celiac disease, Diarrhea
  • Anahita Sadeghi, Behrouz Navabakhsh, Hiva Saffar, Mehdi Mohamadnejad* Pages 235-237
  • Reza Aminnejad, Faezeh Alemi, Saeid Safari, Ahmad Hormati*, Mohammad Reza Ghadir, Mohammad Saeedi, Mahboobeh Afifian Page 238