فهرست مطالب

گوارش - سال بیست و چهارم شماره 4 (پیاپی 109، زمستان 1398)
  • سال بیست و چهارم شماره 4 (پیاپی 109، زمستان 1398)
  • تاریخ انتشار: 1398/10/21
  • تعداد عناوین: 7
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  • ناصر ابراهیمی دریانی*، فروغ البرزی اوانکی، محمد طاهر صفحات 195-205

    بیماران مبتلا به بیماری التهابی روده علاوه بر نیاز به درمان دارویی مناسب نیازمند مراقبت های پیشگیری به موقع و جامع می باشند. نشان داده شده است که میزان ارائه این خدمات به اندازه میزان ارائه خدمات درمانی آنها نمی باشد. برای ارائه بهینه این خدمات لازم است ارتباط قوی بین پزشکان گوارش و تیم ارائه دهنده خدمات مراقبتی اولیه برقرار باشد. پزشکان باید از نیازهای مراقبتی اختصاصی این بیماران به خصوص بیمارانی که تحت درمان با داروهای بیولوژیک یا ایمونومدولاتور هستند، آگاه باشند. واکسیناسیون این بیماران باید به صورت منظم بازنگری شود چراکه اغلب این بیماران در معرض ابتلا به عفونت های مختلف هستند و بسیاری از این عفونت ها با انجام واکسیناسیون به موقع قابل پیشگیری است. در این مقاله به بررسی واکسیناسیون مناسب، مراقبت های لازم جهت استئوپروز و پیشگیری از آن، کانسر سرویکس، کانسرهای پوستی، اضطراب و افسردگی و مراقبت های لازم حین سفر پرداخته می شود.

    کلیدواژگان: بیماری التهابی روده، واکسیناسیون، پیشگیری، سرطان، سرطان پوستی ملانوم و غیر ملانوم، اضطراب، افسردگی، سرطان دهانه رحم، استئوپروز
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  • Nasser Ebrahimi Daryani*, Foroogh Alborzi Avanaki, Mohammad Taher Pages 195-205

    Inflammatory bowel disease (IBD) is a chronic disorder that influences many aspects of a patient’s life. The medical treatment of the affected patient has been broadly investigated. Studies have shown that most physicians are familiar with treatment options, but they are not aware of proper preventive care for their patients. As most patients consider their gastroenterologists as their primary care provider, it is essential for gastroenterologists to inform the primary care providers of the unique needs of the patients with IBD, especially those receiving immunomodulators and biologics or are considered for such treatments. As most patients with are treated with long-term immune-suppressive drugs, and these drugs predispose the patients to many infectious diseases and cancers, it is important for primary care providers to document patients’ vaccination history comprehensively and screen for the cancers that these patients are encountered with, so that many of these disorders be prevented. Identification, safety, and proper timing of vaccinations, screening for cervical cancer, melanoma and non-melanoma skin cancers, osteoporosis, identification of depression and anxiety, smoking cessation, and care during traveling and flights are issues that will be discussed in this systemic review.

    Keywords: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Vaccination, Melanoma skin cancer, Non-melanoma skin cancer, Cervical cancer, Osteoporosis, Anxiety, Depression, Prevention
  • Fatemeh Hasanvand, Amin Talebi Bezmin Abadi*, Ashraf Mohabbati Mobarez Pages 224-229
    Background

    Helicobacter pylori (H. pylori) infection is associated with many gastroduodenal disorders. So far, few updated reports exist on the pattern of susceptibility to antibiotics that are mainly used in Iran. Our main purpose of this study was to investigate the resistance of H. pylori to tetracycline, amoxicillin, metronidazole, and clarithromycin in Iranian patients with dyspepsia. Due to the increasing resistance of H. pylori against the current first-choice antibiotics, alternative drugs including tetracycline may be the focus of attention by clinicians.

    Materials and Methods

    In this survey, after the bacterial culture of 200 gastric biopsy specimens obtained from consecutive patients, H. pylori strains were identified and confirmed using universal standard methods. Minimal inhibitory concentration (MIC) values of tetracycline were determined by E-test method.

    Results

    Of 200 taken biopsy specimens, 73 (36%) samples were positive for H. pylori infection. Overall, the resistance to metronidazole was detected (46%), to amoxicillin (6%), to clarithromycin (16%), and to tetracycline (13%). In our examination, no significant association was found between the H. pylori antibiotic-resistant infections and age or sex. Our findings confirm the urgent need for susceptibility testing to find the best anti-H. pylori therapeutic regimen in our geographical region.

    Conclusion

    Our results support the higher importance of tetracycline and amoxicillin as alternatives and options in first-line therapy.

    Keywords: Helicobacter pylori, Tetracycline, Amoxicillin, Antibiotic resistance, MIC
  • Kamran Bagheri Lankarani, Sulmaz Ghahramani*, Maryam Hadipour, Mohammad Pourhashemi, Ali Mahmoodi, Mahdi Zeraatpishe, Amirhossein Babaei Pages 230-237
    Background

    Rate of hospital admission for inflammatory bowel disease (IBD) and its related cost has an increasing trend worldwide. Iran has an increasing number of patients with IBD. In this study, we aimed to identify in-hospital costs of patients with IBD and its determinants in two tertiary hospitals in the south of Iran.

    Materials and Methods

    Applying relevant ICD (International Classification of Diseases) codes, records and hospital bills of all hospitalized patients with IBD during 2013-2015 were reviewed. Annual hospitalization cost per patient, cost per hospitalization, and daily cost during hospital admissions were also estimated. Predictors of total hospital admission costs were evaluated using Stata SE .11. A significant level was set at 0.05.

    Results

    158 patients with a median age of 35 years admitted to the hospitals during the study period. Most patients were female (63.3%). The median length for hospital stay (LOS) was 3 days. The total hospital cost of IBD was 843,640 International US Dollar (IUSD). Costs were more for patients with ulcerative colitis (UC) than Crohn’s disease (CD). Daily cost during hospital admissions was more than 700 IUSD. Predictors for all three quartiles of total hospital cost for UC were: LOS, living status on check out, and year of study and for CD was LOS, all with p < 0.001.

    Conclusion

    This study showed that patients with UC had higher hospital costs than patients with CD. LOS was a strong predictor for the total hospital cost of IBD. There was a time trend for increasing cost in UC. Living status on discharge strongly predicted higher total hospital costs for patients with UC. Further prospective studies with larger sample size on direct as well as the indirect cost of IBD and its determinants are strongly recommended.

    Keywords: Hospital cost, Determinant, Inflammatory bowel disease, Iran
  • Armin Mokhtariye†, Omid Pouresmaeil†, Fatemeh Baledi, Sima Marzban, Farideh Ghavidel, Aref Derafsheh, Mahdieh Vosoughi, Fatemeh Keyfi* Pages 238-240
    Background

    Hyperthyroidism and hypothyroidism are common thyroid disorders. Thyroid hormones have a great role in regulating mucosal cells and the growth of the gastrointestinal tract. In this study, we investigated the presence of Helicobacter pylori (H. pylori) infection in various types of thyroid disorders.

    Materials and Methods

    Our study included 297 patients whose thyroid status was identified by evaluation of thyroid hormones; triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) using Roche Electrochemiluminescence (ECL). H. pylori antibodies and antigen were evaluated by enzyme-linked immunosorbent assay (ELISA) kits in all cases.

    Results

    Hypothyroidism had a significant correlation with H. pylori infection (p < 0.001). Hyperthyroidism was not related to H. pylori infection (p = 0.171). Also, in hypothyroidism, female sex more than male sex had a significant correlation with H. pylori infection (p = 0.004).

    Conclusion

    Decreasing thyroid hormones can result in dysregulation of gastric mucosal cells, therefore hypothyroidism can lead to more chance of having H. pylori infection.

    Keywords: Hyperthyroidism, Hypothyroidism, H. pylori, Gastric inflammation
  • Ali Reza Balizadeh Karami, Seyyed Ali Mard, Sara Mobarak, Atefeh Zahedi, Masoomeh Asadi, Esmat Radmanesh* Pages 241-246
    Background

    Liver diseases have a lot of pain and suffering for the patients and also cost a lot to cure. In this study, we tried to collect comprehensive and applied information about the incidence of these diseases in Abadan and Khorramshahr cities and provide it to the ministry of health and public opinion.

    Materials and Methods

    Referring to the medical records department of Ayatollah Taleghani and Shahid Beheshti Hospitals in Abadan city and Valiasr Hospital in Khorramshahr city, information about patients with liver diseases from 2012 to 2017 were collected from the Hospital Information System (HIS) of the hospitals. The findings were analyzed using SPSS software.

    Results

    In our study 62.1% of the patients were male and 37.9% were female. The highest frequency of liver diseases was in the age group of 35-44 years. The lowest incidence was in the age group of less than 1 year and 1-4 years. The most common causes were cirrhosis (319 cases), inflammatory liver disease (121 cases), other specified liver diseases (133 cases), liver failure (71 cases), secondary malignant neoplasm (52 cases), hepatitis C (53 cases), hepatitis B (25 cases), and Fatty liver (20 cases).

    Conclusion

    According to the results of this study, it was observed that the prevalence of liver diseases, especially liver cirrhosis, was the highest. As a result, people need to modify their lifestyle and consider weight loss, low-fat diet, and increased physical activity to reduce their body mass index.

    Keywords: Liver diseases, Prevalence, Abadan, Khorramshahr, Cirrhosis
  • Saeed Madani, Jamshid Vafaeimanesh* Pages 247-249

    Ascariasis is a helminthic infection of humans caused by the nematode Ascaris lumbricoides. A 25-year-old woman with a gestational age of 17 weeks presented with acute onset abdominal pain with nausea and vomiting. Clinical and sonographic evaluations were supportive of acute bowel obstruction and small intestine intussusception due to Ascaris lumbricoides who undergone treatment during pregnancy. As intestinal obstruction is a rare but serious event in pregnancy, the importance of a high index of suspicion in the evaluation of abdominal pain in pregnancy is emphasized. The usefulness of ultrasonography in the early diagnosis of intussusception in pregnancy is discussed.

    Keywords: Intussusception, Ascaris lumbricoides, Pregnancy
  • Mahboubeh Afifian, Ahmad Hormati, Mohammad Reza Ghadir, Saeideh Jafari, Azam Farahani, Amir Jabbari* Pages 250-252