فهرست مطالب

Middle East Journal of Digestive Diseases - Volume:3 Issue: 2, Sep 2011

Middle East Journal of Digestive Diseases
Volume:3 Issue: 2, Sep 2011

  • 70 صفحه،
  • تاریخ انتشار: 1390/06/15
  • تعداد عناوین: 11
|
  • Behrouz Navabakhsh, Narges Mehrabi, Arezo Estakhri, Mehdi Mohamadnejad, Hossein Poustchi Page 92
    Hepatitis B virus (HBV) infection is a global public health problem. In endemic areas, HBV infection occurs mainly during infancy and early childhood, with mother to child transmission (MTCT) account­ing for approximately half of the transmission routes of chronic HBV infections. Prevention of MTCT is an essential step in reducing the global burden of chronic HBV. Natal transmission accounts for most of MTCT, and providing immunoprophylaxis to newborns is an excellent way to block natal transmission. Prenatal transmission is responsible for the minority of MTCT not preventable by immunoprophylaxis. Be­cause of the correlation between prenatal transmission and the level of maternal viremia, some authors find it sound to offer lamivudine in women who have a high viral load (more than 8 to 9 log 10 copies/mL). In addition to considerations regarding the transmission of HBV to the child, the combination of HBV infection and pregnancy raises several unique management issues. Chronic HBV infection during pregnancy is usually mild but may flare after delivery or with discontinuing thera­py. Management of chronic HBV infection in pregnancy is mostly sup­portive with antiviral medications indicated in a small subset of HBV infected women with rapidly progressive chronic liver disease.
  • Seydeh Azra Shamsdin, Mehdi Saberifiroozi, Davood Mehrabani, Seyed Taghi Heydari Page 103
    Despite the similar rate of HP infection, the rate of gastric cancer (GC) differs in different regions of the country. There are conflicting reports for using a panel of serologic tests such as pepsinogens I, II (PG I and PG II), and gastrin for population screening. We designed this study to assess healthy appearing adults in Shiraz, southern Iran in order to evaluate the correlation of these serological tests with de­mographics and lifestyle in a region with a low rate of gastric malig­nancy.
    Methods
    In a population-based study, 846 out of 1978 subjects who were selected by cluster random sampling based on postal code divi­sion in Shiraz agreed to participate in the present study. A question­naire that included age, gender, weight and height, lifestyle such as physical activity, smoking and the use of nonsteroidal anti in­flammatory drugs (NSAIDs) was completed. A blood sample was taken after overnight fasting for measurements of PG I, PG II and Cag A status by enzyme-linked immunosorbant assay (ELISA). Gastrin level was measured by radioimmunoassay (RIA).
    Results
    The study included 305 men and 541 women. Their mean age was 50.53+11.4 (range: 35-99 years). The level of PG I was significantly more in males than females (116.6±57.1 vs. 103.1±55.8, p < 0.001), lower in older age groups (p = 0.01), and rural compared with urban residents (110.3+55.7 vs. 100.2+58.1, p = 0.02). The serum level of PG II was less in obese subjects (p = 0.5). There was no significant correlation between PG I, PG II, smoking, NSAID use and activity. Gastrin level were not correlated with any of the demographic charac­teristics. The level of Cag A was significantly different between males and females (30.5±37 vs. 37.7±41.7, p < 0.001), more in older subjects (p = 0.007) and non smokers (p = 0.001). The serum levels of PG I and PG I/PG II ratio decreased significantly in subjects with positive Cag A serology (p < 0.05). The ratio of PG I/PG II was lower than 3 in 35 (4.1%) subjects.
    Conclusion
    In this area, the PG I/PG II ratio is less than 3 in 4% of subjects of which most are positive for Cag A serology and older than 50. We recommend comparison of these findings with high GC mortality regions.
  • Hossein Jabari, Farhad Zamani, Khadijeh Hatami, Arghavan Sheikholeslami, Elham Fakharzadeh, Kiana Shahzamani, Hedye Zamani, Shahin Merat, Reza Malekzadeh, Amir Houshang Sharifi Page 110
    Background
    Chronic hepatitis C (CHC) is a major contributor to cirrhosis and hepatocellular carcinoma and major global public health problem that causes mortality in both developed and developing countries.For the past decade, treatment with pegylated interferon (peg interferon α) and ribavirin (RBV) has been associated with rates of sustained virologic response of ≤ 66% among patients with hepatitis C virus (HCV) infec­tion. In this study, we report the response rate of Iranian treatment-naïve CHC patients to Pegaferon, a locally developed pegylated inter­feron-α2a (PEG-IFNα2a).
    Methods
    Patients diagnosed with CHC who referred to two university based outpatient clinics in Tehran from December 2007 to May 2011 were enrolled in a single-group, open-labeled experimental design. Eligible patients were above 15 years of age and had HCV infection with evi­dence of chronic hepatitis. Exclusion criteria included the presence of a debilitating disease, decompensated cirrhosis or refusal to participate in the study. Patients were treated with 180μg Pegaferon weekly in addition to 800-1200 mg daily, weight-based RBV for 24 or 48 weeks depending on genotype. Viral response and adverse effects were recorded.
    Results
    A total of 216 patients were enrolled in the study of which 83.3% were male and 16.7% were female. In 93 (43.1%) patients, the HCV RNA viral load was ≥ 800,000 IU/ml before starting treatment. “As-treated analysis” indicated that a total of 168 (77.8%) patients achieved sustained viral response (SVR, undetectable plasma HCV RNA 24 weeks after the last planned dose of study treatment).
    Conclusion
    This study, with a larger number of participants, confirms the results of a previous study by the authors that Pegaferon, a PEG-IFNα 2a locally produced in Iran, is effective in treatment-naïve CHC patients.
  • Mohammad Bagheri, Mandana Ashrafi, Mehdi Mohammadnejad, Lila Abdollahzadeh Hosseini, Siavosh Nasseri-Moghaddam, Shahin Merat, Mehdi Saberifiroozi, Masoud Sotoudeh, Reza Malekzadeh Page 115
    Background
    Eosinophilic gastroenteritis (EG) is a rare inflammatory disorder of the gastrointestinal (GI) tract. There have been several case series of patients with EG from the western world and East Asia. However, there has not been a report of patients with EG from the Middle East region. The aim of this study is to describe clinical characteristics and treatment response in a series of EG patients from Iran.
    Methods
    We retrospectively reviewed charts with a diagnosis of EG from 1997 to 2010 at Shariati Hospital and the private clinics of the authors. Clinical characteristics of the patients were evaluated, and the treat­ment response and relapse rate were assessed.
    Results
    Twenty-two patients (9 male) with EG were identified. Mean age of the patients was 45.1±15.5 (range: 27-75) years. Median duration between symptom onset and diagnosis was 12 (range 1- 48) months. Twenty (90%) patients had mucosal involvement, one (5%) had muscular involvement and one (5%) had subserosal involvement. Patients were followed for a median duration of 36.5 (range 4-123) months. Two patients had spontaneous remission with supportive care. The remaining 20 patients responded well to oral corticosteroid treat­ments. The relapse rate was 33%. Episodes of relapse were successfully controlled with a repeat course of corticosteroids. Two patients with several relapses required maintenance treatment with azathioprine.
    Conclusion
    The clinical characteristics and treatment responses of EG patients from Iran are similar to reports from other parts of the world. Patients need to undergo close follow up after treatment to detect early signs of relapse.
  • Fariborz Mansourghanaei, Farahnaz Jokar, Fatemeh Soati, Syrous Gharib Page 119
    Background
    This study aims to elucidate the knowledge and practice of general practitioners (GP) and internists regarding diagnosis and treatment of Helicobacter pylori (H. pylori) infection in a high prevalent area, with the intent to assist with future educational strategies for H. pylori in­fection.
    Methods
    In this cross-sectional study in Guilan, a Northern Province of Iran, all GPs and internists in the city of Rasht were included. Questionnaires consisted of questions on demographic characteristics in addition to physicians’ knowledge and practice regarding H. pylori infection. The questionnaire was verified by a panel of experts, validated by the test-retest method, and distributed among participants. Scores higher than the mean score indicated good knowledge or attitude. Those lower than the mean score indicated poor knowledge and attitude. Data were col­lected and analyzed by SPSS version 14 software.
    Results
    The mean (SD) knowledge and practice score of physicians was 12.1±3.13 and 2.37±1.54, respectively. Overall, 67.9% of GPs and 91.7% of internists exhibited good knowledge scores, while 72.4% of GPs and 95.8% of internists showed good practice. Physicians who used books or educational programs and had working histories of less than 10 years scored significantly higher in terms of mean knowledge. The mean practice score of physicians who worked in public units and had working histories of more than 5 years and those who had used books or educational programs was significantly higher.
    Conclusion
    Since H. pylori infection is prevalent in Iran and GPs’ practices are directly under the influence of knowledge, it is necessary to attempt to increase the level and quality of information among GPs by educa­tional and Continuing Medical Education programs and seminars.
  • Seyed Jalal Hashemi, Abolrahim Masjedizadeh, Ali Akbar Shayesteh, Fariba Jalali Page 126
    Background
    Hepatitis C virus (HCV) infection is responsible for considerable morbidity and mortality worldwide. The HCV genotype has a geographic distribution and an important role in clinical and histological outcomes. This study determined HCV genotypes and their related risk factors among patients from Khuzestan Province, Southwest Iran.
    Methods
    In a cross-sectional study, 223 patients infected with HCV who referred to Ahwaz Jundishapour University Hospitals (AJSUH) and Hepatitis Clinic were enrolled. Specific and nested polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLPs) were performed to determine viral infection and genotype analysis. Liver enzymes including ALT and AST and the correlated risk factors were also determined.
    Results
    The HCV genotype distribution was as follows: genotype 1a (41.7%); genotype 1b (2.7%); genotype 2 (4.1%); genotype 3a (31.4%); and genotype 4 (1.8%). There were 42 samples (18.84%) not classified into any of the known HCV subtypes. No patient was infected with more than one genotype. HIV was found in four (1.8%) cases, of which all were intravenous drug users. Univariate analysis demonstrated an in­dependent association of intravenous drug use (IVDU) and genotypes 1a (60.7%) and 3a (30%).
    Conclusion
    Our findings suggest that genotypes 1a and 3a are the most com­mon ones among Iranian patients with chronic hepatitis C infection in Khuzestan Province, Southwest, Iran.
  • Ramin Niknam, Mehdi Saberifiroozi, Laleh Mahmoudi, Zahra Forouhesh Tehrani Page 131
    Gastrointestinal melanoma (GIM) is occasionally observed in general practice. We report a case of melanoma dispersed diffusely in the stomach and duodenum with no skin involvement.
  • Maryam Rezai Salim, Homayoon Vahedi, Zia Salimi, Hossein Froutan, Masoud Sotoudeh Page 135
    Inflammatory Myofibroblastic Tumor (IMT) is a rare neoplastic lesion with tendency toward local aggressive behavior and recurrence. The tumor most commonly occurs in the pulmonary system of children and young adult, although it may rarely develop in older patients and other organs. Symptoms are non-specific and depend on the location of the tumor. The gastrointestinal tract is rarely the primary site of origin for this lesion. We report an unusual presentation of this rare lesion in a 58 year old woman with intussusception and partial intestinal obstruction.
  • Alireaz Norouzi, Sadaf Ghajarieh Sepanlou, Samaneh Tavassoli, Reza Malekzadeh Page 140
  • Hossein Nobakht, Vahid Semnani Page 151