[ effect of flour extration rate, amount of asparaginase enzyme, and baking temperature and time on acrylamide formation in Sangak bread]

Acrylamide is a carcinogen element which is formed at temperatures higher than 120°C in the foods rich in carbohydrates, such as Sangak bread. At first, a series of confirmed mechanisms effective on the formation of acrylamide was determined: Free asparagine, glucose, fructose, maltose, and sucrose sugars in two kinds of dough made from two kinds of flour with the extraction rate of%82 and%93. Then, the effect of flour extration rate, enzyme asparaginase, temperature and time needed for baking, and interactions of effectual factors was studied on the formation of acrylamide in Sangak bread. The amount of acrylamide was determined by liquid chromatography tandem mass spectrometry [LC/MS/MS]. The data analysis was performed using Spss16, Minitab15, and Factorial test. A significant differenc was seen between average sugars other than sucrose in the two kinds of flour. Also, average acrylamid formed by principal factors affecting [flour extration rate, asparaginase enzyme, baking time and temperature] and reciprocal impact of the 2, 3, 4 factors showed a significant difference [p< 0/001]. The maximum of acrylamide formation from 72 treatments caused by the reciprocal impacts of the four factors was seen at the temperature of 352oC, baking time of 10 minutes, and flour with 93% extraction rate [without enzyme] of 60/30 [mg/kg] and the minimum of acrylamide formation was observed at the temperature of 241oC, baking time of 5 minutes and the flour with 82% extraction rate [with enzyme] of 13/07 mg/kg Sangak bread. The decrease of free asparagine by asparaginase enzyme indicated that glucose and fructose were the major sources of acrylamide formation in Sangak bread. The rate of acrylamide formation increased with the increase in flour extraction rate. This rate has direct relationship with baking time and temperature. Acrylamide formation can be minimized in the presence of asparaginase enzyme. Training the bakers not to toast the bread will result in the production of healthy Sangak bread

[ Case-Control study on the risk factors of IBD in 258 Iranian patients]

Ulcerative colitis [UC] and Crohn's disease [CD] are chronic inflammatory bowel diseases [IBD] with uncertain etiology thought to be triggered by interactions between various environmental, genetic and immunologic factors. Role of different factors in IBD are controversial. The aim of this study is to determine the possible risk factors in a group of Iranian patients with IBD. Ninety five consecutive cases of CD and 163 cases of UC were included. Age matched controls were randomly selected. A total of 489 controls for UC and 285 controls for CD were enrolled. A standard record concerning many variables was completed. Logistic regression analysis was used to evaluate potential confounding variables. A statistically significant protective effect for smoking in UC was found [OR=0.18 95% CI=0.064-0.504, p < 0.05]. The risk of UC increases with prolonged exposure to OCP [OR=0.99, 95% CI=0.98-0.99, p< 0.05]. In patients with CD, 15 cases [15.8%] reported a previous history of appendectomy compared with 19 controls [6.7%] [OR=2.6, 95% CI= 1.2-5.4, p < 0.05]. Tonsillectomy was reported by 16 patients [16.8%] with CD compared with 25 controls [8.8%] [OR= 2.1, 95% CI= 1.07-4.1, p < 0.05]. The logistic regression analysis showed that both appendectomy and tonsillectomy are risk factors in CD. No association with other variables was found for either disease. Current smoking was a significant protective factor in UC. We observed a relationship between duration of OCP use and UC. Duration of using OCP in UC cases was significantly more than controls. Both appendectomy and tonsillectomy were risk factors in CD in this study

Primary signet ring cell carcinoma of the breast: a rare pathologic entity

Primary signet ring cell carcinoma [SRCC] of the breast is a rare and aggressive variant of lobular carcinoma. We present a case of advanced stage primary SRCC of the breast in 71 year old female treated with palliative mastectomy and axillary lymph node dissection. Clinicopathologic features of this rare and aggressive tumor and its unique morphologic features are discussed

Irritable bowel syndrome: a review article

Irritable bowel syndrome [IBS] is the most prevalent functional gastrointestinal disorder noted in the general population worldwide. Its chronic nature, signs and symptoms which vary periodically from mild to severe have many negative effects on the quality of life for the sufferer; therefore the appropriate treatment of these patients is highly important. Patients should be informed by their doctors that the nature of the disease is benign, and educated on how to deal with and control symptoms of the disease. This article sets out a review of recent studies on the prevalence of IBS in Iran and appropriate methods for management of patients affected by IBS

[Inflammatory bowel disease: new comments in diagnosis and treatment]

Ulcerative colitis [UC] and Crohn's disease [CD] are chronic inflammatory bowel diseases with uncertain etiology thought to be triggered by interactions between various environmental, genetic and immunologic factors. Incidence rate of CD and UC is different in various geographic areas around the world, between 0.1-11 and 0.5-24.5 per 100, 000 people for CD and UC, respectively. Recent studies indicate a gradual increase in both CD and UC all over the world. Given the fact that the prevalence of IBD in high rate incidence areas duplicates every 10 years, it is predicted that these diseases are going to be among the most important health issues even in developing countries. Since patients are mostly young adults and because of 50% recurrence rate in IBD, quality of life will be affected greatly. Having more information about these diseases will improve health status in our country. In this study, we decided to discuss the main topics on IBD by reviewing the literature and recent papers

[Wegner's granulomatosis with gastrointestinal manifestation: a case report]

A 55 year-old man was referred with periumbilical and colicky abdominal pain cutaneous lesions' palpable purpura in extremities and 10 kg weight loss. A 55 cm cavitary mass lesion was seen in the lower lobe of right lung in CXR. Pansinusitis in paranasal CT scan was reported. Intramural hemorrhage in ileum and jejunum in abdominal CT scan was noted. ESR was >100 and C-ANCA was positive. Microscopic hematuria was reported in lab studies.Wegner's granulomatosis was diagnosed and prednisolone plus cyclophosphamide was administered. He was improved dramatically in a few days. After 3 months' he had no symptoms or signs' lab data were normal and lung mass lesion became smaller. After six months' he had deep vein thrombosis in left lower extremity

Digestive and liver disease statistics in Iran

Gastrointestinal and liver diseases [GILD] are among the most common causes of morbidity in Iran and constitute a substantial proportion of mortality which imposes enormous economic consequences. Our purpose is to collect information and report current statistics on physician visits, hospitalizations, and deaths due to common GILD in Iran. Data on the leading causes of death were obtained from the Iranian Ministry of Health, Office of Health Statistics. A total of 213,322 deaths were reported from March 2003 to February 2004 [excluding mortality from the Bam earthquake] which equaled 4.4 deaths per 1000 population. Of these, 36,575 were due to accidents. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases [ICD-10; 1992]. The leading causes of hospitalization were obtained from the database of the GILD ward in Shariati Hospital, one of the largest and best known gastroenterology referral hospitals in Iran. Similarly, leading causes of out-patient referrals were identified from a large multi-physician outpatient clinic in Tehran. The five leading gastrointestinal causes of death in order of frequency were: gastric cancer, hepatobiliary cancer, liver cirrhosis, esophageal cancer, and colorectal cancer. The five leading causes of hospitalization in the GILD ward of Shariati Hospital were: liver cirrhosis, hepatitis, peptic ulcer disease, cholycystitis and cholangitis, and colorectal cancer. The most common outpatient diagnosis was gastroesophageal reflux disease followed by irritable bowel syndrome [IBS], duodenal ulcer [DU], non-ulcer dyspepsia, and chronic hepatitis B [HBV]. Gastrointestinal and liver malignancy along with chronic liver disease constitute the main GILD reasons for hospitalization and deaths in Iran. Gastroesophageal reflux disease, IBS, and chronic HBV are the most common GILD outpatient diagnoses

[ breast feeding and measles vaccination in childhood be considered as risk factors for later inflammatory bowel diseases?]

It is claimed that the interaction of altering immune system bowel maturation, and measles vaccine predispose the body to inflammatory bowel diseasesAlso it is proposed that breastmilk components during infancy, regulatemucosal immune activity to antigen and have protective role for ulcerative colitis and Crohn's disease. This study was a case-control study. Data were collected from patients' evidences and questionnaires that were filled up by face to face method for each groups of patients [including ulcerative colitis and Crohn's disease] and control groups [including IBS and GERD] They were selected from the patients <40 years who came to 3 clinics in Tehran during 2005 to 2008. Statistical analysis was performed in two steps univariate and multivariate analysis, using SPSS-16 software. Results: Ulcerative colitis group included 143 patients, Crohn's disease group involved 148 cases and control group included 307 patients. Breastfeeding in Ulcerative colitis and Crohn's groups had been less common than in control group [81.1% versus 88.3% and 83.8% versus 88.3% respectively], but the differences were not significant. [P-Values were 0.225 and 0.397 respectively] The difference between ulcerative colitis group and control group in measles vaccination rate [93% versus 89.9% respectively] was not significant [P=0.121]. Both Crohn's disease group and control group had vaccination rate of 89.9% [P=0.481]. There was not significant correlation between previous exposure to smoking, measles vaccination and breast feeding during infancy with extent and location of gastrointestinal involvement in ulcerative colitis and Crohn's disease [p>0.05]. Breast feeding and measles vaccination during infancy do not correlate with later ulcerative colitis or Crohn's disease in adulthood. There was not any correlation between smoking, easles vaccination and breast feeding with extent and location of gastrointestinal involvement in ulcerative colitis and Crohn's disease

[Study of awareness towards and the pattern of milk consumption in 7-12 year old elementary school students in the city of Sari and their mothers [2005-2006]]

Today, most societies face significant decrease in consuming milk products in children and this process would cause problems in providing the calcium needed by children, particularly since the osteoporosis is definitely connected to a lack of receiving sufficient calcium in children and adolescence age. Therefore, the goal of this study is to study the knowledge and pattern of milk consumption in 7-12 year old children of Sari and their mothers. The research samples consisted 638 male and female student at 7-12 in elementary schools [urban and rural], chosen at random from 16 schools. Necessary data were obtained through separate and different questionnaires on the output of milk consumption and its products through direct interviews. The data of the study were analyzed using t-Test, ANOVA, Duncan follow up, Chi-square and correlation coefficient. In this study, 44% of children and 37.7% of mothers consumed milk and 50.1% of children and 19.4% mothers sometimes consumed milk. 5.5% of children and 19.4% of mothers did not consume milk. Mostly, the reason for non-consuming milk among children and mothers was: not having access to milk [27.9% and 17.7%]. The awareness towards the advantages of milk was desirable in 67% children and 48.7% of mothers. It was almost desirable in 21.1% children and 4.5% of mothers and undesirable in 1.4% of children and 1.1% of mothers. The amount of milk consumption for 62% of urban children and 49% of rural children was only one unit, and, in sum, the amount of milk consumption for 59% of boys and 55% of girls was less than the recommended figures. The mean average of criteria deviation in the amount of milk consumption for children showed a significant difference from their educational levels [p=0.001] and insignificant difference from their sex. In addition, the pattern of milk consumption of children had significant relationship with the sex, education level and education of father; however, it had significant relationship with the education level of mothers and the jobs of mother and father. Children's knowledge about the advantages of milk had a significant relationship with the education level of mothers, fathers and jobs of mothers [P<0.004]; however, it had a insignificant relationship with their sex. In this study, the amount of milk consumption in half of the population subjects of the study was less than the standard recommended amount; therefore, to improve children's health status and prevent the destructive effects of osteoporosis in adulthood, there should be necessary actions to increase milk consumption among children

Assessment of inter-and intra-observer variability of the la classification for gerd

Los Angeles classification is widely adopted as a means of unifying endoscopic observation for GERD. We assessed the inter- and intra-observer variability of LA classification. Two-hundred fifty-four still images of the lower esophagus taken by an expert endoscopist [RM] were randomly selected and presented to 9 gastroenterologists [2 females, 6 experts, 3 trainees]. They were asked to report the images according to LA classification. After 2 weeks the images were re-ordered and the same people were asked to report them again. Kappa-statistics was calculated for intra- and inter-observer variability. Mean kappa for intra-observer agreement was 0.54 for experts and 0.55 for trainees [p = NS]. Mean intra-observer kappa was greater among females than males [0.70 vs 0.50 respectively, p=0.05]. Mean inter-observer kappa was 0.20 and 0.31 for experts and trainees respectively [p = NS]. Mean inter-observer weighted kappas were 0.25 and 0.07 [p = 0.007] for males and females respectively. Analyzing data for source of the discrepancy showed that the least reproducible reading was GERD-A both for intra- and inter-observer agreement calculations. According to our data, the LA classification, although a major advance in reporting GERD, has a poor to fair reproducibility. There was no difference between experts and trainees in using the LA classification. Females seem to be more consistent in their readings, but have less agreement with others. Despite the inherent short-comings of kappa statistics and the limitation caused by the possible quality of the still images, revision of the LA system seems to be advisable

Digestive and liver diseases statistics in several referral centers in Tehran, 2000-2004

Gastrointestinal and liver diseases [GILD] are among the most common causes of morbidity and substantial proportion of mortality with enormous economic consequences in Iran. We aimed to collect and report the most recent statistics on deaths, symptoms, physician visits, and hospitalizations for common gastrointestinal and liver diseases in gastrointestinal referral centers of Tehran. Data on the leading causes of death were obtained from Iranian Ministry of Health, office of Health Statistics, [Table 1]. A total of 189,747 deaths in the 23 [out of the 28] provinces of the country] were reported during March 2003 to February 2004. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases [ICD-10; 1992]. The leading causes of hospitalizations were obtained from the database of the GI ward of Shariati hospital, one of the biggest and well known GI referral hospitals in Iran, through years 2000 to 2004. Data on the leading symptoms prompting an outpatient clinic visit and related physician's diagnosis were gathered from a large multi-physician outpatient clinic, located in Tehran, during 2000-2004. The first 5 leading gastrointestinal causes of death in the country were: stomach cancer, hepatobiliary cancers, cirrhosis of liver, esophageal cancer and colorectal cancer respectively. The first 5 leading causes of hospitalizations in GI ward of Shariati Hospital were cirrhosis of liver, hepatitis, peptic ulcer diseases, cholycystitis and cholangitis and colorectal cancer. The most common outpatient diagnosis was GERD followed by IBS, DU, Non-ulcer Dyspepsia, and chronic hepatitis B. GI and liver malignancy along with chronic liver diseases constitute the main GI and liver etiology for hospitalization and death in Iran.Gastroesophageal reflux disease, IBS, DU, Non ulcer Dyspepsia, and Chronic HBV are the most common outpatient diagnosis in Iran

[Case report: calcified pancreatic tumor in a 41 year-old male]

Endocrine tumors of the pancreas [Islet-cell tumors] are rare with neuroendocrine origin. The patient was a 41- year- old man, admitted with chief complains of epigastric mass feeling, dull abdominal pain, lack of appetite and weight loss up to 2-3 kg since 6 months ago. In physical examination, a mass was detected in epigaster and left upper quadrant [LUQ]. In abdominal x-ray, a calcified mass was seen in LUQ. For better evaluation, abdominal CT was performed in which, a large calcified mass in pancreas tail was reported. Finally, by means of immunohistochemical markers, the neuroendocrine carcinoma of the pancreas was confirmed. In spite of the rareness of calcification in these tumors, it is also necessary to consider malignancies when encountering a large calcified mass in pancreas

[ effect of amitriptyline in patients with pain and diarrhea predominant irritable bowel syndrome: a double-blind randomized controlled study]

IBS is the most common disorder diagnosed by gastroenterologists, which is seen in approximately 40-50% of patients seeking care from a specialist. Several randomized controlled trials, have assessed the therapeutic effect of anti-depressant drugs, but there is not enough evidence to prove their effectiveness. Fifty cases meeting Rome II criteria for IBS with predominance of pain and diarrhea were included in this study. Organic causes were ruled out by detailed history, physical examination, laboratory tests, small bowel transit and rectosigmoidoscopy. Participants were then randomly assigned to receive either Amitriptyline or placebo. Subjects were followed using a simple symptom score system before, after 1 and 2 months of treatment. At the end of the 2nd month, Amitriptyline showed more influence in reduction of flatulence, mucus passing and incomplete defication feeling, than placebo [p<0.05]. Also, symptoms general improvement rate was 39% and 15% in Amitriptyline and placebo groups respectively [p<0.001].The rate of side-effects in the two groups did not have significant differences [p>0.05]. Amitriptyline is an effective and well-tolerated treatment for pain and diarrhea predominant IBS

[Investigation and measurement of pesticidal residues; benomil and mancazeb in cucumber produced in Mazandaran]

Considering the importance and usefulness of fruits in people's daily diet as they play an important role in determining public health and also considering the significance of pesticide residues in foods and fruits, measurement of which has been repeatedly reiterated by WHO and FAO, this research was done. Irregular use of pesticides by farmers knowingly or unknowingly without observing its caress period has led to the contact of these pesticides with humans through foods and fruits and in the long run, they will surely cause chronic complications. In this study, after collecting cucumbers form 76 sample regions, we rinsed them carefully, sliced them thinly and mashed them up. Then, we extracted them three times with n butyl acetate. Later, we evaporated the solvent. At the end, we measured the residue by chromatographic gas [GC] and detector [ECD]. The results obtained were analyzed with the help of two-way ANOVA. It indicated that there is a correlation between the investigated regions and the residual amount [P>0.05]. Calculation of the mean ratings showed that the levels of these two pesticides are higher than the acceptable level in most of the regions. [0.01]

Effect of eradicating Helicobacter pylori on gastroesophageal reflux disease

The effect of helicobacter pylori either in provoking or protecting GERD is unclear and the results of studies are conflicting. We aimed to study the effect of H.pylori eradication on GERD by 24-hour ph monitoring. 14 patients with duodenal ulcer or erosive duodenitis without any endoscopic and clinical evidences of GERD were enrolled. 24-hour ph monitoring were performed before and 12 month after H-Pylori eradication. The score was based on DeMeester scoring system. H.Pylori was diagnosed by rapid urease test before eradication and by urea breath test [UBT] after eradication. The mean age was 41.6..10.2 years. The mean scores of 24-hour ph monitoring were 6.8..4.3 and 5.4..3.9 before and after eradication, respectively. The differences were not statistically significant [NS]. Epigastric pain changed significantly before and after the therapy [p<0.01]. H.pylori eradication did not have any effect on scores of 24-hour esophageal ph monitoring. Epigastric pain significantly decreased after eradication