Evolutionary dynamics of Helicobacter pylori cagA and vacA genes in Iran and their association with clinical outcomes

There is a relationship between specific genotypes of Helicobacter pylori cagA and vacA genes and the increased risk of peptic ulcer diseases and gastric cancer. These genes also possess strong patterns of geographical differentiation. The present study aims to determine the patterns of variation of the virulence genes in Iran and their association with clinical status. Sequence fragments for cagAand vacA were obtained from a total of 147 H. pylori isolates from diverse geographical and ethnic sources within Iran. We used phylogenetic methods to determine the patterns of allelic diversity, and the relationship between evolutionary lineages and clinical status. Phylogenetic analyses of Iranian cagA gene disclosed four lineages, whereas the vacA gene had two distinct lineages. The cagA lineage II showed extensive genetic diversity compared with lineage I. cagA lineages III and IV disclosed mixed ancestries with recombinant nucleotides that originated from lineages I and H Iranian strains with vac A lineage II genotype were significantly cagA+ [> 90%, p = 0.0] and correlated with a higher rate of peptic ulcers in infected individuals [p =0.003]. Most strains in the cagA lineage I showed a vacA lineage II genotype [p = 0.003] and significantly correlated with an increased risk of peptic ulcers in infected individuals [p = 0.022]. Strains with cagA lineage III genotype significantly correlated with gastritis [p = 0.0]. The increased level of allelic diversity in the virulence genes shows strong evolutionary dynamics, resulting in the emergence of new clonal genealogies of the cagA gene within Iran. Particular lineages of the Iranian cagA and vac A genes correlate with peptic ulcer diseases

[Severe active ulcerative colitis and resistance to intravenous hydrocortisone therapy: successful treatment with methylprednisolone pulse therapy]

Ulcerative colitis is a mucosal-inflammatory disease that usually involves the rectum and extends proximally to involve all or part of the colon. Medications for treatment include anti-inflammatory agents such as 5-ASA compounds, systemic and topical corticosteroids and immunomodulators. A 33 year-old female and 52 year-old male both diagnosed with severe active ulcerative colitis who were resistant to intravenous hydrocortisone therapy [400 mg/day] were admitted to our clinic. Respectively, the patients were treated with pulsed steroid therapy at doses of 500 and 1000 mg/day methylprednisolone intravenously, for three consecutive days. After the treatment, the patients potentially achieved complete clinical remission. In conclusion, pulsed steroid therapy may induce complete clinical remission in patients with severe, active ulcerative colitis who have resistance to intravenous conventional steroid therapy

[Determining the role of preoperative laparoscopic staging in prevention of inappropriate laparotomies in patients with gastric adenocarcinoma]

Today the use of laparoscopy before laparotomy is an effective method for decision-making in patients with gastric adenocarcinoma. The reliance on CT scans for decision-making purposes is not only unhelpful, yet also misleading. Nonetheless, indications for laparoscopy and its application are changing daily. The low quality of diagnostic tools and epidemiological situation in our country requires that an independent study should be done in this case. All patients in the interval from the 12th month of 1388 until the 5th month of 1389 who were diagnosed as new cases of gastric adenocarcinoma and admitted to Shahid Sadoghy Hospital, Yazd, Iran were included in this experimental study. At first indication, laparoscopy was defined. All patients with complications who needed palliative surgery such as intolerable dysphagia, obstruction, bleeding or perforation in addition to those with distant metastases were excluded. TNM score and staging were noted for all patients. There were 26 patients who underwent laparoscopies to determine TNM scores and staging. These patients were divided into three groups: 1. Patients eligible for surgery with no neoadjuvant chemotherapy. 2. Patients needing neoadjuvant chemotherapy prior to laparatomy. 3. Non-operable patients, who only required chemotherapy. Subsequently, surgical pathological staging and TNM were determined for all 37 patients and used as the gold standard for comparison with other methods. A total of 30 [88.9%] patients with the aid of CT scans were classified as stages ? and ??, where laparoscopy estimated six patients as stages ? and ??, and surgical pathology diagnosed five [13.5%] cases out of the 37. The 37 patients were divided into the following groups: A-11 patients on clinical evaluation required laparotomy, but no laparoscopy was indicated. B-7 patients were identified as stages ? and ?? who underwent surgery without neoadjuvant chemotherapy. C-8 patients were candidates for neoadjuvant chemotherapy after laparotomy. D-11 patients were estimated as inoperable and were only given chemotherapy. Of these, one patient was assumed to be operable with laparoscopy, yet was unoperable in laparatomy. Another patient did not receive neoadjuvant chemotherapy due to the lower estimation of laparoscopy. If patient management solely depended on the results of CT scans, therefore a total of 87% of patients were mismanaged. With laparoscopy, however, 30 patients [81%] were correctly managed whereas seven patients [19%] were not. There were five patients with surgical pathological stages ? and ?? who did not benefit from laparoscopy and two patients were mismanaged because of incorrect laparoscopic information. No similarities with pathological and CT scan results according to TNM and staging were noted, so there was significant statistical difference. The results of TNM and staging scores of 30 patients who had laparoscopies were similar to the surgical TNM and staging scores, so there was no significant statistical difference Therefore, conventional CT scans are less sensitive than usual in our city. Since access to multi-detector CT scans and endosonography is very difficult in our city, therefore we could not use them for better patient management which is a pitfall for this study. Thus, use of laparoscopy before laparotomy not only decrease the un necessary laparotomies rate, but also help us in selecting the patients who need neoadjuvant chemotherapy before surgery

[ effect of active learning method on stability of information and satisfaction of physiopathology students in Yazd university of medical sciences]

Active Learning Method [ALM] is a model in which students are active in the class. This aim of this study is to compare stability of information and satisfaction of students in classic method of lecture and active learning method. This descriptive cross-sectional study was performed on 48 medical students [29 females and 19 males] selected through census sampling method and spending their physiopathology courses in Yazd Shahid Sadoughi University of Medical Sciences. Some sessions from the courses of "respiratory, digestive, and urinary diseases" were selected. Two forms for assessing students' satisfaction were used as pretest and post-test. The stability of information was assessed by 8 essay questions one month after teaching. SPSS software was used for data analysis using descriptive statistics, Mann Whitney and McNemar tests. Fifty six percent of students were generally satisfied with the project implementation. The median for stability assessment exam in classes held using ALM was 5 while it was 3.42 for classes using lecture method which had a significant difference [P=0.00]. Active learning method increases information stability in students' mind after the teaching session

[Cardiovascular autonomic dysfunction in cirrhotic patients]

Cirrhosis is a pathologically defined entity associated with a spectrum of characteristic manifestations. The cardinal pathologic features reflect irreversible chronic injury of the hepatic parenchyma and include extensive fibrosis in association with the formation of regenerative nodules. Autonomic dysfunction is a frequent and important complication of cirrhosis. The risk of mortality in cirrhotic patients with autonomic dysfunction is higher than that in cirrhotic patients without this complication. This study aimed to determine the frequency of autonomic cardiovascular dysfunction in cirrhotic patients. Thirty cirrhotic patients who admitted to Shahid Sadoughi Hospital and thirty healthy persons [control group, matched age and sex] in Yazd from Dec 2005 to July 2006 were studied. In both group individuals with renal failure, heart failure and diabetes mellitus were excluded. Drugs that influence the autonomic nervous system were discontinued for 24 hours and then, 3standard autonomic function tests were carried out. Results from two group were collected in a questionnaire and analyzed statistically. Of 30 patients, 24 [80%] were men and 6 [20%] were women. The mean age was 51.9+19.4 years and the mean duration of cirrhosis was 3.8 +/- 2.7 years. Twenty-six patients [86.7%] had autonomic neuropathy. Twenty-four out of these twenty-six patients [80%] had parasympathetic dysfunction and two [6.7%] had combined sympathetic and parasympathetic neuropathy. None of them showed sympathetic dysfunction alone. Four patients [13.3%] didn't have autonomic neuropathy. There was significant correlation between the frequency of autonomic neuropathy and the severity of cirrhosis [p<0.001]. Significant correlation was seen between the frequency of autonomic dysfunction and the duration of cirrhosis [p<0.01].There was no significant correlation between age, sex and the frequency of dysfunction neuropathy [p=0.118 and p=0.16, respectively]. To assess the correlation between the etiology of cirrhosis and the prevalence of dysfunction neuropathy, a further prospective study involving a larger number of patients is necessary. More severe and prolonged hepatic failure was associated with more frequent autonomic neuropathy in patients with cirrhosis