Role of air pollution in inflammatory bowel disease flares: a retrospective study

Background: To evaluate relation between air pollution and rate of flare and hospital admission among inflammatory bowel disease [IBD] patients

Materials and Methods: In this retrospective study, during a 10 months period, the number and average duration of hospitalization of patients admitted in GI ward due to IBD flare were recorded in an industrial capital city. Concomitantly the level of 4 major air pollutants including SO[2], CO, NO[2] and O[3] measured and the correlation between severity of IBD flare and air pollution determined by Pearson correlation coefficient

Results: Average number of admission was 7 patients per month [1-12]. This figure for Crohn's disease [CD] was 2.9 and 3.7 for ulcerative colitis [UC]. The average duration of hospitalization for UC and CD were 2.8 days [1-13] and 2.9 days [1-22] respectively. After comparison of average concentration of 4 major air pollutants with rate of IBD flare, there was a relation, although non-meaningful, between CO concentration and number and duration of admissions due to UC flare [p=0.135 and 0.08, correlation coefficient 0.196 and 0.251 respectively]. DATA analysis did not reveal any significant relation between SO[2] and NO[2] and the rate of admission due to IBD flare [p>0.05] and Interestingly there were a reverse meaningful correlation between concentration of O[3] and number and duration of admissions due to Crohn's disease flare [p=0.016 and 0.006, Correlation Coefficient-0.338 and -0.413 respectively]

Conclusion: It seems that CO as one of the major air pollutants can aggravates course of ulcerative colitis and on the other hand O[3] could have a potential protective effect on Crohn's disease. This issue should further be clarified in future studies

case-control study on occult hepatitis b infection in chronic hemodialysis patients from south-west of Iran

Blood born viral infections such as hepatitis B virus [HBV] are major concerns in chronic hemodialysis [CHD] patients and hemodialysis units. Undetected HB[s] Ag in the presence of viral DNA, occult HBV infection [OBI], isa concern in the care of CHD patients and hemodialysis unit as a mode of transmission.In this case-control study we compare the frequency of OBI in the CHD patients with the normal population.82 consecutive CHD patients and 82 healthy individuals without any risk factors for HBV infection were enrolled in this study. A selection criterion was negative serum HB[s] Ag by ELISA method. Subsequently, the sera were tested for HBV DNA by nested PCR method.In the CHD group, 55 [67.1%] were male and 27 [32.9%] were female, with the overall mean age of 54.32 +/- 13.67 years old. The mean age of control group was 32.65 +/- 8.51 years old, with 26 [31.7%] male and 56 female [69.3%]. HBV DNA was present in 9 [11%] CHD patients, 4 [8%] of whom were seronegative for anti-HBc and anti-HB[s] antibodies. No HBV DNA was identified in the control group [p<0.0001]. History of blood transfusion was presentin all OBI CHD patients and 59 [80.9%] of non-OBI CHD patients. Duration of hemodialysis in OBI CHD and non-OBI CHD patients were 73.56 +/- 39.53 and 44.24 +/- 24.59 months, respectively [p =0.002]. The prevalence of occult HBV infection is relatively high in patients with chronic hemodialysis in our region. Duration of hemodialysis and history of blood transfusion are important risk factor for OBI infection. A more sensitive method, such as PCR, may need to be considered in this patient population

High dose versus low dose intravenous pantoprazole in bleeding peptic ulcer: a randomized clinical trial

The appropriate dose of proton pump inhibitors for treatment of patients with upper [GI] bleeding remains controversial. This study compares high-dose versus low-dose intravenous proton pump inhibitor [PPI] infusion for prevention of GI bleeding complications. A total of 166 patients with bleeding peptic ulcers underwent therapeutic endoscopy using concomitant therapy by argon plasma coagulation [APC] and diluted epinephrine injection. Patients were randomly divided into two groups: high-dose pantoprazole [80 mg bolus, 8 mg per hour] and low-dose pantoprazole [40 mg bolus, 4 mg per hour] infused for three days. Initial outcomes were rebleeding, need for surgery, hemoglobin drop more than two units, and hospitalization for more than five days. Secondary outcome included mortality rate. Overall, 166 patients [83 patients per group] enrolled in the study. The average age of patients in the high-dose group was 59.5 +/- 15.6 years and 52.3 +/- 13.3 years in the low-dose group [p=0.58]. Males comprised 69.7% of patients. In the high-dose group, the mean number of units of transfused blood was 3.3 +/- 1.71 and in the low-dose group, it was 2.82 +/- 1.73 [p=0.50]. There were 36 [43.37%] patients in the high-dose group and 40 [48.19%] in the low-dose group who were hospitalized for more than 5 days [p=0.53]. Rebleeding was observed in 27 [32.53%] patients in the high-dose group and in 21 [25.30%] in the low-dose group [p=0.30]. There were no significant differences observed in drop in hemoglobin of more than two units [p=0.15], mortality [p=0.99] and surgery [p=0.75] between the two groups. For controlling peptic ulcer bleeding, there is no difference between high dose and low dose pantoprazole infusion

Evaluation of N-acetyl cysteine for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective double blind randomized pilot study

Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography [ERCP] that can occasionally be fatal. Multiple drugs have been examined for the prevention of this side effect, with generally uncertain results. This study is an effort to prevent this complication by the use of oral N-acetyl cysteine [NAC]. A total of 100 patients who were candidates for ERCP were divided randomly into two groups. In the NAC [N] group, patients received 1200 mg NAC with 150 cc water orally 2 h before ERCP. In the placebo [P] group, 150 cc water was prescribed as a placebo. We measured serum amylase and lipase levels before and 24 h after ERCP. The prevalence of pancreatitis and duration of admission in each group were determined and compared. In group N there were 5 [10%] cases of pancreatitis, whereas in group P there were 14 [28%] cases, which was significant [risk reduction ratio: 2.8; p=0.02].The average admission time was 1.16 +/- 0.55 days in group N and 1.18 +/- 0.44 days in group P, which was not significant. There were significant differences in the prevalence of acute pancreatitis between the two groups. In addition, the number of need to treat [NNT] consisted of five cases for NAC. With regards to the above results and the safety profile of NAC, it could be used as a therapeutic agent for the prevention of post-ERCP pancreatitis. We recommend that the results of this study be verified by additional clinical trials

comparison of impulse oscillometry and spirometry values in patients with gastroesophageal reflux disease

The relationship between gastroesophageal reflux [GERD] and airway diseases is still a matter of debate. Oscillometry is an objective, independent tool for the evaluation of airway resistance. The main purpose of this study is to compare spirometry and oscillometry results before and after treatment by a proton pump inhibitor [PPI] in a group of GERD patients who have no respiratory symptoms. This study was performed on patients with endoscopically diagnosed reflux esophagitis who had no pulmonary symptoms. Patients received omeprazole 40 mg, twice a day for 12 weeks. Spirometry and oscillometry were performed before and after treatment. Impulse oscillometry [IOS] was performed by a force oscillation instrument. We recorded respiratory resistance at 5 Hz [R5] and 20 Hz [R20], resonant frequency [Fres], and distal capacitive reactance [X5] for each patient. Included were 30 patients [17 males; 13 females] whose mean age was 32 years. According to the Los Angeles Classification, 16 patients had grades B or C esophagitis and 14 had grade A. Although all patients had normal spirometry results, 50% had increased airway resistance according to oscillometric findings. After treatment with omeprazole, only 16.3% had abnormal oscillometry results [p=0.004]. Spirometry results [forced expiratory volume at the first second [FEV1]; forced vital capacity [FVC]; FEV1/FVC; and mean forced expiratory flow 25%-75% [FEF 25%-75%]] showed significant further improvement compared to pretreatment normal values [p<0.001 for all]. Abnormal airway resistance may be present in GERD patients even when there is no obvious respiratory symptom. Oscillometry seems to be more sensitive than spirometry in reporting abnormal pulmonary function in patients with GERD

Liver cirrhosis seen in GI clinics of Ahvaz, Iran

Liver cirrhosis is an end-stage condition fornumerous chronic liver diseases. Limited data exists on the epidemiology, natural history and complications of liver cirrhosis in Ahvaz, Iran. In a cross-sectional study we have retrospectively evaluated 165 patients from September 1, 1999 until September 1, 2008. Patients with evidence of cirrhosis of the liver seen on abdominal ultrasound were enrolled. The diagnosis was based on clinical, functional and morphological data. The etiological profile was established by determining viral and autoimmune markers, and by metabolic screening. Patients who were not confirmed to be cirrhotic were excluded from this study. All cases were studied to determine etiological factors, complications and disease prognosis. Data were recorded on a questionnaire. A total of 165 patients were studied, of which there were 114[67%] males and 51[33%] females. The mean age was 47 years. The majority of patients [70 cases [42.4%]] had evidence of HBV infection. Of HBs Ag-positive patients, 31[43.2%] were HDV Ab positive with a mean age of 41.6 years. There was no significant difference by sex among cirrhotic patients [p>0.05]. Other cases included 23 [14%] patients with autoimmune hepatitis [AIH], 15[9.1%] had HCV infection, 2[1.2%] had evidence of Wilson's disease and no etiological factors were recorded in 55 [33.3%] patients. Ascites was present in 32% of cases, splenomegaly in 29%, esophageal varices in 38%, fundal varices in 2%, peptic ulcer in 8%, acute variceal hemorrhage in 8%, various grades of hepatic encephalopathy in 1%, and hepatocellular carcinoma in6% of patients. When cirrhotic patients were grouped according to child-pugh classification, 19% were in class A, 30% were in class B, and 51% comprised class C. HBV infection was the major risk factor for cirrhosis in this study and ascites was the most common complication. There were more patients with Child-Pugh class C cirrhosis than thoseinclasses B and A. A multidisciplinary approach for the prevention and control of the increase in HBV infection must be adopted in order to inform the public about the seriousness of its complications and possible modes of transmission.

Genotypic analysis of hepatitis C virus in Khuzestan province, southwestern Iran

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. In a cross-sectional study, 223 patients infected with HCV who referred to Ahvaz 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. 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%]. 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

Remifentanil-ketamine versus fentanyl-ketamine sedation in patients undergoing phacoemulsification with topical anesthesia: comparison of intraocular pressure changes and sedation quality

Narcotics and sedatives can reduce intraocular pressure. This study was performed to evaluate the effect of remifentanil plus ketamine on intraocular pressure and sedation quality in comparison with fentanyl plus ketamine during and after operation in patients undergoing phacoemulsification with topical anesthesia. Forty four patients were randomized into two groups to receive either a continuous infusion of remifentanil [0.2 micro g/kg/min for 4 min and then 0.1 micro g/kg/min: Group R, n=22] or bolus intravenous fentanyl [1.5 micro g/kg: Group F, n=22] for sedation. Patients in both groups received low dose ketamine [0.15 mg/kg] intravenously. Topical anesthesia was performed using tetracaine 0.5% eye drop in both eyes. Intraocular pressure was measured in non-operative eye before sedation [baseline], 2 minutes after sedation, before intraocular lens insertion, at the end of operation and 15 minutes after the end of operation using Schiotz tonometer. Sedation, cooperation, satisfaction and pain scores and also postoperative nausea and vomiting were recorded in all patients. Surgeon satisfaction scores were evaluated at the end of operation. The intraocular pressure did not differ significantly between the two groups throughout the study. The mean [SD] intraocular pressures 2 minutes after sedation, before intraocular lens insertion, at the end of operation and 15 minutes after the end of operation in recovery room were all less than that of baseline in both groups, but the baseline value was decreased only significantly [P<0.05] in recovery room [13.75 [3.46] to 11.91 [3.43] in group R, respectively and 13.74 [3.05] to 11.57 [2.33] in group F, respectively]. The incidence of postoperative nausea and vomiting in group R was higher than that of group F [7 patients in group R and no patient in group F, P=0.009]. Combination of remifentanil infusion and intravenous ketamine did not offer any advantages over the combination of intravenous fentanyl and ketamine in order to prevent intraocular pressure rising during phacoemulsification. The lower incidence of postoperative nausea and vomiting and higher rate of appropriate sedation in fentanyl group suggested fentanyl as a more suitable medication for systemic sedation compared with remifentanil

Influence of pre-emptive versus preventive analgesia with oral aetaminophen on postoperative pain in painful ophthalmic surgeries: which one is better?

Patients undergoing certain ophthalmic operation are more likely to experience serious postoperative pain. This study was carried out to evaluate the effects of pre-emptive vs. preventive analgesia with oral acetaminophen on postoperative pain in painful ophthalmic surgeries. In a double blind clinical trial, 60 patients undergoing strabismus, retinal detachment or deep vitrectomy were randomized into three equal groups. The first group [G1] received oral acetaminophen one hour before induction of general anesthesia and placebo postoperatively. The second group received placebo before induction and acetaminophen after the operation [G2]. The third group received placebo at both times [G3]. Blood pressure, heart rate and occurrence of oculocardiac reflex [OCR] were recorded during the operation. Pain score [VAS: visual analog scale], the time of the first analgesic use [in hours], and total analgesic requirement [acetaminophen: mg] were determined until 24 hours postoperatively. Data was analyzed using ANOVA, Chi-2 and Kruskal-Wallis tests. The mean pain score was lower in G1 compared with G2 at 2 and 24 hours after the operation [2.1 +/- 0.6 vs. 2.7 +/- 0.4, P=0.001 and 1.1 +/- 0.3 vs. 1.5 +/- 0.5, P=0, respectively]. The pain score at 2, 6 and 24 hours after the operation was greater in G3 compared with G1 [2.8 +/- 0.3 vs. 2.1 +/- 0.6, P=0, 2.3 +/- 0.7 vs. 1.7 +/- 0.5, P=0 and 1.6 +/- 0.4 vs. 1.1 +/- 0.3, P=0.001, respectively]. There was no significant difference among the three groups with respect to the intraoperative hemodynamic changes, occurrence of OCR, the time of the first analgesic use and analgesic consumption. The use of oral acetaminophen as pre-emptive analgesia one hour before painful ophthalmic surgeries may reduce postoperative pain intensity

Preoperative sub-tenon block decreases perioperative pain severity and adveres complications

This study was designed to evaluate the efficacy of sub-tenon block [preemptive analgesia] after general anesthesia and before beginning the repair of retinal detachment [RD] surgery by using scleral buckle and cryopexy. Sixty eight patients scheduled for RD surgical repair with "American Society of Anesthesiologists" [ASA] I or II were included in this clinical trial study. The patients were randomly and blindly divided into two equal groups. The surgery was done under general anesthesia in both groups, but in the case group, sub-tenon block was given as preemptive analgesia after the induction of general anesthesia with similar methods and before the start of surgery. The incidences of intra and postoperative [up to 24 hours] oculocardiac reflex [OCR], ischemic heart disease [IHD] changes, nausea and vomiting [PONV], delirium, total analgesic drug consumption and ocular severity of pain were significantly lower in the case group compared with the control group [p<0.05]. Mean blood pressure, heart rate, time of discharge from the hospital, frequency of requirement to analgesic drug, intra and postoperatively were significantly lower in the case group compared with the control group [p<0.05]. According to this research, the use of sub-tenon block in RD surgery effectively reduces PONV, postoperative pain, analgesic drug requirements, delirium, discharge time from the hospital, IHD, hemodynamic changes and OCR, therefore it is recommended for daily routine ophthalmologic surgeries