Intestinal leishmaniasis in acquired immunodeficiency syndrome

In endemic regions, visceral leishmaniasis is one of the most common opportunistic infections in HIV positive patients. Simultaneous infection with Leishmania and HIV has been reported in some countries but this is the first report of such a case in Iran. Our patient was a 27 years old man with intermittent night fever, abdominal pain, loss of appetite, vomiting, watery diarrhea and severe weight loss for 6 months. He had low socio-economic status with an imprisonment history. The patient was quite cachectic and had low grade fever. Physical exam and upper Gl endoscopy revealed oropharyngeal candidiasis. Microscopic evaluation of duodenal biopsy material showed Leishmania amastigotes in macrophages of lamina propria. Leishman bodies were also observed in bone marrow aspiration specimen. Serologic tests were positive for Leishmania infantum. HIV antibody was also positive with a CD4[+]cell count of 807microl. The diagnosis was acquired immunodeficiency syndrome with simultaneous visceral leishmaniasis involving intestinal mucosa

[Extra-intestinal symptoms and their relationship to psychological symptoms in patients with irritable bowel syndrome]

Irritable bowel syndrome [IBS] is one of the most common functional gastrointestinal disorders. A significant number of IBS patients have extra-intestinal symptoms [EIS], but the etiology of co-morbidity of IBS with these symptoms is unclear. The aim of this study was to evaluate the relationship of EIS with psychological symptoms in IBS patients. This multicenter, cross-sectional study was conducted on 18 to 65 year old IBS patients [Rome III criteria] referred to four gastroenterology outpatient clinics in the city of Isfahan from 2008-2009. Patients completed the IBS symptom severity scale, EIS severity scale, and anxiety and depression scale. Linear regression analysis was applied to evaluate the relationship of psychological symptoms with EIS, controlling for other variables. During the study period, 142 IBS patients [mean age=30.9 +/- .1 years, 81.7% female] were included. ESI score was significantly correlated to IBS severity score [r=0.534], anxiety [r=0.551] and depression scores [r=0.407]; P<0.001. With linear regression analysis, female gender [P=0.028], IBS severity [P<0.001], and severity of anxiety [P=0.001] were related to ESI scores. According to these results, psychological symptoms are associated with EIS in IBS patients, though prospective studies are needed to evaluate a causative association. Thus, gastroenterologists must pay attention to the association of psychological symptoms with EIS in the treatment of IBS patients and refer them for appropriate therapies

[Effect of oral propranolol on prolonged qtc in cirrhotic patients]

Prolongation of QT interval is one of the most important abnormalities in cardiovascular system of cirrhotic patients. The aim of this survey was determination of propranolol effect on frequency adjusted QT interval [QTc]. Thirty six cirrhotic patients [M/F=20/16, mean age:56 +/- 3.8 years] and 40 healthy age and sex matched controls [M/F=25/15, mean age: 58 +/- 2.4 years] were evaluated for blood pressure, heart rate and QTc before and 90 minutes after receiving 40 mg propranolol, orally. Results: Prolonged QTc [more than 0.440 s1/2] was seen in 27 cirrhotic patients [75%] in contrast with to 2 [5%] ones in healthy control group [P<0.001]. In cirrhotic group, mean QTc before and after propranolol administration were 0.470 +/- 0.024 s1/2 and 0.44 +/- 0.008 s1/2, respectively [P<0.001]. In responder patients [those with 25% reduction in basal cardiac rate], mean QTc before and after propranolol administration were 0.482 +/- 0.005 s1/2 and 0.430 +/- 0.009 s1/2, respectively [P<0.05]. In non-responders, mean QTc before and after propranolol administration were 0.461 +/- 0.012 s1/2 and 0.453 +/- 0.011s1/2, respectively [P>0.05]. Non-selective beta blockers [such as propranolol] reduce QTc in cirrhotic patients.The effect of propranolol on QTc was related to 25% decrease in heart rate

Role of Genetic Factors in Inflammatory Bowel Disease

According to the remarks of gastroenterologists, prevalence of inflammatory bowel disease is increasing in our country. Since these diseases are the cause of multiple complications and low quality of life in patients, it mandates more considerations. On the other hand the pathogenesis of inflammatory bowel disease remained unclear and majority of researchers confirm the interaction of genetics, immunologic and environmental factors in its pathogenesis. Considering these factors separately is an important point in understanding the pathogenesis of the disease. This article evaluates the role of genetic factors in inflammatory bowel disease and different studies, in this field. Since discovery of the first inflammatory bowel disease related chromosomal locus in 1996, 10 related chromosomal loci have been recognized. The majority of studies have been performed on CARD15/NOD2 gene [IBD1 locus] and its polymorphisms. Since understanding of exact pathogenesis of inflammatory bowel disease is important in promoting newer and more effective therapeutic modalities, this goal would be accessible with extension of such clarifying studies

[Case report: Intestinal leishmaniasis in a patient with AIDS]

In endemic regions visceral leishmaniasis is one of the most common opportunistic infections in HIV positive patients. Simultaneous infection with leishmania and HIV has been reported in some countries but there's no such report from Iran in medical literature. Patient was a 27-year-old man admitted with chief complaints of intermittent abdominal pain, anorexia and vomiting since 6 months ago. He also mentioned mild night fevers, watery diarrhea and severe weight loss during this time. He was of low socioeconomic status, was unemployed and had a history of imprisonment 4 years ago. Physical examination revealed low-grade fever [T=38.1?C] and severe cachexia [Weight=41 Kg, Height=165 cm]. Oropharyngeal candidiasis was evident in oral examination. In upper GI endoscopy, candidal esophagitis and duodenal nodularity were seen. Candidal plaques were also visible in duodenal mucosa. Microscopic evaluation of duodenal biopsy material showed partial blunting of the villi. Abundant macrophages containing intracytoplasmic microorganisms had infiltrated and expanded the lamina propria. High magnification view revealed leishmania amastigotes with nuclei and kinetoplasts. Leishman bodies were also observed in bone marrow aspiration specimen. Serologic studies [latex agglutination and Immunofluorescence antibody] were positive for Leishmania infantum. Serology for HIV antibody was also positive. CD4+ cell count was 80/microl. The diagnosis was acquired immunodeficiency syndrome with simultaneous visceral leishmaniasis involving intestinal mucosa