Epidemiologic characteristics of patients with inflammatory bowel disease in Kermanshah, Iran

Background: This study was done to define some epidemiological aspects of inflammatory bowel disease [IBD], and to describe its characteristics in west of Iran

Methods: In this descriptive study all patient with the diagnosis of IBD who were visited in university-affiliated medical centers, between 2014 and 2015 were recruited. Their demographic characteristics, disease-related manifestations, complications, disease course and their chief complaints were analyzed

Results: Of 156 referred individuals, 153 patients had ulcerative colitis [UC] and 3 patients had Crohn's diseases [CD]. The mean age of the patients at diagnosis was 35.69+/-12.35 [range: 17-80] years with the most common age group of 25-35 years and slight female predominance [51.9%]. More urban patients were registered [90.4%] and 57% had high school or upper education. Positive family history of the disease was in 25.6% and 66.6% had four or more family members. Furthermore, 51.9% had left sided colitis and 40.4% had pancolitis with bloody diarrhea [79.5%] and abdominal pain [68.6%] as the most common manifestations. 36.5% had other autoimmune diseases. Multiple flare was seen in 47.4%, most commonly due to drug discontinuation [26.28%]. Hospital admission was reported in 34.6%. History of contraceptive pill use was in 38.8% of the female patients

Conclusion: The demographic and clinical manifestations of IBD are usually the same as other developing countries; however, the rarity of CD is eminent. Although the accurate epidemiological characteristic of IBD in Iran is still obscure, it is not a rare disease as previously thought and it seems that gradual reception of a western lifestyle may be linked to the ongoing rise in IBD

Upper gastrointestinal bleeding as the first manifestation of wegener's granulomatosis

Wegener's granulomatosis is an uncommon inflammatory disease that manifests as vasculitis, granulomatosis, and necrosis. It usually involves the upper and lower respiratory tracts and kidneys. Although it may essentially involve any organ, gastrointestinal [GI] involvement is notably uncommon. A 20-year-old male patient presented with epigastric pain, vomiting, hematemesis, and melena. On physical examination, he was pale. There was no abdominal tenderness or organomegaly. Upper GI endoscopy revealed dark blue-colored infiltrative lesions in prepyloric area. Evaluation of the biopsy sample showed mononuclear cell infiltration in the submucosal area, hyperplastic polyp, and chronic gastritis. High dose proton pump inhibitor and adjunctive supportive measures were given but no change in the follow-up endoscopy was detected. During hospital course, he developed intermittent fever and serum creatinine elevation. 12 days after admission, he developed dyspnea, tachypnea, and painful swelling of metacarpophalangeal joints, and maculopapular rash in extensor surface of the right forearm. Chest radiography showed pulmonary infiltration. Serum c-ANCA titer was strongly positive and skin biopsy revealed leukocytoclastic vasculitis. The patient received methylprednisolone pulse, which resulted in complete recovery of symptoms and gastric lesion. The present case indicates that GI bleeding may be the first manifestation of Wegener's granulomatosis. Moreover, it should be emphasized that gastric biopsy is not characteristic or diagnostic in such patients

Prophylaxis for deep venous thrombosis: knowledge and practice of surgeons

Despite high incidence [10%-80%]] for venous thromboembolism [VTE] after surgery, many report show suboptimal risk assessment and inadequate prophylactic measure for this condition. The aim of this study was to determine knowledge, attitude and practice of surgeons about deep venous thromboembolism [DVT] prophylaxis. The knowledge and attitude of faculty member surgeons working in Kermanshah University of Medical Sciences were evaluated using a questionnaire. In addition, their practice was assessed by reviewing the hospital chart of 4105 patients who had elective or emergency surgery. Patients were categorized based on claget criteria into high, moderate and low risk for DVT. Mean knowledge score was 9.05 +/- 1.07 [82.3% of best predicted] and for attitude was 21.9 +/- 2.78 [73.1% of best predicted]. There were no statistical significant differences between surgical clinical groups. Nearly all of surgeons believed that use of low dose heparin was dangerous. Type of prophylactic measure was only low dose heparin. Only 9 [3.2%] patients from high risk group and 9 [1.08%] patients from moderate risk group received prophylactic treatment and no one from low risk group for DVT received prophylaxis. Degree of under use of prophylactic measure for DVT is higher in this study as to compare with other investigations. Increased awareness about optimal prevention and outcomes is needed. It is highly recommended that all patients undergoing surgery must be routinely assess for preoperative risk for DVT and consider aggressive prophylactic measure against this condition

Prevalence, risk factors and severity of asthma symptoms in children of Kermanshah, Iran: ISAAC phase I, II

Asthma is the most common chronic disorder of school-age children and youth, with rising prevalence in all over the world. By attention to the geographic area there is considerable difference in the prevalence of asthma. The International Study of Asthma and Allergies in Childhood [ISAAC], was founded to maximize the value of epidemiological research into asthma and allergic disease by establishing a standardized methodology and facilitating international collaboration. To determine the prevalence of asthma and related symptoms in Kermanshah [a city in west of IRAN] school children and also identifying the related variables that increased asthma risk using the ISAAC protocols. This descriptive analytic study was done by the ISAAC written questionnaire and additional questions about family number, demographic and socio-economic characteristics of two groups of first and second grade of primary and guidance schools [6-7 y, 13-14 y]. Suggested sample size were applied and selected randomly. Results were analyzed by SPSS soft ware by 95% confidence interval. The ISAAC-written questionnaire was completed by a total of 6236 [48.7% were 6-7 and 51/3% were 13-14 years old] school children. 50.4% of students were girls and 49/6% were boys. The prevalence of diseases and symptoms were as follows: 20.6% had ever wheezing [27.4% in 13-14 years old and 13.4% in 6-7 years old children and it was 21.6% in girls and 19.5% in boys]. Among which the estimated mean national 12-month prevalence of wheeze [current wheeze], speech limiting wheeze, exercise wheeze, night cough and physician diagnosed asthma [ever asthma] were respectively 30.1%, 5.4%, 9.4%, 7.3% and 3.3% for the 6-7 year age group and 44.2%, 13.5%, 28.9%, 17.4% and 2.1% for the 13-14 year age group. Current wheeze was higher in Childs and adolescents with family history of smoking and in higher family number. Comparing with regional study the results of this epidemiological survey of asthma in Kermanshah indicate that asthma is more common here, more prevalent in girls than boys and is higher in 13-14 years old than 6-7 years old but sever asthma is much less common. The results may be due to better diagnosis and better control of disease