ABSTRACT
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
ABSTRACT
Giardia duodenalis is one of the most important human enteric parasites throughout the world. Clinical symptoms of this parasite vary from asymptomatic infection to chronic diarrhea. Still it is not clear, whether different types of pathogenesis are due to different strains of organism or to variable host factors. The purpose of this study was to investigate possible correlation of clinical symptoms with assemblages among symptomatic and asymptomatic cases collected from southwest of Iran. Fecal samples were collected from 100 symptomatic and asymptomatic cases, which were positive for G. duodenalis. The samples were subjected to semi-nested PCR and RFLP for gdh gene. Among symptomatic patients, 54% had mixed genotypes AII and BIII, 28% and 18% of samples indicated assemblages BIII and AII, respectively. In contrast, among asymptomatic cases, 64%, 26% and 10%samples had mixed genotypes, BIII and AII assemblages, respectively. Statistical analysis using Chi-Square test showed that there was no significant correlation between assemblage and clinical symptoms in current study. High prevalence of mixed infection in both groups may affect this conclusion, therefore further study in more details are necessary to clarify these finding. Additionally, it is important to carry out investigations regarding human host factors as well
ABSTRACT
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
Subject(s)
Humans , Female , Male , Acetylcysteine , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Double-Blind Method , Pancreatitis/etiology , Pilot Projects , Prospective StudiesABSTRACT
Ulcerative colitis [UC], as the prototype of inflammatory bowel disease of the large bowel, is increasing in Iran and other developing countries. There are few studies that discuss the properties of this disease in the Islamic Republic of Iran. The result of this review may provide a general consensus about the epidemiological features of UC in Iran. This was a qualitative, systematic review that investigated the incidence, prevalence, and demographic properties of UC in Iran. We evaluated all published studies in the PubMed database, Iran Medex, Magiran, and Scientific Information Database [SID] that pertained to the epidemiology and demographic features of UC in Iran from January 1987 to January 2012. After searching with defined keywords and implementing the inclusion and exclusion criteria, 11 case series and 2 case-control studies fulfilled the criteria for inclusion. The estimated prevalence of UC is 15 per 10[5] persons, and the reported incidences were 3.04 and 3.25 per 10[5] persons in two Iranian provinces. The disease was more commonly observed in women and people in their fourth decade of life. Cigarette smoking conferred protection and familial association seemed to be similar to developed countries. UC did not appear to be more common among the higher socioeconomic class. In addition it less commonly involved the proximal colon and rectum. Although the data is limited, the prevalence and incidence of UC in Iran shows an increasing pattern similar to other countries in the region. There is no clear association with socioeconomic status. Milder forms of the disease are common in Iran. A comprehensive nationwide data bank is needed for a better definition of the disease characteristics
Subject(s)
Humans , Female , Male , Colitis, Ulcerative/pathology , Inflammatory Bowel Diseases , Colitis, Ulcerative/diagnosis , PrevalenceABSTRACT
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