Prevalence of narcotic bowel syndrome in opioid abusers in Iran

In spite of the increasing trend in opioid abusers worldwide, the prevalence of narcotic bowel syndrome [NBS] is undetermined. We aimed to estimate the prevalence of NBS and other opioid bowel dysfunction [OBD] in opioid abusers in Kerman, southeast Iran. According to the best of our knowledge, this is the first study to assess the prevalence of NBS in opioid abusers. By referring to addiction treatment centers in Kerman city and in a cross-sectional study, 577 subjects with opium or opioid subtracts abuse were included in our study. A validated questionnaire was used for OBD assessment and diagnosis of NBS was made according to both the presence of chronic abdominal pain despite increasing the opioid dose and ruling out other causes of abdominal pain. SPSS software version 16 was used for data analysis. p value<0.05 was considered as statistically significant. Constipation, regurgitation, and heartburn were the most gastrointestinal complaints that were found in 132[22.9%], 123[21.3%] and 91[15.8%] subjects, respectively. Only 16[2.8%] participants fulfilled all the NBS criteria. Simultaneous use of non-narcotic sedative drugs increased the risk of NBS significantly [the odds ratio 3:1 and p=0.049]. NBS is not rare among opioid abusers and should be considered as a cause of chronic abdominal pain in this group

Fulminate hepatic failure as an initial presentation of non-hodgkin lymphoma: a case report

Viral hepatitis and toxins comprise most common causes of fulminate hepatic failure that are often diagnosed with standard laboratory tests. Herein we discuss a rare, difficult to diagnosis etiology of acute liver failure [ALF]

A 62-year-old man presented with a two-week history of fever and fatigue. At four days before admission he became lethargic

His past medical and drug histories were unremarkable

Physical examination revealed generalized jaundice, fever and loss of consciousness. Laboratory tests showed elevated liver transaminases with direct hyper-bilirubinemia

Abdominal ultrasonography and CT scan showed hepatosplenomegaly and para-aortic abdominal lymph-adenopathy

A further work-up included liver biopsy

The histopathology and imunohistochemistry was compatible with diffuse large B-cell lymphoma. He underwent high dose glucocorticoid therapy but his condition deteriorated rapidly and he died eight days after admission

ALF as an initial manifestation of malignant hepatic infiltration is extremely rare yet should be considered in all patients with unknown hepatic failure that are highly suspicious for malignant neoplasm