Investigation of the Factors Affecting Bone Mineral Density in Children with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Children with celiac disease (CD) are at an increased risk of low bone mineral density (BMD) owing to malabsorption of fat-soluble vitamins, inflammation, and malnutrition. This study aimed to determine the prevalence and risk factors for low BMD in Iranian children with CD. @*Methods@#This prospective cohort study examined 149 Iranian children with CD between 2011 and 2018 at Zabol University of Medical Sciences. BMD was measured using dualenergy X-ray absorptiometry. Demographic, clinical, and laboratory data were collected from patients’ medical records. Logistic regression analysis was performed to identify the factors associated with low areal BMD (BMD-Z <−2) in the lumbar spine and femoral neck.Descriptive data were analyzed using the mean, standard deviation, and relative frequency.Data were analyzed using the chi-square test, t-test, and analysis of variance. @*Results@#Of the 149 children with CD, 27.5% had osteoporosis. The mean body mass index (BMI) Z score was −1.28±1.2. Lower BMI was associated with a higher likelihood of BMD-Z (odds ratio 2.17; p≤0.05). @*Conclusion@#Overall, the findings of this study showed that there was no correlation among Marsh classification, presence of specific human leukocyte antigens, and low BMD in Iranian children with CD. BMI can be a predictor of bone density in children with CD and may be applied clinically in early screenings to evaluate the bone health status in these children.

Impact of Serological and Histological Factors on Neurological Manifestations in Children and Adults with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study. @*Methods@#All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations. @*Results@#A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45–0.96; p=0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18–2.63; p=0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18– 1.11; p=0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999–1.001; p=0.59) did not significantly increase the chances of developing neurological disorders. @*Conclusion@#Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.

Impact of Serological and Histological Factors on Neurological Manifestations in Children and Adults with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study. @*Methods@#All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations. @*Results@#A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45–0.96; p=0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18–2.63; p=0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18– 1.11; p=0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999–1.001; p=0.59) did not significantly increase the chances of developing neurological disorders. @*Conclusion@#Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.

Anatomical variations of the biliary tree found with endoscopic retrograde cholagiopancreatography in a referral center in southern Iran

Background: Anatomical variations in the biliary system have been proven to be of clinical importance. Awareness of the pattern of these variations in a specific population may help to prevent and manage biliary injuries during surgical and endoscopic procedures. Knowledge of the biliary anatomy will be also of great help in planning the drainage of adequate percentage of liver parenchyma in endoscopic or radiological procedures

Methods: All consecutive patients undergoing endoscopic retrograde cholangiopancreatography [ERCP] from April 2013 to April 2015 at Nemazee Hospital, a referral center in the south of Iran, were included in this cross-sectional study. The patients with previous hepatic or biliary surgery, liver injury or destructive biliary disease were excluded from the study. All ERCPs were reviewed by two expert gastroenterologists in this field. The disagreed images by the two gastroenterologists were excluded. Huang classification was used for categorizing the different structural variants of the biliary tree, and the frequency of each variant was recorded

Results: Totally, 362 patients [181 men and 181 women] were included in the study. 163 patients [45%] had type Al Huang classification [right dominant], which was the most prevalent type among our patients. 55% of them had non-right dominant anatomy. The result of the Chi-square test revealed that there was no statistically significant difference between the men and women regarding the anatomical variations [p = 0.413]

Conclusion: The anatomical variation in the biliary system among Iranian patients is comparable to other regions of the world. Significant proportions of our patients are non-right dominant and may need bilateral biliary drainage

prevalence of metabolic syndrome in non-alcoholic fatty liver disease; a population-based study

Background: Some evidence, not in large study populations, suggests that nonalcoholic fatty liver disease [NAFLD] and metabolic syndrome [MetS] share common interactions. We aimed to determine the prevalence of NAFLD and MetS in a large population registered to Kavar Cohort Study center. We also assessed the role of each component of MetS in NAFLD existence

Method: Data were obtained from 3415 volunteers who called and refereed to our center. Complete anthropometric and laboratory measurement and abdominal ultrasonography was done for these individuals to screen NAFLD and its grade. A questionnaire was also used to obtain information on demographical and medical history and alcohol consumption. MetS was defined in all participants based on the National Cholesterol Education Program Adult Treatment Panel III [2001] [NCEP/ATP-III] and criteria for clinical diagnosis of metabolic syndrome in Iranian adults [CCDMIA]

Results: Among the refereed individuals, 2980 peoples were aged ?18 years with male to women ratio of 1:2.45. NAFLD was diagnosed by ultrasound in 32.9% and 27.4% of men and women, respectively. MetS was detected in 65.9 and 64.6 of the patients with NAFLD [based on NCEP/ATP-III] and in 30.1% and 73.7% [based on CCDMIA] of men and women, respectively. There were no significant differences between two gender in none of the components [P>0.05]. Although, OR for hyperglycemia and abdominal obesity were approximately high in CCDMIA criteria [0.9613 and 1.2082, respectively], the differences were not statistically significant

Conclusion: NAFLD was associated with MetS. However, it was not possible to determine whether NAFLD predating the development of MetS

Incidental diagnosis of appendiceal abscess by colonoscopy; a case report and review of the literature

Although complicated acute appendicitis is occasionally observed in general practice, the diagnosis of appendiceal abscess by colonoscopy is unusual. We report a case of appendiceal abscess with spontaneous drainage into the lumen of colon diagnosed during colonoscopy and resolved by the time of surgery

Susceptibility testing of Helicobacter pylori: Comparison of E-test and Disk Diffusion for Metronidazole and Mutations in rdxA gene sequences of Helicobacter pylori strains

Metronidazole is a main stay of modern multidrug therapies for Helicobacter pylori [H. pylori] infection. Metronidazole resistance reduces the effectiveness of these combination therapies. Various methods have been used for the determination of the sensitivity of H. pylori to metronidazole, that have shown conflicting results. The aims of this study are: 1] Comaring E-Test and disk diffusion methods for determining the susceptibility of H. pylori to metronidazole; and 2] As metronidazole resistance in H. pylori has been found to be associated with mutations in rdxA, the role of this gene in metronidazole resistance in H. pylori has been examined in this study. A total of 46 H. pylori strains from 223 consecutive patients were examined. The E-Test was performed according to the manufacturer's guidelines, and the disk diffusion test, according to standard procedure, using 5 micro g metronidazole disks. Extraction of DNA was done from all H. pylori isolates by boiling and the use of phenol-chloroform methods, and afterwards Polymerase Chain Reaction [PCR] was performed. Metronidazole resistance as determined by E-test and disk diffusion methods, was 64.3% and 47.6% respectively. None of the resistant or sensitive samples possessed rdxA gene deletion. Disk diffusion method is not reliable in determining metronidazole resistance in H. pylori. An intact rdxA gene has also been reported in metronidazole-resistant H. pylori, suggesting that additional metronidazole resistance mechanisms exist in H. pylori and even molecular methods are not reliable for the detection of this resistance

Three living fasciola hepatica in the biliary tract of a woman

Fasciola hepatica [F. hepaticd] as a foodborne trematode can occasionally cause hepatobiliary diseases. We report a 67-year-old woman who was referred to our center because of the diagnosis of cholangitis. She was a resident of mountainous area with the history of unsafe water and contaminated vegetables. Endoscopic retrograde cholangiopancreatography [ERCP] was performed as a diagnostic and therapeutic modality for her. Three living R hepatica was removed from biliary tract with a basket via ERCP. Clinical and laboratory condition of the patient improved after therapy of antibiotics and triclabendazole

Management of gastroesophageal reflux disease in adults

Gastroesophageal reflux disease [GERD] is a very common disease. GERD is defined as the reflux of stomach content which causes troublesome symptoms and/or complications. The management of GERD is step by step. Dietary and lifestyle modifications are the first steps. Twice-daily H2RAs at standard doses for a minimum duration of two weeks can be considered in patients with GERD who fail to respond to lifestyle and dietary modifications. If symptoms of GERD persist, once-daily Proton Pump Inhibitors [PPIs] can be recommended. Patients with an unsatisfactory response to once-daily PPIs dosing can be considered to have refractory GERD. Twice-daily PPI therapy can be recommended in patients who fail to respond to once-daily PPI therapy. The add-on treatment with H2RAs, baclofen, or visceral pain modulators can be considered in selective subjects with GERD who fail to respond to twice daily PPI. Anti-reflux surgery may be taken into account in selected patients. This review focuses on the initial and maintenance therapy of GERD and also reviews different management of recurrent and refractory GERD

Acute cholangitis due to anomaly of right hepatic artery

Acute cholangitis [AC] is commonly observed in general practice with different causes. We report a case of recurrent AC caused by anomaly of the right hepatic artery, as a rare underlying condition

An incidentally swallowed toothbrush

Although foreign body [FB] ingestion is relatively common,ingestion of a toothbrush is rare. We are reporting on a 26-year old female who had accidentally swallowed a toothbrush which was successfully removed via endoscopy using a polypectomy snare

Hemobilia due to rupture of hepatic artery pseudoaneurysm

Although gastrointestinal bleeding is common, hemobilia due to the rupture of hepatic artery pseudoaneurysm is uncommon. We report a case of hemobilia which was successfully treated via angiography

Diffuse melanoma of the stomach and duodenum: a case report

Gastrointestinal melanoma [GIM] is occasionally observed in general practice. We report a case of melanoma dispersed diffusely in the stomach and duodenum with no skin involvement