Association of vitamin D receptor gene variants with polycystic ovary syndrome: a case control study

Background: Vitamin D and insulin play an important role in susceptibility to polycystic ovary syndrome [PCOS], and therefore vitamin D receptor [VDR], parathyroid hormone [PTH], and insulin receptor [INSR] gene variants might be involved in the pathogenesis of PCOS

Objective: The present study was designed to investigate the possible associations between polymorphisms in VDR, PTH, and INSR genes and the risk of PCOS

Materials and Methods: VDR, PTH, and INSR gene variants were genotyped in 35 women with PCOS and 35 controls using Polymerase chain reaction - Restriction fragment length polymorphism method. Furthermore, serum levels of glucose and insulin were measured in all participants

Results: No significant differences were observed for the VDR Fokl, VDR Tru9l, VDR TaqI, PTH Drall, INSR Nsil, and INSR Pmll gene polymorphisms between the women with PCOS and controls. However, after adjustment for confounding factors, the VDR BsmI "Bb" genotype and the VDR Apal "Aa" genotype were significantly under transmitted to the patients [p= 0.016; OR= 0.250; 95% CI= 0.081-0.769, and p= 0.017; OR= 0.260; 95% CI= 0.086-0.788, respectively]. Furthermore, in the women with PCOS, insulin levels were lower in the participants with the INSR Nsil "NN" genotype compared with those with the "Nn + nn" genotypes [P= 0.045]

Conclusion: The results showed an association between the VDR gene Bsml and Apal polymorphisms and PCOS risk. These data also indicated that the INSR "NN" genotype was a marker of decreased insulin in women with PCOS. Our findings, however, do not lend support to the hypothesis that PTH gene Drall variant plays a role in susceptibility to PCOS

Non-Helicobacter pylori, non-NSAIDs peptic ulcers: a descriptive study on patients referred to Taleghani hospital with upper gastrointestinal bleeding

The purpose of the present study was to evaluate the number and proportion of various causes of upper gastrointestinal bleeding and actual numbers of non-NSAID, non-Helicobacter pylori [H.pylori] peptic ulcers seen in endoscopy of these patients. The number and the proportion of patients with non- H.pylori, non-NSAIDs peptic ulcer disease leading to upper gastrointestinal bleeding is believed to be increasing after eradication therapy for H.pylori. Medical records of patients referred to the emergency room of Taleghani hospital from 2010 with a clinical diagnosis of upper gastrointestinal bleeding [hematemesis, coffee ground vomiting and melena] were included in this study. Patients with hematochezia with evidence of a source of bleeding from upper gastrointestinal tract in endoscopy were also included in this study. In this study, peptic ulcer disease [all kinds of ulcers] was seen in 61 patients which were about 44.85% of abnormalities seen on endoscopy of patients. Among these 61 ulcers, 44 were duodenal ulcer, 22 gastric ulcer [5 patients had the both duodenal and gastric ulcers]. Multiple biopsies were taken and be sent to laboratory for Rapid Urease Test and pathological examination. About 65.53% of patients had ulcers associated with H.pylori, 9.83% had peptic ulcer disease associated with NSAIDs and 11.47% of patients had ulcers associated with both H.pylori and consumption of NSAIDs. 13.11% of patients had non-NSAIDs non- H.pylori peptic ulcer disease. The results of this study supports the results of other studies that suggest the incidence of H.pylori infection related with duodenal ulcer is common, and that non-H pylori and non-NSAIDs duodenal ulcer is also common

Gluten associated dyspepsia; serology and histological characteristics

The aim of this study was to assess the prevalence of celiac disease [CD] in dyspeptic patients. Although severe mucosal abnormality with villous atrophy [lesions Marsh III] is the histology gold standard for the diagnosis of CD, non-specific microenteropathy [Marsh I-II] with positive serology is also common Patients with dyspepsia, specific CD antibodies and microenteropathy, could have CD. From November 2007 to October 2008, 407 randomly chosen patients who underwent diagnostic upper gastrointestinal endoscopy for dyspeptic symptoms [193 male, 214 women; mean age 36.1 years] were studied. Small bowel biopsies were performed in all of them. Histologic characteristics in duodenal biopsy specimens for CD were evaluated according to the modified Marsh Classification. All the patients were also tested for serum total immunoglobulin A and anti-transglutaminase [tTG] antibodies. Those with IgA deficiency were tested for IgG tTG. Duodenal histology showed Marsh I-IIIc lesions in 6.4% cases. 4 patients [0.98%] were IgA deficient and none of them were positive for IgG tTG. Serology showed positive results for tTGA in 8% of the patients and 2.5% of them had abnormal histology [Marsh I-IIIc] compatible with CD. The results of this study showed that milder enteropathy [Marsh 0-II] have a low specificity for CD. The prevalence of CD among dyspeptic individuals is significantly [2.5%] higher than in the general population [1%] and CD should be investigated in these patients

Duodenal adenocarcinoma might be the cause of intractable nausea and vomiting in patient with coeliac disease

Coeliac disease [CD] is an autoimmune disorder which leads to chronic inflammation of the gut. Untreated CD is associated with upper gastrointestinal malignancies, Small-bowel lymphoma and adenocarcinoma are recognized complications of untreated coeliac disease [CD]. We report the case of a 43-year-old male suffering from CD who was treated with a gluten-free diet one year, presenting with complaints of intractable nausea and vomiting. After several studies, He underwent push enteroscopy, which identified one large mass lesion in the third part of duodenum. However, histopathological examination showed adenocarcinoma. Subsequently, a duodenal segment resection was performed. After surgery, the patient recovered well and left our hospital in good condition. Clinicians should take into small bowel adenocarcinoma is rare but associated with CD particularly in CD patients with worrying symptoms such as nausea and vomiting unresponsiveness to treatment and these patients should be screened for long term complications like malignancy