Clinical and pathological features of ulcerative colitis in patients with and without clostridium difficile infection; an observational study

Background: A dramatic rise in the rate of clostridium difficile infection [CDI] in patients with inflammatory bowel disease [IBD] has been reported in recent years

Methods: In this observational case control study, 65 patients were included and were divided into two groups of IBD+CDI as case group and IBD without CDI as control group

Results: 35 patients who had positive test for clostridium difficile were assigned to the case group. The control group consisted of 30 patients with negative test for clostridium difficile. Pancolitis was seen in the cases more statistically significant than the controls and proctitis was seen more among the controls than the cases [p =0.001]. The cases were on immunosuppressive [p=0.001] and antibiotic [p =0.02] therapy more than the controls. Colonoscopic findings revealed more severe and extensive inflammation among the cases versus milder inflammation among the controls, but these differences were not statistically significant [p =0.2]. Colectomy was seen in 10% of controls and none of the cases and this difference was statistically significant [p value=0.05]. More fecal calprotectin were seen among the cases than the controls and this difference was statistically significant [p <0.05]

Conclusion: This study showed more clostridium difficile infection among the patients on antibiotic or immunosuppressive therapy. Pathological investigation revealed more severe and extensive inflammation among the cases than the controls. Cases had clinically more severe signs and symptoms with higher mayo scores than the controls. ESR[erythrocyte sedimentation rate] and fecal calprotectin were higher in patients with positive clostridium difficile infection and serum albumin was lower in such patients

Endoscopic retrograde cholangiopancreatography of pancreatitis due to microlithiasis in a patient with situs inversus totalis: a case report and literature review

Situs inversus is a rare congenital disorder characterized by transposition of the major thoracic organs and all the visceral organs in the abdomen to the opposite side of the normal place in the body. Herein we present a 73-year-old woman with a history of situs inversus totalis who was referred with the complaints of abdominal pain caused by pancreatitis and large common bile duct due to choledochal sludge. Laboratory tests of serum amylase, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were 960 IU/L, 207 IU/L, 119 IU/L, and 263 IU/L, respectively. The radiographic evaluation confirmed situs inversus totalis, enlarged liver, and dilatation of the intra- and extrahepatic bile duct. The distal end of the common bile duct [CBD] was smoothly tapered. Endosonography also confirmed CBD microlithiasis. Endoscopic retrograde cholangiopancreatography [ERCP] was done to remove microlithiasis. Our Challenge was on ERCP techniques in the position of the patient and endoscopy team. We believe ERCP can be safely performed in usual position with minor modification

[Assessing the effect of octreotide in non-varicose upper gastrointestinal bleeding in emergency department]

Non-varicose upper gastrointestinal bleeding is one of the common causes of hospitalization with high mortality and morbidity. The aim of this study was to investigate the effect of Octreotide in treating non-varicose upper gastrointestinal bleeding. In this clinical trial with IRCT: 1361, patients with gastrointestinal bleeding, with neither gastrointestinal varices nor hepatic failure, were enrolled into two groups designated respectively as A and B. Patients in group A received routine treatment. In group B, in addition to routine treatment, patients received 50 microg bolus Octreotide and 25 microg/h infusions. For comparison between the two groups the difference hemoglobin at arrival time, hemoglobin the time of discharge, length of stay in the emergency department, required blood transfusion, the recurrence rate of bleeding and death rate were assessed. In this study, 80 patients in both groups were examined. There was no difference in age and sex between two groups. Hemoglobin on arrival in the two groups showed no significant difference, but hemoglobin level was different at the discharge time. Our study showed no significant difference between two groups about average of received pack Cell. Our results demonstrated that length of stay at emergency department, decreased hemoglobin and bleeding recurrence rate had no significantly difference between two groups. The result showed that Octreotide can't add an extra value for treating upper varicosdee gastrointestinal bleeding

[Relationships of serum troponin T with ECG, colour doppler sonography of lower extremity venous and arterial blood gas findings in patients with acute pulmonary embolism]

Pulmonary embolism is a prevalent and fatal pulmonary disease. In this study, the relationships between serum highly sensitive [hs] troponin T levels and findings of ECG, colour doppler sonography of lower extremity veins venous [CDS LEV] and also arterial blood gas [ABG] in normotensive patients with acute pulmonary embolism were investigated. A cross sectional study was carried out on 33 patients with acute pulmonary embolism who were hospitalized in Emam Khomeini Hospital, Tehran University of Medical Sciences between 2009 and 2010 [mean age, 49.3; 18 male and 15 female]. [18 patients had with a normal hs-troponin T, lower than 14 pg/ml, and 15 patients had with elevated hs-troponin T.]with acute pulmonary embolism [mean age, 49.3; 18 male and 15 female] who were hospitalized in Emam Khomeini Hospital, Tehran University of Medical Sciences between 2009 and 2010 Serum hs-troponin T level was measured by ELISA highly sensitive method. The prevalence of T invert and S1Q3T3 patterns and also thrombosis in lower extremity deep venous were significantly higher in patients with elevated hs-troponin T. In addition, PCO2 and HCO3- levels were significantly lower in patients with elevated hs-troponin T levels. According to the results of the study, it seems that the elevated hs-troponin T accompanies with ECG and ABG findings and also with thrombosis in lower extremity deep venous prevalence in patients with acute pulmonary embolism

Relationships of highly sensitive troponin T with clinical and echocardiographic findings in patients with acute pulmonary embolism

Pulmonary embolism is a prevalent and fatal pulmonary disease. In this study, the relationships of clinical and echocardiographic findings with serum troponin T level in patients diagnosed as having acute pulmonary embolism with normal pulmonary artery systolic pressure were investigated. A cross sectional study was carried out on 33 patients [18 with normal troponin T, lower than 14 pg/ml and 15 with elevated troponin T] with acute pulmonary embolism [mean age, 49.3; 18 male and 15 female], who hospitalized in Emam Khomeini Hospital, Tehran University of Medical Sciences between 2009 and 2010. Clinical and echocardiographic findings were analyzed by using x2, Exact Fisher's test and student's t-test. Serum troponin T level was measured by ELISA highly sensitive method. The prevalence of dysfunction, hypokinesia and dilatation of right ventricle, and also pulmonary hypertension in echocardiographic findings and right ventricular S3 sound in clinical finding was significantly higher in patients with elevated troponin T McConnell's sign, loud P2 sound, elevated jugular venous pulse and lowered left ventricular ejection fraction were higher in elevated troponin T patients, but there were not significant. According to results of the study, it seems that the elevated troponin T accompanies with right ventricular dysfunction signs in patients with acute pulmonary embolism