association between oral hygiene and gastric pathology in patients with dyspepsia: a cross-sectional study in Southeast Iran

Many studies have reported an association between periodontal infections and some systemic diseases such as respiratory and cardiovascular diseases. Some studies found a direct association between chronic gastritis caused by Helicobacter pylori [HP] infection and poor periodontal health

Methods: In a cross-sectional study from November 2014 to December 2015 in Kerman, the largest province in southeast Iran, patients with dyspepsia who were candidate for diagnostic upper gastrointestinal [GI] endoscopy were included in our study. Decayed, Missing, and Filled Teeth [DMFT] index and Loe plaque index that are two popular indexes in dental epidemiology were used to assess the oral health by a dentist before the upper GI endoscopy. According to the Loe plaque index, score: 0= no plaque, score: 1= a film of plaque attaching to the free gingival border and near area of the tooth, score: 2= moderate reposition of deposits within the gingival pocket, score :3= plenty of soft matter within the gingival pocket +/- on the tooth and gingival border. Scores

Results: According to Sidney's classification 77 [89.5%] patients had superficial gastritis, 3 [3.5%] had atrophic gastritis, and 6 [7%] had intestinal metaplasia. HP was found in 80.2% of the gastric mucosal biopsy samples. There were not statistically significant relationship between Sidney's classification, presence of HP in gastric mucosal biopsies, and hygiene indicators [p>0.05]. No relation was found between the DMFT index and superficial gastritis, atrophic gastritis, and intestinal metaplasia [p>0.05]. Gastric infection with HP was found in 70%, 75%, and 100% of patients with mild, moderate, and sever DMFT index, respectively

Conclusion: Our study showed that there might be a relation between poor oral hygiene and gastric precancerous lesions. In addition, HP infection in gastric histopathology might be associated with periodontal disease

Small bowel bacterial overgrowth in patients with irritable bowel syndrome: the first study in Iran

Small intestinal bacterial overgrowth [SIBO] may have a role in the pathophysiology of irritable bowel syndrome [IBS]. So, the aim of this study was to assess the association between SIBO and IBS by using glucose breath test [GBT] in Kerman city as the first study in Iranian population. 107 patients with IBS and 107 healthy individuals were enrolled in our study. All the participants underwent GBT. A peak of H2 values >20 p.p.m above the basal value after glucose ingestion was considered suggestive of SIBO. SPSS software version 17 was used for data analysis. P value < 0.05 was considered as statistically significant. Of the 107 patients with IBS, 40 had positive GBT [37.4%] compared with 14[12.1%] out of the 107 control participants [p< 0.001]. Dominant symptoms in patients with IBS were diarrhea in 36[33.6%], constipation in 12[11.2%], abdominal pain in 22[20.6%], bloating in 28[26.2%], and change in bowel habit in 9[8.4%] patients. There was not statistically significant difference among any of this IBS subgroups and positive GBT [p=0.44]. There is a positive association between IBS and SIBO. We suggest a Placebo-controlled bacterial eradication study for identifying the role of SIBO in IBS

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