Understanding Female Students’ Needs to Develop Health Promoting School Programme: An Exploratory Qualitative Analysis

Background: This study was carried out on Iranian female adolescents to understandhealth needs for the purpose of designing health promoting intervention in schools.Methods: In this exploratory qualitative study, two focus group discussion (15 teachers)and 30 individual in-depth interviews were conducted among female adolescents in the eighthgrade in Zahedan, Iran. Qualitative content analysis was used for data evaluation.Results: The views of students and teachers demonstrated nine of needs including:informing students about the schools’ health project aims, education and training all dimensionsof health with an emphasis on mental health, use of experts in various fields for education fromother organisations, employing capable and trusted counselors in schools, utilisation of a varietyof teaching methods, activating reward systems for encouraging students’ participation in groupactivities, teaching communication and the ability to establish good relationships with parents andstrategies for resolving family conflict, teaching parents and students high-risk behaviours andstrategies for handling them as well as reforming wrong attitudes and indigenous sub-culture.Conclusion: This study found the different needs of Iranian female students comparedto other cultures about a health promoting school programme. Therefore, their contribution canprovide an insight for formulating policies and intervention in schools.

Mesalazine has no effect on mucosal immune biomarkers in patients with diarrhea-dominant irritable bowel syndrome referred to Shariati Hospital: a randomized double-blind, placebo-controlled trial

Intestinal mast cells may cause gastrointestinal symptoms in patients with diarrhea-dominant irritable bowel syndrome [IBS]. The objective of this study was to determine the effect of mesalazine on the number of lamina propria mast cells and clinical manifestations of patients with diarrhea-dominant IBS referred to Shariati Hospital affiliated to Tehran University of Medical Sciences

Methods: This was a randomized placebo-controlled double-blind trial conducted on 49 patients with diarrhea-dominant IBS. The patients were randomly assigned to one of the experiment or control groups. The patients in experiment group took 2400 mg mesalazine daily in three divided doses for 8 weeks and the patient in control group took placebo on the same basis. Our first targeted outcome was an assigned downturn of mast cells number to the safe colonic baseline and the next one was a marked palliation of disease symptoms. Data were analyzed conforming intention-to-treat method. We used MANCOVA test to compare our both assigned outcomes in the two groups. We also compared the data with baseline values in both groups. All statistical tests were performed at the significance level of 0.05

Results: There was no significant difference between Mesalazine and placebo groups regarding the number of mast cells [p value=0.396], abdominal pain [p value=0.054], bloating [p value=0.365], defecation urgency [p value=0.212], and defecation frequency [p value=0.702]

Conclusion: Mesalazine had no significant effect either on the number of mast cells or on the severity of disease symptoms. This finding seems to be inconsistent with the hypothesis indicating immune mechanisms as potential therapeutic targets in IBS. The possible difference in this effect of Mesalazine should be evaluated in further studies among populations varying in race, ethnic, and geographical characteristics

Mean polyp per patient is an accurate and readily obtainable surrogate for adenoma detection rate: results from an opportunistic screening colonoscopy program

The incidence of colorectal cancer is rising in several developing countries. In the absence of integrated endoscopy and pathology databases, adenoma detection rate [ADR], as a validated quality indicator of screening colonoscopy, is generally difficult to obtain in practice. We aimed to measure the correlation of polyp-related indicators with ADR in order to identify the most accurate surrogate [s] of ADR in routine practice. We retrospectively reviewed the endoscopic and histopathological findings of patients who underwent colonoscopy at a tertiary gastrointestinal clinic. The overall ADR and advanced-ADR were calculated using patient-level data. The Pearson's correlation coefficient [r] was applied to measure the strength of the correlation between the quality metrics obtained by endoscopists. A total of 713 asymptomatic adults aged 50 and older who underwent their first-time screening colonoscopy were included in this study. The ADR and advanced-ADR were 33.00% [95% CI: 29.52-36.54] and 13.18% [95% CI: 10.79-15.90], respectively. We observed good correlations between polyp detection rate [PDR] and ADR [r=0.93], and mean number of polyp per patient [MPP] and ADR [r=0.88] throughout the colon. There was a positive, yet insignificant correlation between advanced ADRs and non-advanced ADRs [r=0.42,p=0.35]. MPP is strongly correlated with ADR, and can be considered as a reliable and readily obtainable proxy for ADR in opportunistic screening colonoscopy programs

Evaluation of trends for iron and manganese concentrations in wells, reservoirs, and water distribution networks, Qom city, Iran

Background: This study aimed to evaluated trends for iron and manganese concentrations in wells, reservoirs, and water distribution networks in Qom city during the summer of 2012

Methods: This was a cross-sectional study. The studied scopes consisted of groundwater [60 wells], reservoirs [10 tanks], and water distribution network [33 points]. One sample was taken from each source monthly. Statistical tests used included post hoc tests [Tukey HSD]. Finally, the results were compared with drinking water standards

Results: The average concentrations of iron in groundwater, reservoirs, and distribution networks were 0.09, 0.07, and 0.07 mg/l, respectively. The average concentrations of manganese in groundwater, reservoirs, and distribution networks were 0.15, 0.09, and 0.1 mg/l, respectively. The turbidity averages in groundwater, reservoirs, and distribution networks were 0.58, 0.6, and 0.52 NTU, respectively. The average concentrations of free chlorine residual in water reservoirs and distribution networks were 1.74 and 1.06 mg/l, respectively. The pH averages in groundwater, reservoirs, and distribution networks were 7.4, 7.7, and 7.5, respectively. The amounts of iron, manganese, turbidity, free chlorine residual, and pH in the investigated resources had no significant differences [P > 0.05]

Conclusion: The amounts of iron, manganese, turbidity, free chlorine residual and pH in groundwater, reservoirs, and water distribution networks of Qom are within permissible limits of national standards and EPA guidelines. Only the amount of manganese was higher than the Environmental Protection Agency [EPA] permissible limit

Is the prevalence of celiac disease higher than the general population in inflammatory bowel disease?

In some studies inflammatory bowel disease [IBD] and celiac disease were considered to be associated and some believe that this association may influence the prognosis of IBD. However, there is a considerable controversy regarding this association. Therefore ,we aimed to assess the association of these two common digestive diseases and evaluate the complications of this association. In this comparative study, 200 patients with ulcerative colitis [UC] and 206 patients with Crohn's disease [CD] were evaluated for celiac disease using relevant diagnostic tests and pathologic studies. Total IgA, IgA tissue transgulaminase antibody and specific IgA anti endomysial antibody were asseyed. In cases of IgA deficiency, total IgG and IgG tissue TG and IgG anti endomyseal Ab were measured. Patients with increased specific IgA and IgG antibodies for celiac disease, underwent endoscopy and 4 standard samples were obtained. Our results were compared with the results of the prevalence study of celiac disease in the general population. Data were analyzed using analytic and descriptive statistics at a significance level of 5%. Among the studied patients, 1 patient with UC had elevated IgA anti tTG antibody and IgA anti-endomysial antibody who underwent endoscopy and celiac was confirmed on pathology. Hence, of the 200 patients with UC, the diagnosis of celiac disease was confirmed in 1 patient [1:200] with no significant difference with the prevalence of celiac disease in the general population [1:166]. However, none of our patients with Crohn's disease had celiac disease [0:206]. We found no significant difference in the prevalence of celiac disease between patients with UC and the general population. Since most of our participants had a mild level of Crohn's activation, none of those with Crohn's disease had celiac disease. Complications of IBD including sclerosing cholangitis, may be more common in patients with concurrent celiac disease. Therefore, it is recommended that celiac disease be considered in patients with severe and complicated IBD

Physicians' knowledge and attitude towards fecal microbiota transplant in Iran

Fecal microbiota transplant [FMT] is employed to replace the 'unhealthy' microbiota of the patient with the 'healthy' microbiota of a pre-screened healthy donor. Given the growing importance of gut microbiota dysbiosis in the pathogenesis of intestinal or extraintestinal diseases; it is conceivable that FMT becomes integrated in the routine clinical practice. Our objective was to assess the knowledge and attitude of the Iranian physicians towards FMT. We surveyed the participants of Iranian gastroenterology and hepatology 2014 conference. Overall, 146 [68.5%] were familiar with FMT; of whom 132 [94.28%] were willing to accept FMT if scientifically and ethically approved and 115 [88.46%] were willing to refer their patients for FMT if indicated. In total, 42 [30.7%] had identified stool preparation as the most unappealing aspect of FMT, while 17 [11.6%] reported the therapeutic use of fecal material as the most unappealing and 39 [28.5%] indicated that both are equally unappealing. The doctors who had an overall positive opinion toward FMT reported less negative feelings towards FMT. Iranian physicians are willing to accept FMT as a therapeutic option if it is scientifically justified and ethically approved. Nevertheless, physicians prefer to skip the stool preparation phase; as they are more in favour of synthetic microbiota as opposed to fecal microbiota

Bilateral Macular Hole Following Myopic Photorefractive Keratectomy

A 42-year-old man was admitted to our clinic complaining of visual distortion in his left eye two months after bilateral myopic photorefractive keratectomy (PRK). Macular optical coherence tomography (OCT) showed a stage II macular hole in the left eye. Simultaneous OCT in the right eye showed vitreous traction and distortion of the outer retina. One month later, the patient underwent vitrectomy for the left eye, and the macular hole was closed. Two months after that, the patient complained of visual distortion in the right eye, and OCT revealed increased traction and accentuated outer retinal distortion indicating a stage IB macular hole. Traction attenuated later without any intervention. The short interval between PRK and hole formation, bilateral involvement, and the moderate refractive error in this case highlight the possible role of PRK in aggravating vitreoretinal interface abnormalities. We recommend the addition of PRK to the list of procedures that may be associated with the formation of a macular hole.

[Approach to chronic constipation]

Constipation is a common clinical problem that can be functional or organic in origin. This condition sometimes overlaps with irritable bowel syndrome. Initially, the clinician should differentiate between true and false constipation by clinical and preclinical evidence such as colonic transit time. Numerous patients believe that all defecation problems are called constipation and use laxatives without a prescription. A vast majority of constipated patients have improvement in their symptoms following life style modification and the use of simple laxatives. However onset of recent constipation in patients over the age of fifty should be considered as an organic disease unless proven otherwise. In these patients, colon cancer must be ruled out. Those with irritable bowel syndrome can transiently face constipation, for which supportive care is sufficient. In this review we explain the diagnosis, workup and treatment of constipation

Characteristics of colorectal polyps and cancer; a retrospective review of colonoscopy data in Iran

Early diagnosis and endoscopic resection of adenomatous polyps is the main approach for screening and prevention of colorectal cancer [CRC]. We aimed to assess polyp detection rate [PDR] and to characterize demographic, clinical, and pathological features of colorectal polyps in an Iranian population. We retrospectively analyzed the data from 5427 colonoscopies performed during 2007-2012 at Masoud Clinic, the main endoscopy center associated with Sasan Alborz Biomedical Research Center, in Tehran, Iran. Our sample included 2928 [54%] women and 2499 [46%] men, with the mean age of 48.3 years [SD=16.1]. The most common reasons for colonoscopy included screening in 25.0%, and gastrointestinal bleeding in 15.2%. Cecal intubation was successful in 86% of patients. The quality of bowel preparation was fair to excellent in 78.1% [n=4235] of colonoscopies. Overall PDR was 42.0% [95% CI: 40.6-43.3]. The PDR in men [51.1%, 95% CI: 49.1-53.1] was significantly higher than women [34.2%, 95% CI: 32.4-35.9, p<0.001]. Polyps were more frequently observed in patients after the 6th decade of life [F=3.2; p=0.004]. CRC was detected in 2.9% [73/2499] of men and 1.9% [57/2928] of women [p=0.02]. The mean age for patients with cancer was significantly higher than that for individuals with polyps, 60.9 [SD=13.4] year vs. 56.9 [SD=13.7] year, respectively [p=0.001]. Almost 82.8% of the lesions were precancerous with tubular type predominance [62.3%] followed by tubulo-villous [10.3%], villous [6.6%], and serrated [3.6%]. Hyperplastic/inflammatory polyps comprised 17.2% of lesions. Distal colon was more prone to develop polyps and cancer than proximal colon in our series. These findings provide a great infrastructure for next preventive programs and have implications for colorectal cancer screening at population-level

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

[Gastroduodenal sarcoidosis: a case report]

Sarcoidosis is a systemic granulomatous disease of unknown etiology. Sarcoidosis involving the gastrointestinal [GI] tract is extremely rare. This is a rare case report of an individual with symptomatic gastroduodenal sarcoidosis. A 34-year-old male with a six-month history of epigastric pain, nausea, early satiety and weight loss presented to our clinic. An upper endoscopy was performed which showed a cardia ulcer that measured approximately 10 mm along with multiple superficial erosions and patchy erythema in all parts of the gastroduodenal mucosa. Biopsies of the stomach and duodenum revealed severe active chronic noncaseating granulomatous gastritis and duodenitis. Stains for Helicobacter pylori, acid fast bacteria, and fungi were negative. An upper GI series showed thickened gastric folds with narrowing of the gastric body and antrum with lack of distensibility. The plasma level of angiotensin converting enzyme [ACE] was elevated. Corticosteroid therapy was started with rapid abatement of his symptoms. In cases of refractory epigastric pain, especially if other organ involvement, gastroduodenal sarcoidosis should be considered

Diagnostic value of fecal calprotectin in patient with ulcerative colitis

Ulcerative colitis [UC] is characterized by recurrent episodes of inflammation limited to the mucosal layer of the colon. Calprotectin is a zinc and calcium binding protein derived from neutrophils and monocytes. It is easily detectable in tissue samples, body fluids, and stools, which makes it a potentially valuable marker of inflammation. The aim of the current study is to evaluate the value of fecal calprotectin [FC] as a marker of disease activity in patients with UC. Seventy three eligible subjects underwent ileocolonoscopy and multiple biopsies were obtained from different parts of the colon and terminal ileum. All patients underwent blood and stool sampling as well as an interview to assess the disease severity utilizing ulcerative colitis activity index [UCAI], subjectively. The diagnostic value of the FC in comparison with Mayo disease activity index as the gold standard technique, was then evaluated. Mean FC level increased linearly according to Mayo disease activity index [r=0.44, p<0.001] and was significantly different between levels of Mayo disease activity index [p=0.003]. In multivariate analysis, Mayo disease activity index, positive CRP and ESR were associated with FC level. FC level > 21.4 ng/ml was able to discriminate between active and inactive phases of UC according to Mayo disease activity index>2 with 72.3% sensitivity and 73.1% specificity. The combination of FC > 21.4 ng/ml and UCAI score of 7 had a 46.8% sensitivity and 88% specificity to diagnose Mayo disease activity index >2. Furthermore, FC level <21.4 ng/ml in combination with UCAI score of <3 showed a highly considerable specificity of 98% to discriminate the remission phase of UC [Mayo disease activity index <2], although with a low sensitivity [31%]. FC appears to be a non-invasive biomarker with moderate accuracy to discriminate the active phase of inflammatory bowel disease [IBD]. The value of FC especially in combination with UCAI is highly considerable to rule out the Mayo disease activity index >2

Probiotic vs. placebo in irritable bowel syndrome: a randomized controlled trial

This study assesses the potential effect of Lactobacillus reuteri as a single strain probiotic preparation [Biogaia[R]] on irritable bowel syndrome [IBS]. Patients diagnosed with IBS who fulfilled Rome III criteria and consented to participate in this study were randomized to receive either the probiotic or an identical placebo once daily for four weeks. Patients used a questionnaire to record any symptoms and adverse reactions over a one-week run-in period and during the final two weeks of intervention. For each group, we calculated the differences between mean scores of the variables and compared the results between groups. Frequency of defecation increased in the Biogaia[R] group and decreased in the placebo group meaningfully. But There were no significant difference in the two groups in other terms of bloating, sense of urgency for defecation, abdominal pain, stool shape, quality of defecation, sense of incomplete evacuation, and treatment satisfaction. The frequency of defecation increased in the Biogaia[R] group and decreased in the placebo group, however this study did not classify patients according to diarrhea or constipated subgroups, the efficacy of this drug is not clear. Hence Lactobacillus reuteri was not better than placebo in controlling IBS symptoms in this study. However, considering the significant placebo effect in IBS patients, it may be necessary to conduct studies with larger numbers of participants to better assess the possible beneficial effects of Biogaia

Evaluation of sterile uveitis after iris-fixated phakic intraocular lens implantation

To evaluate the clinical features, and visual outcomes of sterile uveitis after iris-fixated phakic intraocular lens implantation [pIOLs] [Artisan-Artiflex and Verisyse-Veriflex]. Material and Methods: In this retrospective non-comparative case series, the medical records of 117 eyes implanted with Artisan-Artiflex [Ophtec BV, Groningen, Netherlands] and Verisyse-Veriflex [AMO, Santa Ana, CA] iris claw phakic IOLs were analyzed for postimplantation sterile uveitis. The mean age of the 87 patients included in the study was 27.2 +/- 7.4 years. Of these patients, 56 [64.3%] were men and 31 [35.6%] were women. Patient age, gender, IOL brand type, refractive error, optic diameter, unilateral vs bilateral implantation, and anterior chamber depth were analyzed. Features of uveitis, uncorrected and best corrected visual acuity [VA] at presentation and at follow-up visits were examined. The mean follow-up time was 14.6 months [range: 6-37 months]. Clinically significant uveitis was observed in 12 of 117 eyes [10.3%] in a total of ten patients. Of these ten patients, four [40%] were women and six [60%] were men, and the mean age was 25.1 +/- 5.3 years [range: 18-36 years]. Among those with bilateral implantation, 6.9% of patients developed bilateral uveitis, while 13.8% [4 of the 29 implanted bilaterally] developed unilateral uveitis. Foldable pIOL implantation was the only variable associated with the development of uveitis [P=.03]. Although the prognosis is usually benign, sterile uveitis occurred in 10.3% of patients after iris-fixated pIOL implantation. The implantation of a foldable pIOL was the only variable associated with sterile uveitis. Appropriate medical management can be effective treatment, without the need for pIOL replacement

Squatting and risk of colorectal cancer: a case-control study

The sitting position, rather than squatting, during defecation has been hypothesized to be a risk factor for colorectal cancer [CRC]. We conducted a case-control study to test this hypothesis.A total of 100 CRC cases from two hospitals in Iran and 100 control subjects, selected from the coronary care unit [CCU] of those same hospitals were selected for this study. We administered a detailed questionnaire to the study subjects asking about history of toilet use and other relevant confounders. In logistic regression analysis, the crude and adjusted ORs [95% CIs] for using sitting toilets in any decade were 1.20 [0.89 - 1.61] and 1.07 [0.72 - 1.59], respectively. Also, the crude and adjusted ORs [95% CIs] for using 10 more years of sitting toilets were as 1.16 [0.92 -1.47] and 1.02 [0.74 - 1.40], neither of which indicated a statistically significant increase in risk. Our study did not support an appreciable role for using sitting toilets as risk factors for CRC

effects of riboflavin/ultraviolet: a corneal cross-linking on the signs and symptoms of bullous keratopathy

To evaluate the effectiveness of corneal cross-linking in improving the signs and symptoms of bullous keratopathy. This prospective non-randomized case series evaluated 20 eyes with bullous ketratopathy that underwent corneal cross-linking [C3R] with riboflavin and ultraviolet-A [UVA, 370 nm, 3 mW/cm 2]. C3R was performed for 30 min in a routine procedure after removal of epithelium. Central corneal thickness [CCT], corneal haze, visual acuity [VA], and the presence of irritating symptoms were recorded before the procedure, and at 1 week, 1 month, 3 months, and 6 months after the procedure. The mean CCT was 872 +/- 162 micro m [range: 665-1180 micro m] before the procedure. Following the procedure, CCT was 855 +/- 175 micro m after 1 week, 839 +/- 210 micro m after 1 month, 866 +/- 185 micro m after 3 months, and 863 +/- 177 micro m after 6 months [P>0.05, all visits]. There was no significant improvement in VA or corneal clarity after 6 months. Improvement of the following symptoms: burning, pain, and foreign body sensation were reported after 6 months by 83.3%, 75.0%, and 66.7% of patients, respectively. Persistent epithelial defect occurred in five patients [25%] resolved with frequent lubrication and bandage contact lenses. The outcomes of this study indicate corneal cross-linking is not an effective treatment for bullous keratopathy with respect to VA and CCT, although it can improve irritation and discomfort

Comparing the effects of normal saline and 0.05 betadine on bacterial culture results obtained from conjunctiva before and after irrigation during cataract surgery

To compare the effects of normal saline and 0.05 betadine on bacterial cultures obtained from eye conjunctiva before and after irrigation during cataract surgery. It was a Randomized Control Trial [RCT] in patients with cataract. Culture samples were obtained from the inferior fornix prior to periocular prep and after preparation. Subsequently, inside the eyes and fornices were irrigated with 10 cc normal saline or 4 cc 5% betadine for 3 minutes. Once the data were fed into SPSS software, they were analyzed using ?2, Fisher's and McNemar's tests. We obtained 89 positive culture samples [52.4%] before prep [including 38 samples in the normal saline group and 51 samples in the betadine group], 12 positive culture samples [7.1%] after prep, and 8 positive culture samples [4.7%] at the end of surgery. There was no significant relationship between the two groups; however, irrigation was found to be effective in reducing positive cultures in both groups [p<0.001]. Using 5% betadine for periocular prep and normal saline for conjunctival irrigation is as effective as using betadine for prep and irrigation in terms of reducing positive cultures after cataract surgery

Epidemiology and molecular genetics of colorectal cancer in Iran: a review

Although the incidence of colorectal cancer in Iranian older age subjects is currently very low compared to Western population, the younger generation is experiencing an accelerated rate approaching the Western rates and the burden of disease will increase dramatically in near future. The high frequency of positive family history of colorectal cancer in Iranian patients indicates that a significant number of colorectal cancers in Iran arise in family members and relatives of colorectal cancer patients. It is clear that the familial clustering of colorectal cancer is more often seen in younger probands and cancer located in the right side of the colon. These epidemiologic findings call for a broader attempt to promote public awareness and screening strategies in those families with a member affected by colorectal cancer, especially at younger age or with proximal tumors. Based on our present understanding, the possibility of preventing or curing most colon and rectal cancers is now plausible. The molecular biology of colon cancer has been the subject of many researches and is better understood than those for any other solid cancer and have established an important example for cancer research. It is now clear that colorectal cancer develops as the result of genetic and epigenetic alterations that lead to malignant transformation of normal mucosa. In spite of these scientific progresses and the fact that screening can reduce the rate of death by detecting early cancer or premalignant polyps, the rate of screening is very low globally and negligible in Iran and many other developing countries which is due to cost, resistance by physicians, patients, and the healthcare system. In Iran screening should at least be started in family members at earlier age with colonoscopy as the preferred modality of screening method

Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery

The purpose of this study was to evaluate the conjunctival bacterial flora and its antibiotic susceptibility pattern in eyes of patients undergoing cataract surgery. Conjunctival soap was obtained on the day of surgery before the application of topical anesthetic, antibiotic or povidone-iodine. Culture and antibiotic susceptibility tests were performed. The data was analyseed with X[2] and T tests. Of the 170 patients 89 cases [52.4%] had positive cultures in the eyes. In 79 eyes [88.8%] found coagulase-negative Staphylococcus [CoNS]. Eighty two cases [95.3%] of isolated Staphylococcus were susceptible to Amikacin, 86[100%] sensitive to Ciprofloxacin and 42 [48.8%] sensitive to Ceftazidime. Average susceptibility and resistancy to antibiotics was 2.6 [ +/- 1.8] antibiotics in women and 1.6 [ +/- 1 .4] in men [P= 0.009]. This study showed that the bacterium most frequently found in the conjunctival flora of the patients undergoing cataract surgery was CoNS. Isolates of this bacterium had low CoNS susceptibility rates to Caftazidime and Vancomycin and high susceptibility to Ciprofloxacin and Amikacin