[Colonoscopic diagnostic findings in patients undergoing colonoscopy in Qom hazrat-e-masoome hospital during 2007-2008]

In recent years there have been noticeable changes in diagnosis and treatment of colon disorders by colonoscopy and direct vision. Along with its international development, this useful equipment is being used in Iran to treat various disorders. It should be mentioned that there are no exact statistics of these disorders to date. This study was done with aim of evaluating the diagnostic findings in patients undergoing colonoscopy in Qom during 2007-2008. This descriptive-cross sectional study was done on 500 patients having referred to colonoscopy ward of Hazrate-e-Masoome Hospital in Qom. After colonoscopy, patient data were entered into a special questionnaire and then pathologic findings were added to it. The data were taken for statistical analysis. Out of 500 patients undergoing colonoscopy 279 were male [55.8%] and 221 female [44.2%]. In all groups and both sexes the most common reason for carrying out colonoscopy was abdominal pain [46.6%] rectorrhagia [41%]. As regards diagnosis, a total of 199 cases [39.8%] of all 500 colonoscopies had normal colonoscopy,124 cases [24.8%] had hemorrhoid, 64 cases [12.8%] had polyp, 55 cases [11%] had inflammatory bowel diseases [IBD], 30 cases [6%] had tumor, 17 cases[3.2%] had diverticulosis and 12 cases [2.4%] had solitary rectal ulcer. There was a significant relationship between abdominal pain and tumor, polyp and diverticulosis. [p<0.001] There was also a significant relationship between age and the aforementioned disorders. [p<0.001] Based on the findings of this study, the prevalence of cancer and IBD is higher in men diverticulosis is higher in women. The highest prevalence of IBD was in the age group of 21-30 years. With an increase in age, the incidence rate of this disease decreases

[ case report of eosinophilic gastroenteritis presenting with abdominal pain and ascitis]

Eosinophilic gastroenteritis is a heterogeneous disorder affecting both children and adults, and is characterized by the presence of an intense eosinophilic infiltrate on histopathology of one or multiple segments from the esophagus to the rectum. Eosinophilic gastroenteritis which may involve more than one layer of the gastrointestinal tract. Clinical features depend on the layer and location to be involved. Involvement of the serosal layer occurs in 10% of cases of eosinophilic gastroenteritis and is typically presented as ascites. The patient in our report was as likely as those who refer with full thickness involvement and presenting ascite, and was completely improved after steroid treatment. The patient was presented a 14-year-old boy that referred to the physician with progressive abdominal pain and ascites. After recognition of eosinophilia in blood and ascite fluid, he was suspected to have Eosinophilic gastroenteritis. Ultimately, following serial examinations and after laparascopic full thickness biopsy Eosinophilic gastroenteritis was closely diagnosed. The patient was treated with prednisolone. The abdominal pain and ascites subsided soon after initiation of steroid treatment

[Anemia rate assessment in hospitalized patients with acute bacterial infection in Qom hospitals, Qom, Iran, 2007-2008]

Immunosuppression is regarded among the risk factors for bacterial infection. But in recent studies, anemia was considered a predisposing factor for bacterial infections. The main goals of this study was to assess the rate of anemia in hospitalized patients with acute bacterial infection and to determine the relationship between anemia and bacterial infection as a predisposing factor. 311 hospitalized patients whose bacterial infection was well documented based on the files present in Kamkar, Arabnia, Fatemi, and Sahamieh hospitals in Qom. Iran, were selected for the present study. They were categorized into various age groups from newborns to the elderly. The data included, age, sex, Hb of the patients the first, third and discharge day, HCT in the first, third and discharge day, MCV, MCH, MCHC, WBC in the first, third, fourth day, Diff in the first and fourth days, ESR, CRP, maximum of fever and disease, chronic disease, smoking. A P<0.05 was considered as being significant. On the basis of hemoglobin rate, 43.9% of patients had anemia as a co-desease. There was no anemia among newborns, but 57% of infants had it. Patients who had pyorrheal lymphadenitis had maximum rate of anemia among other patients. On the average, the rate of anemia in this study was 2.1 times more than that of general population in Qom, as well as in any of the age groups. This difference indicates that anemia rate in patients with acute bacterial infections is more common than general population. However, more studies are needed for the assessment of the relationship between anemia and bacterial infection as a predisposing factor. But it seems that the hemoglobin level and severity of disease have direct effects on each other

[Reusable design of esophageal band ligation device]

Variceal bleeding is one of the fatal complications of portal hypertension. There are several remedies for this problem but all of them have their own side effects. The treatment of choice is "endoscopic band ligation" but the high cost of the available instrument on the context of its single use design, is considered its only disadvantage [1.600.000 rials per session]. Therefore, many patients avoid purchasing the instrument.However, we decided to design a reusable device by reloading the original one, using suitable elastic bands and sophisticated deployer nodes taking into account easy use and high efficacy of this treatment modality. Instead of the available granules, a series of special and very suitable nodes was employed for stretching and deployment of the bands.Also, a conical piece was designed to insert bands on cap as a dilator. Hemorrhoid ligation bands [the product of Endo Flex, Germany] were used instead of bands of the original device. Results: Ten node types were consequentially tested on sample and endoscopic device and if suitable, were tested on endoscope and patients thereafter. Node "61" was the fittest among [complete success rate in 429 deployments]. The cost of new designed device is equal to 20.000 rials, which is very low compared to the original one. The new designed reloadable band ligator instrument is very economic and according to accomplished experiments, it has the same quality as the original one. Then, it would be suitable for both patient and physician to use new instrument for endoscopic band ligation

[Hepatitis A and E in the east of Golestan province]

Hepatitis A and E are among the most important etiological factors of acute hepatitis, which can lead to fulminant liver disease and death. The aim of this study was to determine the prevalence of hepatitis A and E in the east of Golestan Province, Iran. Eight hundred inhabitants of Gonbad City and Ghamar Ghozi Village from Kalale district were randomly selected for the study. Hepatitis A virus Antibody [Anti HAV] and Hepatitis E virus Antibody [Anti HEV] were checked by ELISA method. A total of 697 subjects [441 females] with a mean age of 43 +/- 15.1 years participated in this study. A total of 687 [98.6%] and 82 [11.8%] persons had positive Anti HAV and Anti HEV, respectively. This research is the first study on the prevalence of hepatitis A and E in the general population of Iran, which shows that HA V infection is pandemic and hepatitis E is common in the area

Accuracy of endosonography in the diagnosis of obstructive jaundice

Endoscopic retrograde cholangiopancreatography [ERCP] has been used as the method of choice in assessment of obstructive jaundice for a long time. Recently, the development of endoscopic ultrasonography [EUS] has attracted the attention of clinicians as an alternative accurate, safe and cheap method to replace the ERCP procedures performed only for diagnostic purposes, the present study aims to examine the accuracy of endoscopic ultrasonography as an alternative diagnostic procedure to ERCP for detection of causes of cholestasis'. In this study, 100 patients underwent endoscopic ultrasonography in Digestive Disease Research Center, Shariati Hospital. The patients were divided into two groups: 1] those with operable periampullary tumors who were referred to the surgeons, 2] other patients. The final diagnosis made after ERCP and operative removal of the mass was considered as the gold standard and was compared with accuracy of endoscopic ultrasonography. The overall accuracy of endoscopic ultrasonography in the diagnosis of obstructive cholestasis was 92.0%. Sensitivity and specificity of this method in diagnosis of choledocholithiasis were 95.2% and 96.4% respectively. The corresponding values for diagnosis of periampullary tumors were 96.2% and 95.8%.In this study the accuracy of EUS in diagnosis of obstructive jaundice and its sensitivity and specificity for diagnosis of choledocholithiasis and periampullary tumors were high. Therefore, it could be concluded that endoscopic ultrasonography is a reliable diagnostic tool for extrahepatic cholestasis

Treatment of chronic hepatitis B

The primary goal of therapy in patients with chronic hepatitis B is durable suppression of HBV DNA to the lowest possible level. The threshold of HBV DNA level to initiate therapy is >/= 10[5] copies /ml for patients with HBe antigen-positive and >/= 10[4] copies /ml for patients with HBe antigen-negative chronic hepatitis B. Interferon alpha2b, lamivudine and adefovir dipivoxil are PDA-approved and could all be used as an initial first-line therapy in chronic hepatitis B. It was shown that adding lamivudine to either conventional interferon or peg-interferon did not increase the efficacy of treatment. Also, addition of lamivudine to adefovir had no additional effect in compensated patients. Response rate is about 30-40% with first-line drugs. Peg-interferon, which recently received PDA approval, was associated with an increased response rate. Further long-term studies are required in order to use Peg-interferon as a wide-scale first-line treatment. Treatment strategy is changing towards using prolonged combination therapy with evolving nucleoside analogues with or without an immunomodulatory agent, aiming to eradicate cccDNA

[Hepatitis C in Golestan province-Iran]

Hepatitis C is one of the most important etiological factor in chronic liver disease which could lead to the progressive liver cirrhosis and hepatocellular carcinoma. The purpose of this study is to determine the prevalence of Hepatitis C in east of Golestan province [north-east of Iran]. 2123 inhabitants from north-east of Iran of general population have been studied using randomized selection. The taken samples were fresh serum searching for Hepatitis C Virus Antibody [HCV Ab] via ELISA method. A recombinant immunoblot assay [RIBA] was done for the positive HCV Ab samples tested with ELISA as the next step. A total of 2123 samples [female: 1387] with mean age of 41.3+/- 14.8 years and 960 rural and 1141 urban were studied. Fifty six samples [female:44] were HCVAb positive [ELISA], twenty of fifty six samples were also RIBA positive [female: 18 equal 81.8% and male: 4 equal 18.2%]. According to ELISA result the prevalence of HCVAb positive samples in female was 3.1% [44 of 1387 samples] and in male was 1.6 [12 of 714 samples]. As a total result we reached out that the prevalence of Hepatitis C through ELISA method was around 2.6%. This number reduced to 1% considering RIBA positive samples which is the definite test in Hepatitis C diagnosis. This study is the first Hepatitis C determination in general population in Iran. A comparison between the Hepatitis C prevalence in north east Iran and other part of the world showed that Iran relatively has a lower prevalence [Asia: 3.55% Africa: 5.17% America: 1.9%]. No other Hepatitis C evaluation study has been done in any other part of Iran

[Case report: a case of disseminated Burkitt's lymphoma with involvement of the stomach, breast and eye-lids]

Disseminated B cells Burkitt's lymphoma with stomach ,breast and eyelid involvement Burkitt's lymphoma in adult is rare and has a progressive pattern in advanced stages. The current case is a 19 year old lady who was admitted in a hospital due to GI bleeding shown as melena. An upper gastrointestinal Endoscopy report remarked a tomural mass lesion and also multiple masses in breast and abdomen Were found in computerized tomography escan. A B cells Burkitt's lymphoma diagnosis came up after biopsies of stomach and breast masses which was confirmed by immunophenotyping done with flowcytometry [CD[20], Ki[67] = 100%]

[Invasive gastric cancer with metastasis to biliary tract presenting as primary colangiocarcinoma]

Gastric cancer is a relatively common cancer that can metastasize to multiple organs such as liver and the biliary tract. The patient is a 60-year-old woman who was admitted for severe abdominal pain, icterus, rised liver enzymes and a mass at the bifurcation of the common bile duct in MRCP [Magnetic Resonance Cholangio pancreatography] and was diagnosed as a case of primary colangiocarcinoma [Klat skin]. Patient was scheduled for stenting. Because of aggravation of abdominal pain. Upper GI endoscopy was performed and an extensive tumoral mass was found from body down to the pylorus of stomach. The pathology report of biopsies obtained from mass was Signet Ring cell adenocarcinoma of stomach which had metastasized to the biliary tract