Impact of Serological and Histological Factors on Neurological Manifestations in Children and Adults with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study. @*Methods@#All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations. @*Results@#A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45–0.96; p=0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18–2.63; p=0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18– 1.11; p=0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999–1.001; p=0.59) did not significantly increase the chances of developing neurological disorders. @*Conclusion@#Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.

Impact of Serological and Histological Factors on Neurological Manifestations in Children and Adults with Celiac Disease / 대한소아소화기영양학회지

Purpose@#Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study. @*Methods@#All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations. @*Results@#A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45–0.96; p=0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18–2.63; p=0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18– 1.11; p=0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999–1.001; p=0.59) did not significantly increase the chances of developing neurological disorders. @*Conclusion@#Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.

Analysis of TLR7, SOCS1 and ISG15 immune genes expression in the peripheral blood of responder and non-responder patients with chronic Hepatitis C

Aim: To evaluate the baseline expression of the immune genes in PBMCs of responder and non-responder patients with chronic Hepatitis C

Background: Although the contribution of peripheral blood mononuclear cell [PBMC] gene expression in treatment outcome of hepatitis C virus [HCV] infection is supposed, it has remained to be distinctly delineated. The baseline expression of the immune genes inside PBMCs may reflect the responsiveness status following IFN treatment

Methods: Totally, 22 chronic HCV encompasses 10 responders and 12 non-responsive cases enrolled randomly regarding medical records. The PBMCs from the peripheral blood samples were isolated and then incubated for 6 hours in the culture media. The baseline expression of TLR7, SOCS1 and ISG15 was measured by Real time PCR

Results: The gene expression pattern in PBMCs of both groups showed a similar trend. The expression of SOCS1 and TLR7 genes showed higher levels in non-responder group [P>0.05]. The result of ISG15 showed a higher but non-significant expression in the responder group [P>0.05]

Conclusion: The similar pattern of TLR7, SOCS1 and ISG15 expression in the responder and non-responder patients indicated their poor discriminating and predictive value in PBMCs sample

Management of gastroesophageal reflux disease in adults

Gastroesophageal reflux disease [GERD] is a very common disease. GERD is defined as the reflux of stomach content which causes troublesome symptoms and/or complications. The management of GERD is step by step. Dietary and lifestyle modifications are the first steps. Twice-daily H2RAs at standard doses for a minimum duration of two weeks can be considered in patients with GERD who fail to respond to lifestyle and dietary modifications. If symptoms of GERD persist, once-daily Proton Pump Inhibitors [PPIs] can be recommended. Patients with an unsatisfactory response to once-daily PPIs dosing can be considered to have refractory GERD. Twice-daily PPI therapy can be recommended in patients who fail to respond to once-daily PPI therapy. The add-on treatment with H2RAs, baclofen, or visceral pain modulators can be considered in selective subjects with GERD who fail to respond to twice daily PPI. Anti-reflux surgery may be taken into account in selected patients. This review focuses on the initial and maintenance therapy of GERD and also reviews different management of recurrent and refractory GERD

Incidental diagnosis of appendiceal abscess by colonoscopy; a case report and review of the literature

Although complicated acute appendicitis is occasionally observed in general practice, the diagnosis of appendiceal abscess by colonoscopy is unusual. We report a case of appendiceal abscess with spontaneous drainage into the lumen of colon diagnosed during colonoscopy and resolved by the time of surgery

In-vitro callus induction and rosmarinic acid quantification in callus culture of satureja khuzistanica jamzad [lamiaceae]

In the present study, an efficient protocol has been developed for callus induction and production of RA in callus culture of Satureja khuzistanica for the first time. In-vitro callus induction was achieved from young shoot tip explants cultured on MS and B5 media supplemented with different concentrations of IBA [0.1, 1.0, 2.0 and 5.0 mgL[-1]] solely or in combination with cytokinins BAP and KIN [1.0, 2.0 and 5.0 mgL[-1]]. B5 medium supplemented with 1.0 mgL[-1] IBA plus 5.0 mgL[-1] BAP and MS medium fortified with 2.0 mgL[-1] IBA and 2.0 mgL[-1] BAP were the most favorable media for callus formation with the highest induction rate [96%]. Maximum growth index [2.89 and 2.63] and maximum callus biomass [2.34 and 2.33 g fresh weight] were obtained from the callus cultured on B5 medium supplemented with 1.0 mgL[-1] IBA plus 5.0 mgL[-1] BAP and MS medium fortified with 1.0 mgL[-1] IBA plus 1.0 mgL[-1] KIN, respectively. Determination and quantification of RA in cultured calli were performed by HPLC UV/MS analysis. Calli induced from the plant and maintained on supplements of IBA and BAP in the absence of light produced RA 7.5% based on dry weight [DW]. No differentiation was observed in any callus during the course of this study

Economic burden of hepatitis B virus infection in different stages of disease; a report from southern Iran

To estimate the total annual cost due to chronic hepatitis B [CHB]-related diseases imposed on each patient and his/her family in Iran. Economic burden of CHB-related diseases [CHB, cirrhosis, and hepatocellular carcinoma] were examined. In this retrospective study, 100 Iranian patients were identified to obtain their socioeconomic status, utilization [direct and indirect costs] and costs of treatment, and work days lost due to illness with a structured questionnaire during 2012. Costs of hospital admissions were extracted from databases of Nemazee Hospital, Shiraz, Iran. The outpatient expenditure per patient was measured through the rate of outpatient visits and average cost per visit reported by the patients, while the inpatient costs were calculated through annual rate of hospital admissions and average expenditure. Self-medication and direct non-medical costs were also reported. The Human Capital Approach was used to measure the work loss cost. The total annual cost per patient for CHB, cirrhosis, and hepatocellular carcinoma were US[dollar sign] 3094.5, US[dollar sign]17483, and US[dollar sign] 32958 during 2012, respectively. CHB-related diseases impose a substantial economic burden on patients, families, and the society. This study provides useful information on cost of treatment and work loss for different disease states, which can be further used in cost-effectiveness evaluations

Serotonin transporter gene polymorphisms in southwestern Iranian patients with irritable bowel syndrome

Irritable bowel syndrome is a common chronic functional gastrointestinal disorder of unknown etiology. Serotonin is an important factor in sensory signaling in the brain-gut axis, which plays a key role in intestinal motility and secretion. Serotonin clearance is mediated by a specific protein called the serotonin reuptake transporter. Transcription activity of the serotonin transporter gene is affected by some polymorphisms in this gene. The aim of this study was to investigate the relationship between serotonin transporter gene polymorphisms and irritable bowel syndrome. The 5-HTTLPR, rs25531 and STin2VNTR polymorphisms of the serotonin transporter gene were analyzed by PCR-based methods in 50 patients with irritable bowel syndrome and 100 healthy controls. Serotonin transporter polymorphisms were similar in patients and healthy controls. There were no significant differences in allele or genotype frequencies between the two groups. Our findings suggest that polymorphisms in the gene encoding for the serotonin transporter are not associated with irritable bowel syndrome. Interactions between environmental factors and predisposing genetic factors are important in the pathophysiology of irritable bowel syndrome, and further genetic and epigenetic research may provide novel insights into the mechanisms contributing to this disease

Double pylorus in a cirrhotic patient: a case report and review of the literature

Double pylorus [DP] is a rare condition characterized by the presence of two openings from the gastric antrum to the duodenal bulb, which may be congenital or acquired. Herein, we describe a case of DP in a cirrhotic patient

Castleman's disease of the porta hepatis

Castleman's disease is an uncommon cause of lymph node enlargement that mostly involves the mediastinum and lung hilum. It is divided into 2 types: localized, which is usually asymptomatic and presents with a mass lesion; and multicentric, which is characterized by chills, anemia, generalized lymphadenopathy and hepatosplenomegaly. An extrathoracic site of involvement is very uncommon, and may be located in the mesentery of the intestines, axilla, and pelvis. Hepatic localization of this disease is a rare event. Herein, we report our experience with a symptomatic case of Castleman's disease in the porta hepatis who has been treated successfully by excision of the hilar lymph nodes, but recurred after 2 years with the same clinical picture plus abnormal liver function tests. However, at the time of recurrence, no lymphadenopathy was detected and liver biopsy showed giant lymphoid follicles with germinal centers. She was treated with steroids and showed a dramatic response

Ruptured Meckel's mesodiverticulum and Meckel's diverticulum following blunt abdominal trauma

To present a case of simultaneous rupture of Meckel's diverticulum and mesodiverticulum with abdominal pain following a blunt trauma to the abdomen, sustained during an automobile accident. Following a head-on automobile collision a 36-year-old man was referred to the emergency room with abdominal pain, guarding and rigidity and was taken to the operating theater with a preoperative impression of peritonitis due to rupture of a hollow viscus. Upon abdominal exploration, ruptured Meckel's diverticulum [from the base] and ileum with active bleeding from mesodiverticulum was found. The ileum was repaired in two layers: a segmental bowel resection including Meckel's diverticulum and the gastrointestinal tube anastomosed without any tension. The patient has a normal postoperative course. This case shows that a blunt abdominal trauma can tear the mesodiverticulum and rupture the Meckel's diverticular base simultaneously, resulting in hemoperitoneum and chemical peritonitis. Diagnosis and management of this type of injury are basically the same as those of acute surgical abdomen following trauma