[ effect of omeprazole on the number and size of after-endoscopic band ligation ulcers of esophageal varices]

Endoscopic variceal ligation [EVL] is an effective option in treatment of esophageal varices bleeding or elective ablation. Although the after-EVL ulceration is well recognised, the effect of acid suppression on ulcer healing is not determined, definitely. In this study, we tried to evaluate the efficacy of Omeprazole as the most available protone pomp inhibitor [PPI] on the numbers and size of after-EVL esophageal ulcers in patients electively underwent this procedure. We performed a randomised placebo-controled trial of Omeprazol after elective EVL. Fifty consecutive cirrhotic patients who were cadidated for EVL randomly enrolleded in and were divided equally into case [25] and control [25] groups. After endoscopy and EVL, case subjects received Omeprazole [20 mg twice a day] for 2 weeks and control subjects received placebo for the same period as well. All the patients underwent a follow up endoscopy 13-15 days after EVL. Forty two patients [20 cases and 22 controls] completed the study. Numbers and size of ulcers were evaluated throughin the follow up endoscopy. Numbers of ulcers were significantly higher in control group [3.15 vs. 2.59, p=0.03]. The ulcers in Omeprazole group were on average half as large as in the placebo group [37.08 mm[2] vs.73.74 mm[2], p<0.0001]. After elective EVL, Omeprazol-treated Patients experienced a significant reduction in number and size of their post-banding ulcers. It seems that Omeprazole reduces the numbers and size of after-EVL ulcers

[ frequency of C3435T MDR1 gene polymorphism in Iranian patients with ulcerative colitis]

P-glycoprotein, the product of MDR1 [multi drug resistance] gene, is a trans membrane efflux pump, transferring drugs and toxins from intracellular to extracellular domains. It acts as a protective barrier to keep toxins out of the body by excreting them into the bile, urine and intestinal lumen. In the human gastrointestinal tract, P-glycoprotein is found in high concentrations on the epithelial cells of colon and small intestine. MDR1 gene polymorphism such as C3435T is associated with lower Pglycoprotein expression, thus it is suggested to have an association with ulcerative colitis. We tried to determine the frequency of C3435T polymorphism of MDR1 gene in Iranian patients with ulcerative colitis and compare it with healthy control population. In this case-control designed study, we assessed the C3435T polymorphism of MDR1 gene, in 150 ulcerative colitis patients and 150 sex- and ethnicity-matched healthy controls, who were visited at a teaching hospital during a one year period.[2002-2003]. The extracted leukocyte DNA was amplified by polymerase chain reaction [PCR] with specific primers, and C3435T polymorphism was detected by RFLP method. The mean age of patients was 40.1+/-13.9 years [14-74] and of controls was 40.7+/-14.0 years [16-79]. The frequency of C3435T allele was significantly higher in ulcerative colitis patients compared with controls [OR=1.58, 95% CI= 1.13 - 2.22, p<0.008]. The frequency of C/T genotype was also significantly higher in patients with ulcerative colitis [OR=1.67, 95% CI=1.06-2.64, p<0.028]. This study suggests that the higher frequency of 3435T allele has an association with ulcerative colitis in Iranian population as previously reported in western countries

[Association of the vitamin D receptor gene polymorphisms with inflammatory bowel disease in Iran]

Different genes such as vitamin D receptor [VDR] gene have some roles in IBD susceptibility. Some studies have recognized the relation of VDR gene polymorphisms with inflammatory and autoimmune disorders. Determining the frequency of these polymorphisms and their possible relation with IBD can improve understandings about genetic background of these diseases. The objective of this study was to assess the association of VDR gene polymorphisms [Apa I, Taq I, Bsm I, Fok I] with IBD in Iran. In this case-control designed study 100 UC, 50 CD patients and 150 sex and age matched healthy controls, hospital base, were selected. These patients were referred to [Taleghani Hospital] during a one year period [2004-2005]. Assessment of VDR gene polymorphisms was performed by PCR-RFLP method. Only the frequency of the Fok I polymorphism was significantly higher in UC and CD groups. The frequency of the polymorphic allele f was higher in UC and CD groups comparing with controls [p=0.019, OR=1.581 and p<0.001, OR=2.642, respectively]. The f/f genotype was significantly more frequent in UC and CD patients comparing with controls [p=0.010, OR=2.774 and p<0.001, OR = 5.947, respectively]. There were no significant differences between frequencies in patients and controls in other polymorphisms. There is a relation between Fok I polymorphism in VDR receptor gene and IBD in Iran but no association was observed with other 3 polymorphisms

[Case report: Intestinal leishmaniasis in a patient with AIDS]

In endemic regions visceral leishmaniasis is one of the most common opportunistic infections in HIV positive patients. Simultaneous infection with leishmania and HIV has been reported in some countries but there's no such report from Iran in medical literature. Patient was a 27-year-old man admitted with chief complaints of intermittent abdominal pain, anorexia and vomiting since 6 months ago. He also mentioned mild night fevers, watery diarrhea and severe weight loss during this time. He was of low socioeconomic status, was unemployed and had a history of imprisonment 4 years ago. Physical examination revealed low-grade fever [T=38.1?C] and severe cachexia [Weight=41 Kg, Height=165 cm]. Oropharyngeal candidiasis was evident in oral examination. In upper GI endoscopy, candidal esophagitis and duodenal nodularity were seen. Candidal plaques were also visible in duodenal mucosa. Microscopic evaluation of duodenal biopsy material showed partial blunting of the villi. Abundant macrophages containing intracytoplasmic microorganisms had infiltrated and expanded the lamina propria. High magnification view revealed leishmania amastigotes with nuclei and kinetoplasts. Leishman bodies were also observed in bone marrow aspiration specimen. Serologic studies [latex agglutination and Immunofluorescence antibody] were positive for Leishmania infantum. Serology for HIV antibody was also positive. CD4+ cell count was 80/microl. The diagnosis was acquired immunodeficiency syndrome with simultaneous visceral leishmaniasis involving intestinal mucosa

Epidemiology of dyspepsia in Nahavand, Iran

The prevalence and demographic features of dyspepsia are unknown in Iran. Thus, the present study was conducted to determine the epidemiology of dyspepsia in Nahavand. From 5 urban regions in Nahavand [with more than 61000 population], 1518 subjects [mean age +/- standard deviation 36.4 +/- 9.7 years, 865 females] were recruited through a systematic random sampling. Patients were questioned about dyspeptic symptoms, presence of any chronic disease, frequently used medications, previous operations and cigarette smoking in the previous 12 months. Dyspepsia was defined as the presence of following symptoms; pyrosis, upper abdominal pain, bloating, nausea, vomiting, or early satiety, and abdominal fullness, for at least one month during the previous six months. Data obtained through face-to-face interview was documented on structured questionnaires. The association between various demographic and lifestyle factors with dyspepsia was quantified by odds ratios [ORs] using logistic regression. 358 subjects [23.6%] had dyspepsia. Abdominal fullness [n=165] and abdominal pain [175] were the most common symptoms. More than half [n=183, 55%] had symptoms suggestive of dysmotility-like dyspepsia; mixed type dyspepsia was the next most common [n=126; 38%]. Dyspepsia was more prevalent in subjects exposed to tobacco smoke, but it was not associated with alcohol abuse. Use of nonsteroidal anti-inflammatory drugs [OR=1.92, 95%CI=1.49-2.49, p < 0.001], current smoking [OR= 2.45, 95%CI=1.45-4.07, p < 0.001], and lower education level [OR=1.73, 95%CI=1.21-2.47, p < 0.001] were associated with dyspepsia. 258 subjects with dyspepsia [60.7%] had received treatment with H2 blockers or proton pump antagonists, 7.7% had undergone previous endoscopy. Dyspepsia is reported by almost one-third of the population in Nahavand. Sixty percent of these cases receive treatment; however endoscopy is performed in a small number of patients

Barrett's esophagus in patients candidated for endoscopy

Barrett's esophagus is a precancerous lesion leading to esophageal carcinoma in 10% of cases. It is usually remained undetected during endoscopy and most of physicians do not take biopsy from gastroesophageal junction [GEJ] when it seems to normal. In the present study we have determined the frequency of Barrett's esophagus in a group of Iranian patients referring for endoscopy to our unit. During an eight-month period, 146 patients who had referred to our endoscopy unit entered our study regardless of their indication for endoscopy. A questionnaire dealing with demographic features, clinical manifestation of reflux, and indication for endoscopy was completed. During endoscopy, 2-4 biopsies obtained from Z-line. Finally, data were analyzed using SPSS software. The study population included 78 females and 68 males. Abdominal discomfort was the most common presenting manifestation [67.8%]. Other symptoms were reflux [7.9%], dysphagia [17.1%], chest pain [28.1%], and regurgitation [4.8%]. Endoscopy revealed short segment Barrett's esophagus in 13%, long segment Barrett's esophagus in 4.8%, esophagitis in 11% and hiatal hernia in 11%. Pathologic studies showed Barrett's esophagus in 4 [2.7%] patients, of whom, 2 had clinical manifestations of reflux and 3 failed to have endoscopic appearance of Barrett's esophagus. As noted previously, 10% of cases with Barrett's esophagus may lead to esophageal adenocarcinoma, thus, appropriate criteria should be established to diagnose patients with Barrett's esophagus during their early stage

frequency of three common mutations of CARD15/NOD2 gene in Iranian IBD patients

CARD15/NOD2 gene, located on the pericentromeric region of chromosome 16 [IBD1] has been reported to have an association with IBD, especially Crohn's disease [CD]. Many independent studies have shown a variable association between three common mutations of CARD 15, with Crohn's disease in different ethnic groups. Thus, raising the hypothesis that genetic and / or allelic heterogeneity may influence the relationship between CARD 15 and Crohn's disease. In the present study, we have investigated the frequency of three main mutations of CARD 15 gene [Arg 702 Trp, Gly 908 Arg and Leu 1007 fsinsC] in Iranian IBD patients and compared it with healthy control population. For this case-control study, 100 ulcerative colitis [UC], 40 Crohn's disease patients and 100 sex- age- and ethnicity-matched controls were enrolled from a teaching hospital during a one year period [2003-2004]. All three mutations were assessed on DNA of leukocyte cells, by PCR [Polymerase Chain Reaction] and RFLP [Restriction Fragment Length Polymorphism] methods. The mean age of UC, CD and healthy controls were 38.6 +/- 14.3, 36.6 +/- 14.1, and 38.6 +/- 14.2 years. Among the three evaluated CARD 15 gene mutations, the frequency of Arg702Trp mutation was significantly higher in Iranian patients with Crohn's disease [OR19.2; 95%CI:4.2-87.3, p<0.001]. None of these mutations were associated with ulcerative colitis. This study showed that Arg702Trp mutation of CARD 15 gene is probably associated with Crohn's disease in Iranian population; indicating that genetic polymorphisms may differ between populations

[Clinical manifestation of retroperitoneal tuberculosis as psuedotumor in an 18-year-old female]

The case was an 18-year-old female with progressive crampy abdominal pain, nausea and vomiting, initiated from 4 months ago, Who had 4-5 Kg weight loss in this period. In physical examination, an ill-defined mass with mild tenderness in periumblical region palpation was detected. In upper GI endoscopy, bulging folds with a necrotic mass in D2- D3 were detected. In small bowel series study, cut off of barium in D2-D3 portions was seen. For better evaluation spiral CT was performedin which a large mass with extension to small bowel in retroperitoneum was seen. In Pathologic study, classification granuloma compatible with tuberculosis was reported. This finding was confirmed with Ziel Neelsen staining and PCR

[ case report of porphyria cutanea tarda in hepatitis C]

A 42-year-old male with history of HCV, presented with cutaneous lesions which were initiated from 2 weeks ago. Lesions presented with tenderness and red bulla in anterior aspect of left leg. The lesion gradually began to rupture and desquamation. Patient had similar lesions during the last year. Hyperpigmentation in old lesions was seen. Porphyria cutanea tarda was suspected. Diagnosis was confirmed with high urinary levels of uroporphyrinogen