Bowel preparation for a better colonoscopy using polyethylene glycol or c-lax: a double blind randomized clinical trial

Background: Ideal bowel preparation regimen for a suitable colonoscopy should be safe, and well tolerated, and should rapidly clear gastrointestinal tract. Soluble polyethylene glycol [PEG] is the most common cleansing drug and Senna or C-Lax [Cassia angustifolia Vahl] is an alternative herbal one. This study was designed to compare the efficacy of PEG and C-lax in bowel preparation

Methods: In this randomized double blind trial [registry number in IRCT.ir: IRCT201601161264N7], 320 patients were randomly assigned in PEG or C-lax groups. PEG solution was prepared from 5><70 gr sachets in 20><250cc water [250 ml every 15 minutes], prescribed 24h before the colonoscopy. In the other group 3x60 ml C-lax syrup glasses [each containing 90 mg senozid B] was given in two divided doses [1.5 glasses of 250cc every 12 hours], 24h before the colonoscopy. Ottawa score was used to evaluate the quality of bowel preparation. Chi-square test, Student t test, Mann-Whitney test and multivariate analysis were used to analyze the data

Results: Of these patients with the mean [SD] age of 50 [15.16] years, 162 [50.8%] were men. Mean [SD] Ottawa score was 2.57 [0.2] and 3.15 [0.31] in the PEG and C-lax group, respectively [p value = 0.81]. Multivariate analysis showed that less opium consumption [p < 0.001] and higher educational level [p =0.005] were associated with better bowel preparation

Conclusion: C-Lax is non-inferior to PEG solution in cleansing colon. The quality of bowel preparation was lower in opium consumers and better in those with higher educational level

Comparison of the serum levels of trace elements in areas with high or low rate of esophageal cancer

Background: there is a critical role for trace elements in cancer prevention. Since northeast Iran is known as a high risk area for esophageal cancer, this study was designed to compare the serum levels of some trace elements in high and low rate areas of Golestan province

Methods: we used 240 fasting serum samples obtained in 2011 from eastern and western parts of Golestan province during the non-communicable diseases' screening program. To carry out laboratory examinations, the samples were firstly deproteinated and then the concentrations of the intended elements were measured by an atomic absorption spectrometer. A total of 227 samples were used in the present study and the remaining 13 samples were excluded due to inappropriate conditions

Results: the mean serum level of zinc in the high-risk region was significantly lower than that in the low-risk region. But no significant difference was detected in serum levels of copper, magnesium, and manganese in the low-risk and high-risk regions

Conclusion: as this study was an ecological study with no comparison between patients with cancer and healthy population, its results cannot be used for the general population. Therefore, complementary studies including case-control studies are suggested for further evaluation of the relationship between these elements and the incidence of esophageal cancer

Inverse association of plasma level of glutathione peroxidase with liver fibrosis in chronic hepatitis B: potential role of iron

Background: Oxidative stress plays a major pathogenic role in liver injury following chronic hepatitis B. Glutathione peroxidase [Gpx] has a central role in regulating the oxidative state. Hepatitis B virus [HBV] results in down-regulation of Gpx. On the other hand, iron homeostasis is disrupted in HBV infected patients. Therefore, the objective of this study was to assess the interplay of Gpx and serum iron on clinical and virological characteristics of patients with chronic HBV infection

Method: One hundred and fifty adult, treatment-naïve, patients with chronic hepatitis B were randomly selected from an ongoing cohort of patients with HBV. Plasma Gpx1 concentration and HBV DNA quantity were measured. Liver stiffness was measured by transient elastography

Results: Serum iron had a positive association with HBV DNA count in the total population. Serum iron was not associated with liver stiffness. However, HBV DNA was significantly associated with liver stiffness only in male patients. Serum Gpx was inversely associated with liver stiffness. Serum iron and Gpx had indirect effects on liver stiffness via HBV DNA count. We observed distinct effects of serum iron on HBV DNA and Gpx on liver stiffness in male and female patients

Conclusion: We identified interplay of serum iron and Gpx1 in relation to level of liver fibrosis in patients with chronic hepatitis B. Our results suggest that oxidative stress and serum iron are differentially implicated in the progression of chronic hepatitis B in male and female patients

Hesa-a effects on cell cycle signaling in esophageal carcinoma cell line

Background: Hesa-A is a natural compound with anticancer properties. The exact mechanism of its action in esophageal cancer is not clear, yet. The aim of this study was to evaluate the cell toxicity effect of Hesa-A on the esophageal carcinoma cell lines, KYSE-30, and cell cycle genes expression

Methods: In this study, we tested cell toxicity with MTT [3-[4,5-Dirnethylthiazol-2-yl]-2,5-Diphenyltetrazolium Bromide] assay and flow cytometry to evaluate the cell cycle arrest

Real time polymerase chain reaction was used to assess the expression of P53, PI6, P21, cyclin Dl, and cyclin Bl genes

Results: Our results showed that Hesa-A is effective in the expression of cell cycling check point proteins. Hesa-A induced an arrest in G2 phase of esophageal cell cycle. The levels of P53 [>13 times], P21 [>21 times], PI6, cyclin Bl, and cyclin Dl genes were increased 48 hours after Hesa-A treatment

Conclusion: P21 and P16 expression were the potential mechanisms for G2 arrest of KYSE-30 esophageal cancer cell line by Hesa-A

Correlation between low bone density and disease activity in patients with ulcerative colitis

Different clinical and epidemiological studies using dual-energy X-ray absorptiometry have shown an increased prevalence of low bone mineral density in patients with inflammatory bowel diseases. The aim of this study was to assess the correlation between bone density and the disease activity in patients with ulcerative colitis. In this cross-sectional study, 52 patients with ulcerative colitis [duration of the disease less than 5 years] were invited to our research center, Golestan province, northeast of Iran, during February 2012 up to August 2012. A demographic checklist and Simple Clinical Colitis Activity Index was completed for each patients and 5 cc of blood sample was taken after obtaining the informed consent. We used colorimetry method for measuring serum calcium, UV method for serum phosphorus and ELISA for serum vitamin D. Dual-energy X-ray absorptiometry was done to evaluate the bone density. Data analysis was done using SPSS software version 16. Normality of data was assessed using Kolmogorov-Smirnov test. T and ANOVA tests were used if data had normal distribution. Mann-Whitney U or Kruskal-Wallis tests were used for the remaining data. Correlation between qualitative variables was evaluated by Chi-square test. The mean [ +/- SD] age and disease activity of the patients were 37.72 [ +/- 12.18] years and 4.78 [ +/- 1.98], respectively. There were no correlation between disease activity and mean age Low bone density was seen in 30.8%, 11 .5%, and 15.4% in spine, femur neck, and hip, respectively. There was no relationship between Z-score of total hip, spine, and femur neck with disease activity, age, and duration of disease [p>0.05]. Our results showed an acceptable rate of low bone density in patients with ulcerative colitis without any correlation with the disease activity index

Evaluation of some plasma coagulation factors in women with spontaneous miscarriage

It has been reported that 15-20% of parous female have experienced at least one miscarriage, while 3% of them have experienced two miscarriages. The goal of this study was to evaluate the plasma level of coagulation factors in women with a his-tory of spontaneous abortions. In this case-control study, 82 women with a history of two or more abortions referred to the six private gynecologic clinics in Gorgan city without any structural abnormality were recruited during 201 1-2012. Plasma levels of antithrom-bin III [ATIII] using colorimetric assay, protein C, protein S, factor V Leiden and lupus anticoagulant [LAC] using coagulation method were measured. The control group was women with a history of normal delivery and no abortions. Those under anti-coagulant therapy were excluded from the study. Data were entered into the computer using the Statistical Package for the Social Sciences [SPSS, SPSS Inc., Chicago, IL, USA] version 16 and analyzed by Chi-square, t test and non-parametric tests. At least one abnormality was reported in 35 cases [42.7%]. Among them, protein C deficiency was the most prevalent [30.5%]. ATIII was abnormal in 17.1% and lupus anti-coagulant was abnormal in 8.5%. Factor V Leiden was normal in all cases and protein S deficiency was only seen in one case. We suggest to perform these tests in regards to the thrombophilia in cases with spontaneous abortions in order to find an early cure for this treatable disorder

Cohort profile: Golestan hepatitis B cohort study-a prospective long term study in northern Iran

Hepatitis B virus [HBV] infection is the most common cause of end stage liver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand the natural course of HBV infection. To date, several studies of HBV epidemiology, natural history, progression to cirrhosis and association with HCC have been reported from other countries. However, few of these are prospective and fewer still are population-based. Moreover, the underlying molecular mechanisms and immunogenetic determinants of the outcome of HBV infection especially in low and middle income countries remains largely unknown. Therefore, the hepatitis B cohort study [HBCS], nested as part of the Golestan Cohort Study [GCS], Golestan, Iran was established in 2008 with the objective to prospectively investigate the natural course of chronic hepatitis B with reference to its epidemiology, viral/host genetic interactions, clinical features and outcome in the Middle East where genotype D HBV accounts for >90% of infections. In 2008, a baseline measurement of HBV surface antigen [HBsAg] was performed on stored serum samples of all GCS participants. A sub-cohort of 3,505 individuals were found to be HBsAg positive and were enrolled in the Golestan HBCS. In 2011, all first degree relatives of HBsAg positive subjects including their children and spouses were invited for HBV serology screening and those who were positive for HBsAg were also included in the Golestan HBCS

Frequency and perception of sexual activity during pregnancy in Iranian couples

Pregnancy stimulates partners to search for ways to preserve their mutual emotional relations and satisfy their sexual needs, with some limitations. This study evaluates the frequency and perception of sexual intercourse during pregnancy in a group of Iranian couples. In this cross-sectional study, 155 pregnant women were recruited from two academic clinics in Tehran. The exclusion criteria were: any underlying disease, history of pelvic surgery or gynecologic and obstetric complications, abortion or sterility, and previous preterm labor. A checklist was administrated in the labor room, that included: demographic data, partus and their viewpoints about sexuality. Frequency of sexual activity in each trimester, vaginal intercourse, coitus position, orgasm, breast stimulation, condom usage, and pregnancy outcome were recorded. Data were analyzed with t- and chi-square tests. Women and their husbands with sexual behaviors during pregnancy had a lower mean age; the majority were nulipara [p<0.05]. The biggest reason for decreased intercourse in the first trimester was fear of abortion [39.45%]. No significant relationship between sexual activity in pregnancy and preterm labor, gestational age, membrane rupture, and fetal outcome was shown. There was a significant negative relationship between intercourse in the 2nd and 3rd trimesters and need to induction. Although our results showed that sexual intercourse had no adverse effect on the fetus and was a proper stimulus for the induction of delivery, its frequency was reduced during the gestational stage due to parents' fear of adverse effects

Hepatocellular carcinoma in pregnancy with unusual presentations

Hepatocellular carcinoma [HCC] is very rare during pregnancy and has a worse prognosis in pregnant women compared to those who are not pregnant. We present a case of HCC in a 41- year-old pregnant patient who was referred to our academic hospital. The patient presented with chief complaints of abdominal pain, jaundice, ede-ma and hypertension. Laboratory results were notable for elevated liver enzymes and features of microangiopathic hemolytic anemia with normal alpha fetoprotein [AFP] and elevated cancer antigen 125 [CA125]. At laparotomy for termination of pregnancy, multiple massive lesions were detected in the liver. Histologic evaluation showed features of HCC. HCC must be included in the differential diagnosis of any pregnant patient who presents with elevated liver enzymes and hemolysis.

role of cefazolin in prophylaxis of central vein catheter-related infection in dialysis patients

Dialysis via central vein catheter [CVC] is a temporary procedure for dialysis in chronic renal failure and is suitable in patients without artery-venous fistula [AVF] or in whom their AVF needs almost two months to be mature. Infection is one of the most common and dangerous complications during this procedure. Controversies are reported regarding the use of prophylactic antibiotics before the insertion. This study was done to measure the role of prophylactic antibiotics therapy in prevention of infections. This interventional study was conducted on end stage renal disease [ESRD] patients admitted to the referral hospital of Golestan province, Northeast of Iran for inserting CVC. In this study, 95 cases of ESRD were randomized into two groups. Intravenous Cefazolin [1 gram] was administered to the intervention or case group [54 patients] before CVC and control group had been administrated no antibiotic [controls=41]. Data regards to the infection-free catheter survival, fever and any symptoms of infection were recorded during 45 days of followup. Data were entered into SPSS-15 software and analyzed with one-way ANOVA test. Relative risk [RR] was calculated and compared between the two groups. Cumulative incidence was 15.2% and 27.1%, in cases and controls, respectively. Relative risk of infection was 1.78 fold in controls versus the cases, but it was not significant [RR=1.78; CI=1.141-2.421; P-value>0.05]. Relative risk of the infection was not significantly different in this study, but it could be suggested to try antibiotics before CVC and compare the results

[Nutritional characteristics in patients with colorectal cancer in Golestan Province of Iran, a case-control study]

Colorectal cancer is the third common malignancy in the world. Personal habits including life style and nutrition have been proposed as risk factors of colorectal cancer. We conducted this study to assess the nutritional characteristics in colorectal cancer patients in Golestan province of Iran. This case-control study was done on 47 colorectal cancer cases, diagnosed during 2004-05 and 47 healthy controls. A questionnaire containing socio-demographic and nutritional characteristics [FFQ] was filled for each of the participants. Chi square test was used to assess the relationship between variables. In each of the two groups, 40.4% were females and 59.6% were males. The mean +/- SD age of age in cases and controls were 52.4 +/- 13.4 and 52.1 +/- 13.1 years, respectively. Total energy expenditure of higher than 1837.5 Kcal/day was significantly related to colorectal cancer [OR= 3.8; 95% CI: 1.2-11.3]. Colorectal cancer risk was higher in individual with frying cooking method [OR=3; 95% CI: 0.8-11.1]. The risk of colorectal cancer was 6.5 times higher in individuals with fat consumption of higher than 118.5 grams/day [95% CI: 1.5-28.8].No significant relationship was seen between vegetables consumption and the risk of colorectal cancer. This study showed that high total energy expenditure, high fat consumption and using frying method for cooking are risk factors of colorectal cancer in Golestan province in Northern of Iran

[Relation between drinking water hardness and the incidence of esophageal and gastric cancers]

Esophageal and gastric cancers are among the most prevalent cancers in the world which cause a high mortality rate annually. Several risk factors are supposed for them. Water hardness is considered as a protective factor against above cancers. This ecologic study was designed to determine the correlation between water hardness and upper gastrointestinal cancers. In this ecological study data on water components in Golestan's urban areas were obtained during 2004-05 and the averages were reported. All cases of esophageal and gastric cancers resided in urban areas which were diagnosed during this period were recruited to estimate the incidence and age standardized rates [ASR]. The province was divided into low, intermediate and high incidence, based on 33% and 66% quartiles of both cancers. Pearson correlation coefficient test and regression model were used to analyze the data. The water hardness was in the normal standard range permitted for the drinking water, and did not have any relation with the risk of esophageal and gastric cancers. This study showed that water hardness has no effect on the incidence of esophageal and gastric cancer in this area

Common signs and symptoms in hypothyroidism in central part of Iran

This study was designed to evaluate the common signs and symptoms of hypothyroidism in persons with clinical diagnosis of hypothyroidism that was confirmed with laboratory tests. This descriptive cross-sectional study was done during 13 months in medical centers of Shahrood city, in central part of Iran. All cases with probable diagnosis of hypothyroidism based on the signs and symptoms, referred to health care services were included in the study. Radioimmunoassay tests and thyroid hormones evaluation were done. Demographic data and signs were recorded through interview. Data were entered in the computer and analyzed by SPSS software. Patients who completed questionnaires [n=50] were interviewed three times during this period. Female/male ratio was 6/1. The most common signs were cold intolerance [95%], weight gain and menorrhagia. The most common symptoms were edema [80%] and pallor [60%]. The severe disease was seen in 4%. Mild type was the most common presentation of hypothyroidism [60%]. The most common signs and symptoms of hypothyroidism in the central part of Iran [Shahrood city], that is one of the iodine deficient areas in Iran; were different from other studies. Socio-demographic and nutritional status, illiteracy level and personal self-care are among the probable causes. Unfortunately, concomitance of some of the signs and symptoms are not diagnostic for hypothyroidism. It seems that strong clinical suspicious and laboratory confirmation are the only reliable methods for hypothyroidism diagnosis

Silica and esophageal cancer in golestan province northeast of Iran

Association of silica with diseases like cancers has been determined previously. This study was designed to determine the quantity of silis in flour produced in Golestan province and its relation to the esophageal cancer. We took flour samples from all flour mills in Golestan province. Base-melting method in nickel cruise was used in 550°C; the extract was reduced with acid. The differences between silis concentration in various regions were compared. P-value <0.05 was assumed significant. Median silis concentration was 0.0030 grams, mean was 0.008760 +/- 0.004265 [SD] grams in each 100 grams flour. The differences in mean silis concentrations of various regions were not significant [P>0.05]. This study did not show high level of silica in the flour of Golestan province. We could not find significant differences between silica contaminations in the various areas. Further studies on the consumed bread and rice in the various regions of the province can be helpful

[Serum ferritin in thalassemic [major] patients with subcutaneous desferal versus subcutaneous and intravenous desferal therapy]

beta-thalassemia is a widespread disease. Long term transfusion is the most important therapy in these patients but the best regimen is controversial yet. In this study two groups of thalassemic patients were compared. Subcutaneous desferal regimen was compared versus subcutaneous in combination with intravenous desferal. This clinical trial was done on thalassemic patients in Pediatric Center who were similar in mean age, number of subcutaneous desferal infusions and number of transfusions. This study was done in one year and serum ferritin was measured every 3 months in patients [cases] and at the end of the study [in controls]. Mean serum ferritin was significantly different in two groups at the end of the study [after one year follow-up], it was higher in case group than in controls [1.7 times] [P value=0.04]. In this study, combination therapy of intravenous and subcutaneous desferal was more effective to reduce the iron overload. With more accurate management we will achieve a better long term prognosis in these patients