HER-2/neu and E-cadherin expression and microsatellite instability in gastric dysplasia

Gastric dysplasia [GD] is a precursor lesion of gastric adeno-microsatellite instability [MSI] and the diffuse type is associated with down regulation of E-cadherin. HER-2/neu is over-expressed in some cases of gastric cancer. In this study, MSI and expression rates of HER-2/neu and E-cadherin in GD were evaluated. Paraffin blocks of 21 cases of low grade dysplasia [LD], 11 cases of high grade dysplasia [HD] and 25 cases of indefinite for dysplasia [ID] were collected. After deparaffinization and antigen retrieval, the sections were incubated with antibodies against E-cadherin, hMLH1, hMSH2 and HER-2/neu. The streptavidin-biotin complex method was used followed by peroxidase enzyme development with diaminobenzidine. HER-2/neu was positive in six cases of HD [50%], four LD [21%] and two ID [9%]. E-cadherin was absent in two cases of LD and showed normal expression in all HD and ID cases. hMLH1 expression was absent or markedly decreased only in the zones of dysplasia in HD [3/11], LD [3/21] and Id [4/25]. Absence or diminished expression of hMSH2 was seen in HD [3/11], LD [2/21] and ID [3/25] cases. HER-2/neu expression showed close association with diminished expression of hMLH1 or hMSH2 [p<0.05]. Stepwise increase in the expression rate of HER-2/neu was seen in ID, LD and HD cases implying its role in cancer evolution. The absence of hMLH1 and hMSH2 in GD may predispose individuals to over-expression of other oncogenes such as HER-2/neu. Abnormal of E-cadherin is not frequent finding in GD

[ impact of hyperglycemia or hypoalbuminemia on duration and need to mechanical ventilation in critically ill patients]

In addition to lung mechanics measurements, many physiological factors also have impact on weaning of critically ill patients, but are often overlooked. Hyperglycemia is common in critically ill patients. The purpose of this study was to assess the utility of hypoalbuminaemia or hyperglycemia as predictors for need ventilator and weaning success in critically ill patients. A single center, descriptive- analytical trial was done on 600 patient's >= 16 years old admitted for 3 or more days to intensive care unit. Patients were classified into five different groups based on the cause of respiratory failure. The following parameters were recorded: serum albumin and glucose concentration; Acute Physiology and Chronic Health Evaluation III score; need ventilator, ventilation days, and fluid balance. The initial mean serum glucose concentration was 9.3 +/- 0.2 mmol/l and the initial mean serum albumin concentration was 30.2 +/- 0.02 [0.2 g/dl] g/l. Although the circulating albumin concentration was significantly lower and serum glucose concentration was significantly higher in ICU nonsurvivors than in ICU survivors, albumin [r=-0.031, P>0.05] and blood glucose concentration [r=0.050, P>0.01] on ICU admission were not a predictor of the length of time spent receiving mechanical ventilation. Patients with serum albumin concentration less than 30.3 [3.03 g/dl] g/l were one and two tenth times more likely to need ventilator than normoalbuminemic patients [relative risk 1.2, 95% confidence interval 1.06 to 1.31]. The risk of need to mechanical ventilation did not raise with blood glucose concentration more than 11 mmol/l [200 mg/dl]. These findings suggest that albumin or blood glucose may be an index of the metabolic status of the patient, which could be important in determining the need ventilator and wean ability of the patients who are mechanically ventilated for prolonged periods of time

[Evaluation of combination therapy with interferon and ribavirin in patients with chroni hepatitis C: a genoty based study]

About 200,000 of Iranian population are infected with Hepatitis C Virus. On the basis of Iranian consensus on management of chronic hepatitis C [CHC] infection in 2004, combination therapy with conventional alpha-Interferon [IFN] plus Ribavirin is the first therapeutic choice in CHC patients. Data are limited on treatment response rate in most areas of the country. To assess the treatment results, we performed this study in a referral center in province of Fars, in Iran, to compare with the response rates to therapy in Western patients. A total of 118 patients with CHC [males 88%] with mean age of 37.47 [SD 11.4] years, mean Histologic Activity Index of 8.21 [SD 4.5], and mean pretreatment Alt level of 81.26 [SD 72.86] were enrolled in the study. IFN 3 million unit/TIW plus Ribavirin 1-1.2 gr/d were administered for 6-12 months [depending on genotype], and the patients were followed up for 6 months period to assess sustained virologic response [SVR]. The most common route of acquisition of the virus was intravenous drug using seen in 39.8% of patients. 40.7% were infected by genotype 3a, 22% 1a and 9.3% by 1b. Seventy- three patients completed the course of therapy. End of treatment response [ETR] was achieved in 54 [74%] patients. SVR rate was 48% with a relapse of 13.7%. Hepatic decompensation was seen in 2 [2.7%] patients in follow-up period. With respect to the duration of therapy, genotype of viruses was not significantly different in both responders and non-responders [0.05]. Despite the different genotyping pattern ETR and SVR rates were comparable in Iranian CHC patients treated by combination therapy of conventional IFN plus ribavirin in comparison with Western patients. SVR was greater in cases with pretreatment lower HAI

Changing epidemiology of esophageal cancer in Fars province, Iran

Esophageal carcinoma is one of the most lethal gastrointestinal [GI] malignant tumors worldwide. The disease is known to have a high incidence in northern Iran; however, its condition in the South is not much clear. In this retrospective study we investigated the epidemiology and time trends of esophageal carcinoma in Fars Province, South of Iran. In a retrospective study, we reviewed pathologic reports of all laboratories in Fars Province, South of Iran, from March 1997 to March 1999 to find cases of esophageal carcinoma. Annual and average incidence in different age groups were calculated for both sexes, based on four censuses results. Esophageal carcinoma was the third most common GI cancer in Fars, with an average incidence of 2.95 per 100,000 in the population older than 15 years. The incidence of esophageal carcinoma was found to drop by 64% during the study period. This was mainly due to the decreased incidence of squamous cell carcinoma. Females developed squamous cell carcinoma in relatively younger age as compared to males. Our region in the South of Iran is one of the low incidence areas of esophageal carcinoma as compared to that of northern borders of the country and other parts of the world with some special features

Irritable bowel syndrome: clinical manifesrtations and relation to lactase deficiency

Eight hundred and four medical students, selected by multistage random sampling, filled a questionnaire, adapted from Manning's criteria for irritable bowel syndrome [IBS]. More than 16% of students were found to fulfil the criteria for IBS. H2 breath test, both fasting and after ingestion of 50 gm lactose, was performed on the 64 students with, and 115 without IBS. There was a statistically significant correlation between the prevalence of IBS and age [p<0.001], while no correlation was found with sex, or marital status. Food intolerance, history of acid peptic disease, and symptoms of dyspepsia were more frequent in students with IBS [p<0.001]. Twenty-five% of the students with IBS had nocturnal symptoms. Lactose intolerance was present in 8% of the study group, with no correlation with IBS. It is concluded that IBS is a common gastrointestinal disorder in Iran and some features are probably different from those described in other geographic regions