Changes in serum ghrelin level in relation to meal-time in patients with functional dyspepsia.

BACKGROUND: Ghrelin is a peptide hormone that is involved in gastrointestinal motility and secretion; and therefore, may play a role in functional dyspepsia. OBJECTIVES: To compare the change of serum ghrelin level in relation to meal-time, between patients with functional dyspepsia and a control group. MATERIALS AND METHODS: In a cross-sectional study, 18 subjects with functional dyspepsia according to the Rome III criteria were enrolled in our study. Blood samples were collected five times: 30 minutes (min) before a standard breakfast; at the time as serving breakfast; and 30, 60 and 90 min after breakfast. Serum ghrelin concentration was measured in these patients and compared with eight normal individuals, as controls. RESULTS: The serum ghrelin level 30 minutes after breakfast was significantly higher in dyspepsia patients, compared to controls (751 ± 171.84 pg/ml versus 576.9 ± 195.62 pg/ml, p = 0.033). Although patients had a higher mean serum ghrelin level 30 minutes before, exactly at the time of serving breakfast and 60 min after breakfast there was no statistically significant difference between patients and controls. The shape of the curve was also different between the two groups, from 30 min until 90 min after breakfast, which is the time that most dyspeptic symptoms usually occur, although this difference was not significant (p > 0.05). CONCLUSION: The significantly different ghrelin levels between dyspeptic patients and the normal population showed that ghrelin may have an important role in inducing symptoms, in functional dyspeptic patients.

Insulin resistance and metabolic syndrome: is Helicobacter pylori criminal?

Insulin resistance and metabolic syndrome are contributors to atherosclerosis and coronary heart disease. Insulin resistance is also responsible in pathogenesis of type II diabetes. Several studies previously evaluated the role of H. pylori infection in coronary heart disease and type II diabetes. Recently published data have described the association between H. pylori infection with insulin resistance and metabolic syndrome. However, this is still a controversial subject. Here in, we reviewed current status and present data toward this topic.

Causes of organ donation refusal in southern Iran.

BACKGROUND: Family refusal is an important factor that limits the number of organ donations. Some studies from different centers have reported various reasons for family decisions of organ donation refusal. This study evaluated the reasons for organ donation refusal by family members covered in our organ procurement organization. METHODS: This cross-sectional study was performed among families of potential organ donors who satisfied brain death criteria as identified between March 2009 and March 2010. RESULTS: Among 125 potential donors 73 (58.4%) families refused donation. Their main reasons were as follows: lack of acceptance of brain death n=26 (35.6%), belief in miracle and patient recovery (n=22; 30.1), fear of gossip regarding sale rather than autonomous organ donation (n=11; 15.1%), and fear about deformation of the donor's body (n=9; 12.3%). CONCLUSION: Family members play an important role in the final decision for organ donation. The general public should be encouraged to register their donation preferences in the case of brain death.

De novo fatty liver due to vascular complications after liver transplantation.

INTRODUCTION: The incidence, risk factors, and natural history of de novo nonalcoholic fatty liver disease (NAFLD) after liver transplantation have not been well described. In this report we examined the risk factors and demographic characteristics of 3 patients. MATERIALS AND METHODS: During a 16-year period, we performed 900 liver transplantations. We reviewed donor and recipient liver biopsies to identify patients who developed de novo fatty liver following liver transplantation, recording the pretransplantation and posttransplantation blood sugar values and lipid profiles as well as body mass indices (BMI) of affected patients. RESULTS: Three patients developed de novo fatty liver after transplantation. The primary liver diseases among these patients were as follows: Crigler-Najjar syndrome, biliary atresia, and tyrosinemia. All of the patients who developed NAFLD were children. None of them had obesity; all had normal blood sugar values and lipid profiles (triglyceride cholesterol) at the time of and after the operation. Two patients received liver allografts from living related donors and 1 from a deceased donor. The BMI, lipid profile, and blood sugars of all donors were normal. Preoperative donor liver biopsy specimens showed normal histological findings with no evidence of a fatty liver, but the postoperative liver biopsy in recipients specimens revealed steatosis and fatty liver (20%-40% fat). Portal vein thrombosis and hepatic artery thrombosis were observed in the patients using color Doppler sonography. CONCLUSION: De novo NAFLD after liver transplantation occurred less frequently than noted in previous reports. All 3 patients experienced complicated courses. Portal vein thrombosis and hepatic artery thrombosis seemed to be important factors for development of de novo fatty liver after transplantation.

Short term outcome of patients with hematochezia and normal initial colonoscopic findings: do they really need further screening?

BACKGROUND: In a significant number of the patients with hematochezia, colonoscopy turns out to be normal and therefore is unable to determine the cause of bleeding. This study investigates outcomes and possible necessity for further work up in cases of hematochezia with normal colonoscopy. METHODS: Ninety-seven patients with normal colonoscopy were followed for at least one year from the time of colonoscopy by regular visits and phone calls. Mortality and recurrent bleeding were recorded as primary end points. Those with recurrent or continued hematochezia were invited for a new visit and further work up. RESULTS: Among the ninety seven patients, nine cases (9.3%) were lost at follow ups, 10 experienced rebleeding (10.3 %), and the remaining 78 (80.4 %) were apparently healthy and had no further complaints. There were two mortalities during the follow up, one due to gastric cancer and the other due to cerebrovascular accident. CONCLUSION: It is unusual for the cases of hematochezia with a normal initial colonoscopy to have recurrent bleeding as a result of a significant missed lesion in the colon.

The effect of simvastatin on lowering panel reactive antibody titer in sensitized dialysis patients: a randomized placebo controlled clinical trial.

BACKGROUND: Patients with panel reactive antibodies (PRA) have many difficulties to find a crossmatch-negative kidney for transplantation and are at a higher risk of post-transplantation rejection. OBJECTIVE: To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized patients. METHODS: 82 patients with end-stage renal disease (ESRD) with a PRA ≥25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched controls receiving placebo tablets. At the end of the second and 12(th) month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplantation. Serum creatinine levels were checked at monthly intervals post-operation. RESULTS: The mean±SD PRA level at the end of the second month was 36.63%±31.14% and 45.34%±24.36% in cases and controls, respectively (P=0.012). Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month. The mean±SD PRA level at the end of the 12(th) month was 24.02%±31.04% in cases and 43.15%±26.56% in controls (P=0.001). 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean±SD creatinine level 6 months after kidney transplantation was 2.05±1.14 mg/dL and 3.15±1.09 mg/dL in cases and controls consecutively (P=0.02). CONCLUSION: Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes.

Safety of topical methimazole for the treatment of melasma. Transdermal absorption, the effect on thyroid function and cutaneous adverse effects.

Methimazole is an oral antithyroid compound that exhibits a skin-depigmenting effect when used topically. However, the effect of topical methimazole on thyroid function has not been reported. This study was aimed at assessing the safety of topical methimazole used to treat pigmented lesions, without affecting thyroid hormones due to systemic delivery. The pharmacokinetics of methimazole, either applied in the form of a 5% topical formulation to facial skin or taken orally in the form of a 5-mg tablet by 6 volunteers, were determined. In addition, the effect of long-term topical applications of 5% methimazole on the function of the thyroid gland in 20 patients with epidermal melasma was determined following 6 weeks of once-daily application. Cutaneous adverse effects of topical methimazole were determined. From 15 min up to 24 h after application, methimazole was undetectable in the serum of the individuals receiving single topical methimazole dosing. Methimazole, however, was detected in serum after 15 min of oral administration and remained detectable in serum up to 24 h after administration. Long-term topical methimazole applications in melasma patients did not induce any significant changes in serum TSH, free thyroxine and free triiodothyronine levels. Topical methimazole was well tolerated by the patients and did not induce any significant cutaneous side effects. Present data together with the previously shown non-cytotoxic and non-mutagenic characteristics of methimazole indicate that this agent could be considered as a safe skin-depigmenting compound for topical treatment of skin hyperpigmentary disorders in humans.