Govaresh
Volume:22 Issue: 4, 2018

Gastric cancer (GC) is the fourth most common disease worldwide and approximately one million people are diagnosed as having gastric adenocarcinoma. Each year, nearly 700,000 people lose their lives because of GC. Several altered molecular pathways are involved in the pathogenesis of GC, which can be targeted by specific monoclonal antibodies (mAbs). In recent years, the use of mAbs has provided considerable success in the treatment of cancer. Such mAbs are laboratory-produced molecules that incur changes to precisely bind to specific sites. These drugs are similar to naturally produced antibodies as part of our immune system’s response. They play an important role in the treatment of many diseases, such as the different types of cancer. In cancer therapy, bispecific antibodies are used for targeting immune effector cells to destruct tumor cells (cancer immunotherapy) or neutralize two different pathways through inactivation on the level of either receptors or ligands. It seems that the development of this type of therapeutic agents to effectively treat a variety of cancers such as GC, is inevitable. The aim of the present study was to describe molecular-targeted therapy by using new-generation mAbs and inhibitors for the treatment of GC.

The aim of this study was to evaluate the psychological characteristics of negative affect, social inhibition, and ambiguity tolerance in prediction of quality of life in patients suffering from irritable bowel syndrome (IBS).
In this cross-sectional study, 62 patients suffering from IBS who were referred to the Digestion Clinic of Shadid Beheshti Hospital in Qom city were selected with available sampling method. For data gathering, quality of life questionnaire in irritable bowel syndrome (IBS QOL), D personality type scale (DS-14), and ambiguity tolerance questionnaire were used Lin. Research data were analyzed using Pearson correlation and regression tests.
This study showed that psychological characteristics of negative affect, social inhibition and ambiguity tolerance are factors prediction of quality of life in IBS suffering.
For the recovery of the quality of life in patients suffering from IBS, appropriate interventions, training, counseling, and referral to psychologist to make positive changes in the mentioned psychological factors are recommended.

One of the most stressful situations in clinical environments is exposure to invasive diagnostic methods, one of which is the endoscopy of the digestive tract. Endoscopy related anxiety can prevent achieving optimal results. Aromatherapy is one of complementary treatments that can reduce anxiety. The aim of this study was to determine the effect of inhalation of matricaria chamomile essential oil on the anxiety before Esophagogastroduodenoscopy.
This study is a randomized clinical trial that was carried out in May 2014 among patients referred to the Endoscopy Department of Imam Reza Hospital in Mashhad. The population of the study included 152 participants who were randomly divided into intervention and control groups. Anxiety was measured by using State-Trait Anxiety Inventory (STAI) questionnaire. Then for 20 minutes, the intervention group inhaled matricaria chamomile essential oil and the control group inhaled placebo (sesame oil). 10 minutes after inhalation, anxiety was again measured and compared between the groups. Data analysis was done using SPSS software version 21.
The mean age of the participants was 42.05 ± 4.5 years and 41.33% of them were male. Mean level of anxiety after inhalation in the intervention group was 35.89 ± 8.40 and in the control group was 39.88 ± 8.40, which decreased in both groups but in the intervention group the decrease was significant.
The findings showed that matricaria chamomile essential oil inhalation was effective in decreasing the anxiety of patients who were candidate for endoscopy. It is recommended to reduce anxiety in stressful situations.

A 40-year-old woman was referred to our health center with a bulky rectorrhagia. The patient was treated with meropenem and vancomycin for an enterococcal meningitis one week earlier. A colonoscopy was performed at a different center, which was unsuccessful due to high blood volume in the colon and poor vision. The patient underwent angiography of the superior and inferior mesenteric arteries and the rectum artery, but the origin of the bleeding was not known. A polypoid mass with ulcer and bleeding from the site was seen in repeated colonoscopy of the left colon reagion. Due to the severity of the bleeding, the patient was transferred to the operating room and a large uterine mass that had transmitted to the lobes of the sigmoid colon was observed. Due to the diagnosis of uterine tumor, hysterectomy and oophorectomy were performed, and the descending colon was removed as a colostomy from the abdominal wall. In the pathological examination, diffuse endometriosis was found, which had involved the left ovary, the left fallopian tube, and both parametrium and sigmoid to the submucosal layer. On the 26th day, the patient was discharged with a good general condition and full vigilance.

Studies have reported the controversial association between multiple sclerosis (MS) and celiac disease (CD). Thus, we aimed to conduct a case control study on patients with MS, CD, and controls to investigate CD in patients with MS by means of comparing CD genetic markers in patients with MS and controls. We also evaluated serological markers in patients with MS.
This is a case control study conducted on 60 patients with MS, 140 patients with CD, and 151 healthy controls in 2015 in Tehran, Iran. HLA typing was done to identify the carriers of the DQB1*02, DQB1*0301, DQA1*05, or DQA1*0201 alleles for HLA-DQ2, DQB1*0302, or DQA1*03 for HLA-DQ8. All data were analyzed using SPSS software (version 23, IBM Corp). Serological markers including anti-gliadin antibodies (AGA) (IgA, IgG), anti-tissue trans glutaminase antibodies (Anti tTG) (IgA, IgG), anti-endomysial antibody (EMA) (IgA, IgG), and total IgA were assessed in MS group by enzyme immunoassays.
The data of 60 patients with MS (26.7% male, mean age=34.83 years), 140 patients with CD (33.6% male, mean age=38.37 years) and 151 controls (48.3% male, mean age=40.43 years) were analyzed. The results of serological markers were not positive in any of the patients with MS. The prevalence of IgA deficiency (IgA≤0.7) was 13.3% in patients with MS. 34 (56.7%) patients with MS, 90 (59.6%) controls, and 135 (96.4%) patients with CD had positive results in either or both HLA DQ2 and DQ8. There was a significant difference in the HLA typing results between the patients with MS and controls with CD group (POur results did not show any correlation between MS and CD, which was similar to other studies.

Clinical trials and meta-analyses have reported about 20% failure rates in first-line Helicobacter pylori (H. pylori) eradication. This reflects the need for effective second-line eradication regimens.
61 patients with H. pylori infection who had failed previous non-bismuth clarithromycin-containing first line therapies entered the study. They were given a 14-day levofloxacin-containing triple regimen consisted of pantoprazole 40 mg, amoxicillin 1gr, and levofloxacin 500mg, each given twice daily. Eight weeks after the treatment, H. pylori eradication was assessed by 14C-urea breath test.
All patients completed the study. The eradication rate was 91.8% (95% confidence interval = 84.9% – 98.6%) by both intention to treat and per-protocol analyses. Side effects of therapy were reported by eight patients (13.1%), but they were severe in only two patients (3.2%).
According to the high H. pylori eradication rate and the very low rate of severe adverse effects, levofloxacin-containing triple therapy seems to be a suitable second-line option in case of previous failure by clarithromycin-containing therapies. We suggest further studies with shorter duration of treatment or lower dose of levofloxacin.

This study assessed the causes of infection in cholecystectomy and compared the infection rates between the open and laparoscopic cholecystectomy.
This was a retrospective cohort study, performed on all patients admitted to Shariati Hospital since February 2017 for cholecystectomy. Initially, the patients were evaluated for infection risk factors, and then surgical site infection rates in these individuals were measured. Infection was assessed at the time of patients discharge (in the first few days after surgery) and again a month later, either in clinic or by phone. Information from 81 patients was collected, and SPSS software version 24 was used to analyse the data using appropriate statistical tests. Statistical significance was defined as p value The mean age of the participants was 45.89 ± 13.38. The relationship between surgical site infections (SSI) and age, sex, comorbidities (diabetes, hypertension, ischemic heart disease, malignancy, chronic lung disease, and chronic kidney disease), taking corticosteroids, smoking, and the emergency or elective nature of the surgery was not significant. The mean age of the patients who underwent open cholecystectomy was higher than the laparoscopic group (p = 0.005). Similarly, the average hospitalization period for those underwent open cholecystectomy was higher (p = 0.03). Finally, the infection rates for open cholecystectomy were 6 times higher than laparoscopic surgeries (RR: 6.11).
There was no significant relationship between SSIs and the risk factors assessed in this study. However, infection rates were higher in the open cholecystectomy group. More studies on the various risk factors of infection and the differences between the laparoscopic and open surgical methods are required.

Achalasia is a medical condition presenting with dysphagia to both liquids and solids. Although it is usually a primary disease, there are cases in which achalasia occurs secondary to other conditions. Despite its presentation as a secondary condition in a number of diseases, it is very rare for achalasia to be associated with multiple myeloma especially as the presenting symptom when the patient’s disease has not been diagnosed yet. Initial manifestations of multiple myeloma include array of symptoms such as back pain, bone lesions, and anemia, but as mentioned before it is extremely rare for it to initially present with achalasia. Here we describe a man who initially presented with dysphagia and further studies confirmed the diagnosis of achalasia. Later he was diagnosed as having multiple myeloma following other presentations of the disease, thus making the dysphagia caused by achalasia his presenting symptom of multiple myeloma.