فهرست مطالب

Govaresh - Volume:21 Issue: 1, 2016

Govaresh
Volume:21 Issue: 1, 2016

  • تاریخ انتشار: 1395/03/31
  • تعداد عناوین: 9
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  • Neda Nozari, Akram Pourshams Pages 7-19
    As the incidence of obesity increases, less invasive weight loss methods rather than bariatric surgery will be needed. This article reviews the advances in endoscopy, results, benefits and side effects of these techniques for treating obesity. The endoscopic options for weight loss could be broadly grouped under the following categories: restriction procedures, malabsorption procedures, and neuromodulation. With the most common options were related to restriction procedures, which include intragastric balloons (BioEnterics Intragastric Balloon and Heliosphere BAG), endoluminal restriction gastroplasty by intermittent sutures or continuous sutures, and transluminal oral gastroplasty. Malabsorption procedures such as duodenojejunal sleeves are effective particularly in obese patients with diabetes mellitus. Electrical stimulation of stomach is effective on weight loss because of reduced gastric adaptation and a delay in gastric emptying. It is important to identify which endoscopic technique must be used, depending on the desirable outcomes. Currently, the most important issue is to develop an effective and standardized endoscopic procedure.
    Keywords: Endoscopy, Obesity, Treatment, Technique, Weight loss
  • Maryam Hashemian, Hossein Poustchi, Fatemeh Mohammadi, Nasrabadi, Maryam Sharafkhah, Akbar Fazeltabar, Malekshah, Azita Hekmatdoost, Reza Malekzadeh Pages 20-26
    Background
    Dietary factors such as intake of minerals may play a role in the etiology of esophageal cancer. Although it has been hypothesized that manganese can affect the risk of some types ofcancer, its role in esophageal cancer is unknown. The objective of this study was to investigate the association between intakes of manganese with esophageal cancer in Golestan Cohort Study.
    Materials And Methods
    Golestan Cohort Study was launched in Golestan province, northeast Iran, and 50000 participants were enrolled from January 2004 to June 2008. Intake of manganese was assessed with a validated food frequency questionnaire. A Cox proportional hazard model was used to estimate hazard risks and 95% confidence intervals.
    Results
    During the follow-up period, we identified 201cases of esophageal cancer according to the reports of pathological evaluations. Manganese intake was not significantly associated with the risk of esophageal cancer (Hazard Ratio (HR) for the top versus bottom quartile = 1.49, 95% CI: 0.91–2.45, p for trend =0.09). HR for 1 mg increase in manganese intake was1.05, (95% CI: 0.98–1.11, p=0.15). Although the graphical Restricted cubic spline (RCS) plots showed that the associations between manganeseand risk of ESCC washyperbolic-shaped, P for non-linear association was not significant (p =0.08).
    Conclusion
    Manganese intake is not associated with the risk of esophageal cancer in linear pattern.
    Keywords: Esophageal cancer, Minerals, Manganese, Cohort study
  • Elnaz Saeedi, Mohsen Nasiri Toosi, Masoud Salehi, Saeede Khosravi Bizhaem, Jamileh Abolghasemi Pages 27-34
    Background
    Including multivariate survival data can be pointed competing risks data. There are various methods to analyze such data such as semi-parametric methods of cause-specific hazard function, and cumulative incidence function. The aim of this study was to deploy competing risks model to analyze the determinants of patients with liver cirrhosis.
    Materials And Methods
    During the one-year study period (June 2008-June 2009), we used the recorded information of patients with cirrhosis who were scheduled for liver transplantation and were followed up for at least 7 years in Imam Khomeini Hospital. In order to determine the effective factors for the time of death and transplantation of the patients, the cumulative incidence function regression method and data analysis were performed using R statistical software. The error level of 0.05 was considered for all tests.
    Results
    305 patients with cirrhosis including 180 men and 125 women were studied. The mean age SD of the patients was 39.8 14.54 years. At the end of the study, 82 patients died and 40 patients underwent liver transplantation. 7-year survival for the dead patients and for those who received liver transplantation was 18.3 and 21.2 months, respectively.
    Conclusion
    To investigate the effective factors for the time of death and transplantation of patients with cirrhosis, cumulative incidence function seems desirable. After fitting the multivariate regression model of cumulative incidence function, age, serum albumin, and encephalopathy had a significant effect on the time of the patients’ death. So planning and policy making in prioritizing patients to receive liver transplantation can be made on the basis of their age. Also serum albumin and encephalopathy as two other effective factors can contribute to the prioritization. In this study, among the various causes of cirrhosis, hepatitis B (23%) and cryptogenesis (22.6%), were the most important factors.
    Keywords: Competing risks, Cause, specific hazard function, Cumulative incidence function, Liver cirrhosis, Liver transplantation
  • Mohammad Taghei Safari, Mohammad Bagher Miri, Mohammad Javad Ehsani Ardakani * Pages 35-41
  • Bijan Shahbazkhani, Amin Shafaroudi, Mohammad Jafar Farahvash, Hossein Forootan, Reza Taslimi, Najmeh Aletaha, Amir, Hossein Shahbazkhani, Amir Mirbagheri Pages 48-54
    Background
    Improvements in imaging techniques has led to an increase in the number of diagnosed pancreatic cysts. Although most of the detected cases are benign, a significant percentage of them are malignant or are potentially malignant. Currently, endosonography, and analysis of cyst morphology, fine needle aspiration (FNA) of the cyst contents, and measurement of the amylase and carcinoembryonic antigen (CEA) levels of the aspirated fluid are the common methods used for evaluating such lesions (80% accuracy in the final diagnosis). We have used these same techniques to analyze cystic lesions of the pancreas, in two referring centers in Iran.
    Materials And Methods
    This is a descriptive case series study. In addition to demographic information and findings of the cystic morphology, we determined the cytology of the centrifuged sediments of cystic fluid aspirations, and the amylase and CEA levels of the fluid.
    Results
    Sixty eight patients were included in the study with an average age of 51 years. 68% of the participants were female (n=46). Analysis of the lesions was performed based on the cytology findings as well as the other results (CEA, amylase, cyst morphology, and history of pancreatitis). The patients who were diagnosed as having pseudocysts were the youngest group, with an average age of 41 years, and those with cystic adenocarcinoma were the oldest group, with an average age of 62 years. The most common types of lesions were pseudocysts (n=18, 26.5%), mucinous cystic neoplasms (n=11, 16%), serous cyst adenomas (n=10, 14.7%), intraductal papillary mucinous neoplasms (n=9, 13.2%), and cystic adenocarcinoma (n=9, 13.2%). The most common location of cysts was the head of pancreas (n=25, 35.2%). Excluding the neuroendocrine tumors, all other types of lesions were more common in women than men. Septation in the cysts was observed in cystic adenocarcinomas, serous cystadenomas, and intraductal papillary mucinous neoplasms (IPMNs). Lesions smaller than 2 cm were found most frequently in IPMNs, endocrine tumors, and simple tumors whilst pseudocysts were all greater than 2 cm in maximum diameter.
    Conclusion
    47% of the patients in this study had malignant or premalignant lesions, which despite being asymptomatic, they needed follow-up imaging or surgery. Endosonography played an important role in the diagnosis of the cystic tumors of the pancreas. Diagnosis of premalignant lesions and providing appropriate treatment increase patients’ life expectancy. Diagnosis of benign cysts, leads to fewer unnecessary surgeries.
    Keywords: Mucinous cystic neoplasm, Serous cystadenoma, Intraductal papillary mucinous neoplasm, Fine needle aspiration
  • Joseph Aje Anejo, Okopi I., Onyemocho Audu, Rosemary Ajala Adaiche, Julius Oseme Okojokwu, Murna Ali, Amali Adekwu, Patricia Lar, Stella Ifeanyi Smith Pages 55-63
    Background
    Helicobacter pylori (H. pylori) infection is common among humans and plays a major role in the etiology of peptic ulcer disease with significant morbidity in patients with HIV-1 on antiretroviral therapy. There are conflicting prevalence patterns of H. pylori in HIV-1 infected patients using various methods of detection. The noninvasive technique used for detection of H. pylori infection is inexpensive and convenient with no complications.
    Materials And Methods
    We aimed to determine the prevalence of H. pylori infection among patients infected with HIV-1 on antiretroviral therapy using H. pylori stool antigen. 139 patients infected with HIV-1 were recruited, stool samples were collected and the H. pylori stool antigen (HpSA) test was used to detect H. pylori antigen.
    Results
    46.8% of the respondents were positive for H. pylori and 53.2% were negative, 18 (13%) were men and 47 (33.8%) were women. HpSA is a relatively simple, inexpensive, and time-saving non-invasive test for the detection of H. pylori infections in patients infected with HIV-1.
    Conclusion
    We also observed that the prevalence of H. pylori was low in these patients compared with the general population. However, more studies using H. pylori stool antigen test are needed in these patients in the North-Central, Nigeria to further evaluate the infection rate.
    Keywords: Prevalence, Helicobacter pylori, stool antigen, enzyme immunoassay, HIV, 1 infected
  • Hosein Ali Abbasi, Abbas Esmaeeilzadeh, Homan Mosanan Mosannen Mozaffari, Ali Bahari, Kambiz Akhavan Rezayat, Omid Ghanaei, Azita Ganji, Ali Mokhtarifar, Ladan Goshayeshi Pages 64-71
    Background
    Vitamin D deficiency is believed to cause variety of abnormalities such as liver stiffness and fibrosis. It is also shown that vitamin D deficiency may result in chronic liver disease or liver cirrhosis. In this study, we aimed to systematically review the literature wherein the relationship between vitamin D deficiency and the severity of chronic liver disease or liver cirrhosis had been investigated.
    Materials And Methods
    PubMed, Scopus, and Google scholar were searched using the following search method (((vitamin D deficiency OR vitamin D insufficiency OR insufficient vitamin D)) AND (chronic liver disease OR chronic hepatitis OR cirrhosis OR liver cirrhosis)) AND (severity OR intensity) to evaluate the role of vitamin D deficiency or vitamin D inadequacy in the occurrence and severity of chronic liver disease. Articles were collected and the data were extracted.
    Results
    Totally, 641 articles were found through searching the databases and reference list scanning. Of the collected documents, only 19 articles with 4895 studied patients were included and analyzed. The results of this study showed that almost 80% of patients with chronic liver disease had severe vitamin D deficiency.
    Conclusion
    Vitamin D deficiency is associated with the occurrence of chronic liver disease. The severity of liver cirrhosis is also associated with the level of 25(OH)D in progressive liver disease.
    Keywords: Chronic hepatitis_Liver disease_Vitamin D_Vitamin D deficiency
  • Hossein Ajdarkosh, Sanam Javid Anbardan, Zahra Azizi, Nasser Ebrahimi, Daryani Pages 72-75
    With an occurrence of 7%, appendicitis is one of the most common abdominal emergencies requiring surgery. Since the variation in positions and length of the appendix may produce varying symptoms and signs which mimic other diseases, having knowledge of the variations in the position of the appendix is of significant importance.
    Here, we present a 77-year-old man with acute appendicitis presenting with lower abdominal pain, fever, chills, and dysuria. Physical examination revealed tenderness and rebound tenderness in the left lower quadrant more pronounced in the right lower quadrant with leukocytosis on blood tests. Both ultrasonography and abdominopelvic computed tomography scan demonstrated a severe inflammation at paracecal mesenteric fat with extension to para sigmoid portion which was in favor of diverticulitis rather than appendicitis. A 2-week treatment with intravenous antibiotic regimen was initiated for the patient and from the second day of antibiotic therapy, the patient’s fever and abdominal pain improved. A second CT-scan performed three weeks after completion of a 14-day course of antibiotics, revealed a dilated long appendix (diameter: 12mm, length: 10 cm) with extension of its tip to the medial wall of sigmoid. Physicians should consider appendicitis when evaluating an acute abdomen to prevent any delay in diagnosis of atypical presentations and decrease the mortality and morbidity related to the complications.
    Keywords: Appendicitis, Atypical, Left lower quadrant pain, Diagnosis
  • Marziye Ghalamkari, Mahdi Khatuni, Mohammad Taher, Mahmood Khaniki Pages 76-80
    Despite the fact that hepatic involvement is frequently seen in systemic primary amyloidosis, major hepatic symptoms as primary manifestation and severe impaired liver function are rare. Herein, we report a 38-year-old woman with primary hepatic amyloidosis, and severe portal hypertension. The patient had ascites and markedly elevated alkaline phosphatase level at presentation. She had a rapid downhill course resulting in death. In case of an unexplained intrahepatic cholestasis or portal hypertension the possibility of amyloidosis should be considered and a Congo red staining should be performed.
    Keywords: Intrahepatic cholestasis, Primary amyloidosis, Liver amyloidosis