فهرست مطالب محمود یوسفی مشهور

Pulmonary complication of IBD include airway inflammation involving small and large airways, pulmonary paranchymal disease, and serositis. The aim of this study was to determine the prevalence of Pulmonary Function Test (PFT) possible abnormality in ulcerative colitis (UC) patients. In this cross sectional study, during spring and summer of 2006, PFT (spirometry & body box plethysmography) of 50 UC patients were compared to 50 healthy people of the same age and sex (control). Data collection forms including demographic specification and UC condition were filled. Out, and then analyzed by SPSS 10. Mean age was 37.2(SD=14.57). Active UC was seen in 24.3% of patients. 24.9% of the patients had severe UC. PFT result demonstrated; 100% air trapping(only increase in Residual Volume/Total Lung Capacity); 20% small airway obstructive pattern (only decrease in maximal expiratory flow at 25-75% of vital capacity); 12% restrictive ventilation defect; 2% obstructive airway; 2% hyperinflation and 6% upper airway obstructive pattern. There was a significant relationship between small airway obstructive pattern and duration of UC, (PV<0.05), and no relationship between other pulmonary disorders and severity, activity, duration of UC was observed. Discussion & According to high prevalence of air trapping, small airway disease may be the prominent feature of lung involvement in UC patients. Therefore, a meticulous work-up for respiratory diseases seems necessary in UC patients.

Psychiatric disorders are common in Irritable Bowel Syndrome (IBS) patients. Prevalence of psychiatric disorders is varies in IBS patients in different societies. Objevtive: To determine the prevalence of psychiatric disorders (anxiety-depression) in IBS patients in Rasht. In this cross-sectional study, 256 IBS patients were selected (using criteria of Rome III) and evaluated for psychiatric disorders. In the first phase, subjects were screened by GHQ28. In the second phase, those patients who had scores equal or more than 23 were assessed through semi-structured psychiatric interview. Socio-demographic variables including age, gender, marital status, educational level and occupation, were recorded as well. P-values less than 0.05 were considered statistically significant. Among 256 subjects 30 patients (11.7%) had no significant psychiatric symptoms and 226 subjects (83 male, 143 female) suffered from some degrees of psychiatric problems. After performing semi-structured psychiatric interview; 190 subjects (74.2%) had anxiety-depressive problems [89 patients were suffered from pure anxiety disorders, 41 patients suffered from depressive disorders and 60 patients had co-morbid anxiety-depressive disorders]. In anxiety disorders; generalized anxiety disorder (53.7%) and in depressive disorders; dysthymia (53.5%) had the most frequencies, 53.7% and 53.5% respectively. In comparisone of anxiety-depressive subjects (190 persons) and normal subjects (66 persons), there was a significant statistical differences between the gender (P=0.019), occupation (P=0.002) and intensity of IBS (P<0.001). Although, further studies are needed to determine the relations of demographic variables and types of IBS with psychiatric disorders, it seems to more attention to the psychiatric disorders of some specific patients suffering from IBS is helpful to their treatment.

Treatment team perform a variety of practices in the fields of treatment and caring. The main domain of nursing practice is to prepare patients for diagnostic tests. Colonoscopy is a method of endoscopy of lower gastrointestinal system which needs proper colon preparation that allows proper assessment, diagnosis and positive treatment. Currently, there are different methods of bowel preparation. Therefore more research by a clinical nurse on this can result in better care. This study was aimed at comparing the routine method (caster oil and bisacodyl tablet) and oral sodium phosphate on the level of patients’ acceptance and bowel cleansing in patients undergoing colonoscopy. The study was a one-blind controlled randomized clinical trial done on 90 outpatient candidates for colonoscopy referring to Razi Training Center in Rasht city. Samples were randomly chosen on the visit day and divided to 2 groups of experiment and control. Data collection instrument included a demographic questionnaire and checklist to assess the level of patients’ acceptance and bowel preparation. Primarily demographic data form for each patient was filled, and then intervention was done for two groups with 45 samples. During the process the acceptance form was filled by the researcher by asking the patient and also the check list on the residual stool score and global preparation assessment left was marked by colonoscopist and the nurse. The findings indicated that patients’ acceptance (p<0.000) and the level of bowel preparation (p<0.000) was better with oral sodium phosphate. According to the results result oral sodium phosphate has better acceptance and is more effective on colon cleansing prior to colonoscopy when compared with routine regime (caster oil and bisacodyl tablet).

Chronic hepatitis B and C will result in limitations of physical and mental functions which in turn reduces the quality of life of the patients. This study examines the quality of life in patients with chronic hepatitis B and C in Rasht Razi hospital between the period of 2003-2004. In this cross- sectional study, 74 patients with chronic hepatititis living in Rasht were selected. Using a convenient sampling, a specialized questionnaire on quality of life among patients with chronic liver diseases, consisted of 29 questions with 7 choices for each question completed by the patients. The questions were about the 6 domains of quality of life (containing: abdominal signs, tiredness, systemic signs, emotion, and activity Then, collected data were analyzed using Kolmogorov-Smirnov and MANCOVA statistical test. The meaningful level of the test was assigned 0.05. The study sample contained 15 (20.27%) and 59 (79.72%) patients with chronic hepatitis B and C, respectively. No significant difference was found between the two sex. Systemic symptom domain was 23.7±8.1 for males and 17.85±8.3 for female (P=0.007). The highest adjusted mean of quality of life score was belong to abdominal domain and the least one was for emotional domain. The total adjusted mean score and means of all other domains scores were higher for those who had school education compare to those with no/some school education. The total adjusted mean score of quality of life in people with other chronic conditions were lower than those without such condition. The quality of life score was not favorable in patient with chronic hepatitis. No significant difference was found between the treated and untreated patients with chronic hepatitis in any of the 6 domain. This might be related to the social fear or stigma caused by their disease.

Cholestasis is impairment of normal bile excretion into the duodenum and classified as mechanical and non mechanical cholestasis. Mechanical Cholestasis presents with increase in bile duct diameter or obstruction in bile duct in an ERCP. Cholestasis leads to different complications. One of these complications is mucosal peptic erosion leading to gastrointestinal bleeding, perforation and even obstruction due to stricture. We therefore carried out this study to assess the relative frequency of peptic ulcer and erosion in patients with different type of cholestasis.

In a case control study, 170 patients with mechanical cholestasis on the basis of physical examination, liver function tests, radiologic and serologic assay were candidates for ERCP as final therapeutic and diagnostic test. Collected data was registered in questionnaire and evaluated by the Fisher Test. Later, sonography (common bile duct diameter) in the two groups: mechanical (85 patients) and non mechanical (85 patients) and endoscopy was done for exact survey and location of mucosal erosions.

Frequency of mucosal peptic erosions in mechanical cholestatic groups was42.6% ( 36 patients ) and significantly more than frequency of mucosal peptic erosion in non mechanical cholestatic groups (15 patients, 17.6%) (P=0.02). 51 patients (30%) of the total patients with cholestasis had mucosal erosion. From these patients, 25 patients had peptic ulcer [frequency of duodenal ulcer was 17 patients (68%) and gastric ulcer was 8 patients (32%) ](P=0.01). There was significant difference in prevalence of duodenal ulcer in patients with mechanical (12 cases, 70.6%) and non mechanical (5 cases, 29.4%) cholestasis(P=0.01). There was a significant difference between prevalence of duodenal ulcer (12 cases, 70.6%) and gastric ulcer(5 cases, 29.4%) in patients with mechanical cholestasis (P=0.01) but this was not so in patients with non mechanical cholestasis.

According to present study, prevalence of duodenal and gastric mucosal lesions in different types of cholestasis is greater than the general population and prevalence of duodenal mucosal lesions in mechanical cholestasis is more than non mechanical Cholestasis.

The pathologic accumulation of fluid in the peritoneal cavity, which is named ascites, is observed in different diseases. Paracentesis is used to diagnose the causes. The difference of albumin concentration between ascitic fluid and simultaneous blood serum less than 1.1 g/dl, indicated low gradient ascites. Regarding the importance of low gradient ascites causes, this study proposed to find causes of this type of ascites in Rasht in a 7 –year period. This cross sectional study was done according to the data, which were obtained from the recorded files of referral patients to two hospital of Rasht from 1993 to 2000. The type of ascites was determined by albumin concentration between ascitic fluid and simultaneous blood serum. Ascitic fluid Glucose and LDH were measured in the patients too. A data form including Patients’ demographic information and final diagnosis was prepared. Thereafter, the data were analyzed using SPSS 10 software. Of 148 studied patients there were 72 (48.6%) males and 76 (51.4%) females with the mean age of 56.03 ± 13.54. The most frequent causes of low gradient ascites were tuberculous peritonitis (68, 45.9%) and cancers (62, 41.9%). Of cases, 12.2 % were associated with other causes. Type of low gradient ascites didn’t show any significant differences between male and female groups, but age groups had significant differences (p<0.0001). The mean Serum-Ascites Albumin Gradient (SAAG) and LDH were 0.68 ± 0.19 and 342.38± 135.46, respectively. Mean ascitic fluid Glucose of peritoneal tuberculosis (TB), malignancies and others were 71 ± 13.82, 101.4 ± 17.21, 89.16 ± 13.15 mg/dl respectively and these differences were significant (P<0.001). In our area in patients with low gradient ascites, it is necessary to rule out TB, this treatable disease, at first. Afterwards we do other diagnostic tests such as ascitic fluid glucose and LDH, for diagnosis of malignancies and then other causes.

Decompensated cirrhosis resulting from chronic hepatitis B causes a significant decrease in survival of these patients. Prescription of Alpha interfrone for these patients is forbidden. Several studies have shown the effectiveness of Lamivudine in decreasing the Symptoms arising from this decompensation.

The aim of this study is to determine the effect of Lamivudine on liver function and clinical status of the patients with decompensated cirrhosis arising from HBV presenting to the Supporting Center of patients with liver diseases or those being hospitalized at Gastrology Department of Imam Khomeini Hospital.

In a clinical trial on the basis of liver consideration in 55 patients with cirrhosis that had positive HbsAg, positive HBV DNA, child-pugh score more than 8, but not with positive HCV Ab or positive HIV Ab and creatinin of serum, more than 2 mg/dl, they were treated with 100 mg of Lamivudine tablets daily.In these patients, serum level of bilirubin, albumin, ALT, AST and also the PT coagulation time (on the basis of INR) were controlled at the beginning of study and then at intervals of 2 to 6 months and finally 12 months after the start of treatment and in terms of presence and intensity of ascites and encephalopathy, the patients were examined by a physician. Also at the beginning of the study and 6 and 12 months later, HBs, Ag, HBV DNA, Hbe Ag and Hbe Ab were checked. On the basis of the table related to child-pugh, its amount was calculated at the beginning of the study and at intervals of 2 to 6 months and then 12 months.

5 patients died in the first 6 months of treatments. The following results are related to 50 patients being under treatment with Lamivudine at least for a period of 6 months. In these patients mean child-pugh score was decreased from 11±2 (mean ± criterion deviation) to 7±1 (p<.0001), mean level of bilirubin from 4.5±2 to 1.3±1.6 mg/dl (p<.0001) and mean level of albumin from 2.6±2 to 3.8±1.3 g/dl (p<.0001) and mean PT (INR) from 1.7±2 to 1.2±2 (p<.0001) and mean ALT from 98±10 to 32±10 units per liter (p<.0001). Out of 19 patients not being precormutant, 4 patients (22%) had Hbe Ag seroconversion after 6 months of treatments and 5 (26%) after a 12-month treatment with Lamivudine. All of the patients tolerated this drug very well.

Lamivudine can be effective in improvement of liver function in patients with decompensated liver cirrhosis resulting from HBV, but for determination of proper period of treatment, further studies are necessary.