malekzadeh r

An important indicator of mental health is the emotional response that one exhibits to mental stress. The purpose of this study was to compare the level of mental health and emotional response in nurses of Sari Zare Psychiatry and Burn Center with other educational centers in Mazandaran province.

This cross-sectional study was performed on 304 nurses working in educational centers of Mazandaran province in 1396 using GHQ-28 questionnaire and DASS-21 depression and anxiety questionnaire. Data were analyzed by SPSS software version 21 using descriptive statistics (frequency distribution, mean, standard deviation) and inferential statistics (independent t-test and multivariate analysis of variance).

The results showed that the level of stress, anxiety and depression in nurses of Zare educational center was higher than other educational centers. Mean and standard deviation scores of mental health status and its components in nurses of Zare Psychiatry and Burn Center were lower than other educational centers of Mazandaran province (47.66 10 10.40). The mean of physical, anxiety, social and depression components in nurses of Sari Psychiatry and Burnout Center were lower than the mean of social functions components of nurses in other educational centers (P <0.05).

The results showed that with increasing levels of depression, anxiety and stress, the level of mental health decreased and anxiety and depression were identified as priority dimensions of emotional response that require corrective measures to improve mental health of nurses.

Data on the natural history and long term follow up of patients with autoimmune hepatitis who refer for regular medical attention is limited. We aimed to evaluate the clinical presentation and the natural history of a large cohort of type I AIH from Iran. Between 1997 and 2008, 102 patients were included in the study. Patients were diagnosed using the international autoimmune hepatitis group criteria and were followed up for an average of 60 months. Clinical and biochemical data were gathered from all patients at both the beginning and end of follow-up. Liver biopsy was done for all of the patients before, and for 28 patients after treatment. Biochemical remission was achieved in 80 (79.4%) cases among whom, 53 (66.5%) attained cure with almost normal liver histology and/or liver function test and sonography. The remaining 27 (33.5%) patients also achieved clinical and biochemical remission, but developed compensated cirrhosis as well. Relapse was seen in 24 patients (32.5%) after remission. From 22 (21.6%) subjects with ultimate treatment failure, 6 underwent orthotopic liver transplantation and 3 died from liver failure while in transplant list. Sixteen 16 (72.7%) of 22 patients who did not respond to therapy were non-compliant with medications and had irregular follow up. Ten year survival for all cohort was 96%. Long term Survival in AIH patients is very good. Prompt diagnosis and appropriate first line and salvage therapy with close follow-up will make liver transplantation rarely necessary for treatment of this disease in future.

Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings and confirmed by radiologic, endoscopic and manometric evaluations. Several treatments for achalasia have been introduced. We searched the Pubmed Database for original articles and meta-analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures utilized for treatment. We also report the Iranian experience of treatment of this disease, since it could be considered as a model formedium-resource countries. Laparoscopic myotomy with fundoplication is the best surgical method for treatment of achalasia with its high success rate and therapeutic response. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer.Graded pneumatic dilation with a slow rate of balloon inflation seems to be an effective and safe initial alternative.Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to the lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment.In summary, laparoscopic myotomy can be considered as the procedure of choice for surgical treatment of achalasia. Graded pneumatic dilation is an effective alternative and can be recommended as a first therapeutic option in the majority of achalasia patients.

Previous evaluations revealed that cancer registration in Iran is not functioning appropriately and a reform is needed. We evaluated cancer registries in 18 countries and suggested a new cancer registration system for Iran.

We compared information from Iranian cancer registry with the same information from selected countries with a population size more than 10 million that their cancer registration data were published by International Agency for Research on Cancer (IARC). Moreover, we studied trends in the number of registration centers, from establishment of their first center up to 1997. Finally we suggested a new program for establishment of a national cancer registration system in Iran.

On average, geographical coverage of cancer registries was 24.6% in these countries. They all had population-based cancer registration system. Overall, every ten years, 3 cancer registry centers were added in all the mentioned countries together.

Instead of pathology-based cancer registry, we should promote establishment of population-based cancer registries in Iran. Given limited resources available, coverage of 25-30 percent of the country by cancer registry would be sufficient to produce national cancer incidence data. We suggest promoting population-based cancer registry in Fars, Tehran, Golestan and Ardabil provinces and try our best to provide qualified data from these regions before extending the registration activities to other regions.

Food consumption pattern and lack of some nutrients is known as main environmental risk factor of esophageal cancer. We investigated nutritional risk factor and food consumption pattern of people who live in high risk area in Golestan province. We investigated food consumption pattern of more than 30 years old Gonbad and Kalale's people who recruited in Golestan cohort study. Assessment carried out with validated 117 items semi quantitative food frequency questionnaire. We also used Iranaian data bank for nutritional analysis. Multiple linear regressions used to compare between sex, Gender, place and ethnicity. From 30463 subjects, aged 52.2 women, Turkmen ethnicity and rural dweller was 57.7%, 75% and 73.6% respectively. Overweight and obesity were common among urban dweller women in compare to other groups. Energy induced from carbohydrate, fat and protein were 65%, 22% and 13% respectively. People in Golestan had lower intake of some nutrients such as Riboflavin, fiber and vitamin A than recommended dietary allowance by FAO/WHO. Govaresh/ Vol. 12, No. 4, Winter 2008; 239-243

Hepatitis B virus (HBV) infection has a high incidence among injection drug users (IDUs). Several important behavioral risk factors influence transmission of HBV in this group. However, consensus has not been achieved on many of them. The aim of this investigation was to assess the prevalence and risk factors for HBV in IDUs. This cross-sectional study was carried out between 2001 and 2002 in Tehran. IDUs included people who were being treated for drug abuse and those in the prison. Physician-completed risk factor questionnaires and blood samples (5 ml) for serologic HBV markers (ELISA) were used. Risk factors were evaluated in binary logistic regression (LR) model (forward) procedure for possible association with odds of past or current HBV infection. The evaluated risk factors were age, gender, sexual behavior, shared syringe use, duration of addiction, imprisonment, tattooing, past history of surgery, dental procedures, blood transfusion, jaundice, type of illicit drug use and level of education. This study sample was comprised of 518 IDUs (89.6% males), including 386 (74.5%) prisoners. Antibody against HBV core antigen (HBcAb) was detected in 61.2% (n=317). The prevalence of hepatitis B surface antigen (HBsAg) was 3.7% (n=19). Among HBsAg positive patients, HBeAg was positive in 12 individuals (63.2%). In comparison with seronegative IDUs for HBcAb and/or HBsAg, the odds of using shared syringes, male sex and past history of bisexual relationship were 1.5 (P<0.05), 1.9 (P<0.05) and 2.4 (P<0.01), respectively. These results suggest that seroprevalence of hepatitis B is high but chronic carrier state is not frequent in IDUs. Imprisonment, male sex and having past history of bisexual relationship are independent risk factors for past or current hepatitis B infection.

There are eight genotypes (A-H) of hepatitis B virus (HBV), which show a characteristic worldwide distribution. Genotyping can be accomplished based on a partial sequence of HBV genome such as the PreS or S gene. The aim of this study was to determine the HBV genotypes in Iranian hepatocellular carcinoma (HCC) patients with chronic HBV infection. Serum sample of 10 HCC patients with chronic HBV infection were subjected to PreS Hemi-Nested PCR. The viral genotype of each sample was determined by bi-directional sequencing of the PreS amplicon and phylogenetic analysis by comparing the nucleotide sequence with 33 reference HBV strains obtained from the GenBank. Phylogenetic analysis based on PreS region sequences disclosed that all isolated strains belonged to genotype D. Analysis of sequences revealed that all the sequences contained amino acid substitutions. In the PreS2 region of two samples, a point mutation in the start codon was found. There were some deletions with 3, 6 and 8 amino acids in PreS2 region of three samples. Despite the low number of samples, these data revealed that the HBV genotype D is dominant in Iranian HCC patients. Most of the mutations are located at immunodominant epitopes involved in B or/and T cell recognition.

The effect of helicobacter pylori either in provoking or protecting GERD is unclear and the results of studies are conflicting. We aimed to study the effect of H.pylori eradication on GERD by 24-hour ph monitoring. 14 patients with duodenal ulcer or erosive duodenitis without any endoscopic and clinical evidences of GERD were enrolled. 24-hour ph monitoring were performed before and 12 month after H-Pylori eradication. The score was based on DeMeester scoring system. H.Pylori was diagnosed by rapid urease test before eradication and by urea breath test (UBT) after eradication. The mean age was 41.610.2 years. The mean scores of 24-hour ph monitoring were 6.84.3 and 5.43.9 before and after eradication, respectively. The differences were not statistically significant (NS). Epigastric pain changed significantly before and after the therapy (p<0.01). H.pylori eradication did not have any effect on scores of 24-hour esophageal ph monitoring. Epigastric pain significantly decreased after eradication.

Non-alcoholic Fatty Liver Disease (NAFLD) constitutes a spectrum of liver disorders including the simple steatosis at one end and steatohepatitis at the other. In contrast to the previous believes, Non-alcoholoc Steatohepatitis (NASH) can lead to advanced fibrosis and cirrhosis. Implementation of a valid and reliable scoring system is necessary for better determination of prognosis and monitoring the effectiveness of different treatment modalities in this disease. We faced some practical difficulties using the system proposed by Brunt and coworkers from Saint Louis University in 1999 and proposed some revisions in the original scoring system. This study was performed to evaluate the validity, reliability and practicability of the revised scoring system by correlating the scores with the serum levels of the aminotransferases in the patients with NASH. Microscopic slide sets of 60 patients with NASH were reviewed by two independent pathologists expert in histological diagnosis of liver diseases. The four histological criteria of steatosis, ballooning degeneration, lobular and portal inflammation were scored zero to 3 according to the existence and severity of each criterion. Spearman's rho test was used for determination of correlation of the level of serum transaminases with the necro-inflammatory scores. Degree of inter-observer variation of the proposed scoring system was evaluated by the Cohen Kappa Coefficient. Except for portal inflammation, significant statistical correlation existsted between the scores for the histological criteria and level of serum aminotransferases (p<0.01). The interobserver agreement for the histological diagnosis was good (p<0.01). The proposed revised scoring system is easy to use, reliable and reproducible and shall be considered in clinical practice for grading of the necro-inflammatory process in non-alcoholic fatty liver disease.

Studies have shown that chronic hepatitis B infection could lead to an increased risk of poor outcomes like hepatocllular carcinoma and cirrhosis. This study aimed to estimate relative risk of mortality of chronic hepatitis B infection to no infected population and their life expectancy in Iran.

Analysis is based on comparing prevalence of hepatitis B infection in general population and annual death. Prevalence of HBs Ag in all dead men and women was estimated as a weighted average of prevalence of HBs Ag in 3 liver related death (Cirrhosis, HCC and acute viral hepatic failure) and non-hepatic death by relative frequency of them. According to total death and death due to HCC and cirrhosis, relative risk of mortality was estimated. Then with age specific mortality rate of general population, life table for community and HBV infected subjects with and without 0.5 percent annual chance of seroclearance of HBs Ag were calculated and loss of life expectancy due to HBV related death was estimated.

There was a paucity of evidence based epidemiologic data from Iran in these regards. In spite of this fact the relative risk of mortality due to HBV infection associated death was estimated to be 1.3 in males and 1.4 in females. By probabilistic sensitivity analysis of used parameters in acceptable range of values, the standard deviation of RR mortality was about 0.03. This excess mortality decreased 3 years of life expectancy at one-year-old to 1 year at age 80 in both sexes.

Based on existing data and modeling, we estimated that chronic hepatitis B infection results in significantly increase mortality and decrease in life expectancy. This study should be validated by long-term prospective epidemiologic studies.

Interferon monotherapy is currently the only approved treatment for chronic hepatitis C (CHC) infection in transfusion dependent thalassemic patients, in whom ribavirin has limited use because of its hematologic complications. Our aim was to evaluate the efficacy and safety of pegylated Interferon monotherapy for the treatment of HCV infection in transfusion dependent thalassemic patients. The trial was a multicenteric, open label, single treatment prospective study of Peginterferon alfa-2 a (PEGASYS, 180 micg per week) for a period of 48 weeks. 32 subjects, 18 to 42 years old (mean ± SD: 24.1 ± 9.44 years), whose serum HCV RNA was positive and mean ALT remained greater than 1.5 times upper limit of normal were enrolled. A percutaneous liver biopsy was performed before treatment and all patients underwent monthly assessment of any adverse events and were monitored for serum ALT. Efficacy was assessed by measuring serum HCV RNA following 24 week treatment-free period. One patient missed follow up and another died due to a drug unrelated cause and 30 patients were evaluated. Liver biopsy showed mild fibrosis in 31.2%, moderate fibrosis in 53.1% and cirrhosis in 15.6% of patients. Siderosis was severe in 16 patients (50%). In 26 out of 30 patients (86.6%) HCV RNA was negative at the end of treatment (ETR response). Data about 24 weeks post treatment was available in 23 patients, which showed a sustained virological response (SVR) of about 14/23 (60.8%). Two patients had an elevated end of treatment serum ALT instead of negative HCV RNA but their ALT returned to normal as soon as the treatment stopped. These 2 patients were considered to have INF toxicity. Our experience indicates that the cure of HCV-related liver disease in thalassemic patients is not an unrealistic aim and may be reached with Peginterferon alfa-2 a monotherapy in a sizable portion of cases.

Patients with inherited bleeding disorders who regularly receive clotting factors are frequently infected with hepatitis C virus (HCV). Liver biopsy in these patients is high-risk and not always performed. There is no report on pegylated interferon (PEG-IFN) and ribavirin in patients with bleeding disorders in whom no histologic data is available. To assess the safety and efficacy of combined PEG-IFN alfa-2a and ribavirin in patients with inherited bleeding disorders and hepatitis C. We studied 37 patients with inherited bleeding disorders and HCV infection. Patients where planned to receive pegylated interferon alfa 2a (PEG-IFN alfa-2a) 180micg weekly and ribavirin 800mg daily for 48 weeks. They were then followed for 24 weeks after the end of treatment. Early virologic response at week 12 of treatment was achieved in 31/34 patients (91%) and end-of-treatment response was achieved in 30/31 patients (97%). Sustained virologic response was 26/32 (81%) and 26/35 (74%) on per-protocol and intention-to-treat analysis respectively. Dose reduction due to adverse effects was necessary in 11 patients. The combination of PEG-IFN alpha 2a and ribavirin is safe and highly effective in patients with inherited bleeding disorders and HCV infection, even when histologic data is absent.

The aim of the present study was to describe the clinical and laboratory findings among a series of patients with non-alcoholic steatohepatitis (NASH). The clinical, biochemical features of 26 patients with non-alcoholic steatohepatitis, observed for 4 to 44 mo (mean 15.2 mo) were analyzed. Eleven of the patients (42.3%) were women and the rest were men (57.7%). Mean age was 40.12  11.4 (range 17-67). Two of the 4 obese patients (BMI 30) were men (15.4%) and the only morbid obese patient (BMI 40) was a women. Totally thirteen patients were over weight (40 BMI<30) 6 of whom were women. Thirteen patients (6 men and 7 women) had BMI within the range of 25 to 30. Eight patients (6 men and 2 women) had normal weight. Twelve patients (46.2%) had hyperlipidemia, while only 2 had the past consumption history of drug-induced NASH (7.7%). Initially 10 patients were asymptomatic, another 10 had non-specific symptoms (totally 80.8%) and 5 patients had the symptoms related to NASH. Only 1 patient progressed to cirrhosis and 5 showed fibrosis in their liver biopsy. The finding of this study suggests that non-alcoholic steatohepatitis can be a progressive liver disease. Furthermore, it suggests that this disease should not be considered a disease predominantly seen in an obese women with diabetes mellitus.

Abstract: Achalasia is a well- defined esophageal motor disorder. Graded pneumatic dilation using Rigiflex ballon is one of the therapeutic modalities that had not been evaluated in a large long-term study. We aimed at evaluating long-term efficacy of graded Rigiflex pneumatic dilation in the treatment of achalasia. Symptomatic patients with achalasia who had been referred to our center were consecutively enrolled. The diagnosis was established by clinical, radiographic and endoscopic criteria. Exclusion criteria included pregnancy, coagulopathy, serious medical illness or malignancy. Initially all patients were clinically scored based on the severity of five main symptoms and then underwent pneumatic dilation wit at 3 cm ballon. Symptom scores were evaluated at 1, 6, 12. . months. Clinical recurrence was defined as an increase of symptom with 3.5 cm balloon dilation. If recurrence occurred again, third dilation was done with a 4 cm ballon. Over a five-year period, 99 patients [mean age: 35.6 (3.0-72) years.] were followed to an average length of 47.4 (18-20) months. 35 patients needed- retreatment, only 6 of them required third dilation. After third dilation two patients did not reveal improvement and underwent cardiomyotomy. Over this time period, cumulative remission rate was 65% without redilation and 94% with redilation. The mean remission period was 44.7 months (95% CI, 43.52-51.27) for single pneumatic dilation by use of Kaplan- Meier survival analysis. There was no significant predictive value for age, gender, previous treatment and severity of initial score to outcome (P>0.4) by use of Cox regression analysis. Pneumatic dilation by a Rigiflex balloon using a graded approach is effective long-term therapy for achalasia in majority of patients.

Multiple therapeutic combinations have been tested to determine the ideal regimens for eradication of Helicobacter Pylori as the major factor in peptic ulcer diseases with different results depending on geographic area. Our aim was to evaluate the effectiveness of currently prescribed anti H. Pylori regimens in Tehran-Iran. We enrolled 415 subjects (242 males, 173 females, age 11-82 years) with documented H. Pylori infection of the stomach from outpatients of the gastroentrology department of Shariati Hospital. In all patients H. Pylori infection was identified by rapid urease test and or histology. Patients were then treated by different H. Pylori regimens (Triple or quadriple) on an intention to treat basis. One to six months after completion of therapy C 14 urea breath test (C14-UBT) was performed for assessment of eradication. Overall success rate of all regimens were 37%, patient compliance (usage of< 80% drugs) were satisfactory (94%) and was identical for all regimens. The results of this intention-to - treat study was comparable with controlled (perprotocol) studies. The regimen containing amoxicillin + furazolidone was more successful than that of amoxicillin + metronidazole (83.3% vs 66.2%, P>0.05). Only the regimen containg amoxicillin + aetronidazole + omeprazole was superior to H2 receptor antagonists (86.6% Vs 66.2%, P>0.05). The most successful antibiotic combination was tetracycline + furazolidone (100% success rate) which warrants more evaluation in a separate study. Successful eradication rate was identical in groups 1 and 2 evaluated 1-3 months and 3-6 months after completion of therapy respectively (73.6% vs 71.1%, P<0.05). Conventialy there was no significant difference between intention-to-treat therapy with reported preprotocol eradication rate. The best drug regimen in this study was bismuth + tetracycline + furazolidone + acid secretory inhibitors. Replacement of metronidazole by furazolidone was effective in improving eradication rate. In assessment of success of eradication, results of 3 months versus 6 months after therapy were almost similar and comparable.

Abstract: Helicobacter pylori (H.pylori) is an etiologic factor for chronic gastritis and peptic ulcers. Serological testing of H.pylori infection is common in Iran, as other parts of the world. There are geographical variations in the humoral immune response to various H. pylori strains in different parts of the worl. We studied the immunogenic proteins of H.pylori by means of an Immunoblot assay with antigens of H.pylori strains isolated in Iran. Sera of 64 patients suffering from dyspepsia were analyzed to determine antibodlies which were good marker of infection and the antibody patterns associated with peptic ulcer.54 out of 64 dyspeptic patients were infected by H. pylori based on positive culture or positive results of both rapid urease test and direct examination. 14 out of fity-four had peptic ulcers and the rest were catagoriied as patients with non-ulcer dyspepsia. Some of them had multiple erosions in the gut or deodenum. Tweny –two major bands were identified by immunoblot. Of these, IgG antibodies against 10 protients, and they produced immunoreative bands at 14, 16, 22, 26, 32, 32, 44, 87, 92, 120 Kda. Antibody patterns were not identical in the patients. The presence of at least one band at 14, 16, 22, 26, 32, 35Kda was the best marker of infection(sensitivity, 90% and specificity, 80%) Major serological cross reactions were found at moderate molecular weight bands (50, 52, 54, 60, 66 KDa). The presence of at least one band at 14, 16, 22, 26, 32, 35Kda was the best marker of infection (sensitivity, 90% and specificity, 80%). Major serological crossreactions were found at moderate molerate molecular weight bands (50, 52, 54, 60, 66 KDa). The presence of antibodies to 120 Kda protein (Cag A and 87 Kda Protein (Vac A) were not associated with the presence of peptic ulcers. These were in contradiction to results obtained across Europe and U.S but in agreement with Asian studies. However the presence of at least one band at either 32 or 35 Kda was more frequent in the sera of peptic ulcer patients and non-ulcer dyspeptic patients with erosions (P<0.05). These results could be applicable to design new serological kits. In Iran and could also be used to identify new putative virulence factors for H. pylori