A study of clinical, Pathological and paraclinical findings in patients with IBS based on Rome criteria and its discerepancies with classic forms.

HISTORY AND AIM:Â Considering the incidence of Irritable bowel syndrome or IBS, present diagnostic tests based on Rome criteria and different pathological findings in Iran, this study.MATERIALS AND MATERIALS:This research was done clinically and paraclinically on the patients with Rome criteria more than 3 months. Firstly the suspicious patients with lactase deficiency were put aside and then FBS, ESR, BUN, CBC and stool examination for leukocytes, RBC and culture and occult blood test six times were done. The sonography of abdomen and pelvis was also conducted. The patients, then, were studied through Barium Enema with Double Contrast Method. The patients with some problems in these tests were deleted and the rest were studied through colonoscopy and several colonic biopsy. FINDINGS: Some 80 patients with IBS conditions based on Rome criteria were studied through colonoscopy and biopsy 59.5 percent of which were male and the rest female The commonest age in patients was 20-3-. Lymphocyte infiltrtion in lamina propria was reported in 96.3 and histology was normal only in 3.7 that is against the classic medical books. RESULTS: In our country (Iran), in the patients with IBS, the pathological findings in colon include lympbocytic infiltration in lamina propria, the reasons of which are: Â a) Opposite to Rome criteria that implies colon pathology is normal and there is only movement disorder, lymphocytic infiltration can also be seen in patients with IBS. Â b) Perhaps What we refer to as IBS in our country based on Rome criteria in medical books is part of a lymphocytic colitis. Â c) Lymphocytes is lamina propria in patients with IBS is an immunological reaction to flora microbe in colon in our country

Clinical, paraclinical and pathologic findings of irritable bowel syndrome

Background: Irritable bowel syndrome(IBS) is a common GI complaint. Since there exist some controversies with reference books regarding the clinical and pathological findings, the present study was conducted to determine the clinical, paraclinical and pathologic findings of irritable bowel syndrome in a group of patients. Materials and methods : For this descriptive study, 80 patients who had been diagnosed as IBS according to the ROME criteria were selected. Other diseases were excluded by complementary studies. Colonoscopy and barium enema was performed and multiple biopsies were obtained. Results : The study population included 42 males and 38 females with the mean age of 26.5±7 years. The most common chief complaints were flatulence, abdominal pain, and diarrhea. Pathologic findings were revealed in 77 cases (96.3). Conclusion : High prevalence of pathologic changes is a unique finding in our patients. Further studies regarding the diagnostic modalities and proper treatment are suggested

Diabetes mellitus and its control at Shahid Beheshti Hospital in 1997

History and Objectives: Due to the prevalence of diabetes mellitus and the importance of controlling its well known side effects and in order to determine the state of patients with diabetes, the present study was conducted at the Shaheed Beheshti hospital in Kashan in 1997. Materials and Methods: A descriptive study was carried out on 100 patients who were receiving insulin. The control of the illness was determined on the basis of HbA1c measurements. Values under 8 were considered as good control, values between 8-11 were considered as fair and values over 11 were considered as poor control. HbA1c was determined by gel electrophoresis. Patients records, age, sex educational levels, type of diabetes, type of insulin prescribed, number of insulin injections, duration of insulin therapy and BMI were recorded for each patient. The rate of poor control and confidence interval for the population and the effect of influencing factors were assessed. Results: From 100 patients, 41 patients were male and mean age was 58 years and range was 16 to 80 years. 70 of patients were illiterate and 40 of the patients were type I diabetes mellitus. All patients were receiving insulin at the time of study. 3 of patients had blood control, 22 fair and 75 had poor diabetic control. Patients having been under insulin therapy for more than 5 years, NPH alone, one injection per day and type I diabetes mellitus were under increased the chance of poor control. Conclusion: Due to high prevalence of poor diabetic patients, further analytical study is needed in order to elucidate the underlying factor for poor diabetic control and subsequently, experimental studies are required in order to reduce the rate of poor control

Acute complications of diabetes mellitus in patients hospitalized in Shahid Beheshti Hospital, Kashan, 1991-99

Background: With respect to the prevalence of diabetes mellitus, its known complications, the impact of epidemiological features on prognosis and in order to determine the acute complications of diabetes mellitus and its related mortality and morbidity, the present study was conducted in Shaheed Beheshti University hospital in Kashan, during an 8-year period (1991-99). Materials and Methods: It was an existing data type study. Demographic characteristics as well disease profile were all recorded. Then descriptive statistics was used. Results: 114 patients with 144 acute complications were included. Diabetic ketoacidosis, hyperosmolar syndrome and hypoglycemia were reported in 54 (37.5), 9 (6.3) and 81 (56.2), respectively. Diabetic ketoacidosis was more obvious in 12-20-year-old individuals (21 cases). The mortality rare was 11.1, 66.6 and 6.2, respectively.Conclusion: Hypoglycemia was by far the most common complication. Diabetic ketoacidosis was found more common among 12-20-year-old individuals. Whereas hyperosmolar syndrome and hypoglycemia were more prevalent after 60. Mortality had occurred among these patients. Thus an experimental study is strongly recommended

Frequency of musculoskeletal complications among the diabetic patients referred to Kashan diabetes center during 2009-10

Background: Diabetes Mellitus is one of the most common metabolic disorders causing pathophysiologic changes in multiple organs. Considering the burden of diabetes and its complications, this study aimed to evaluate the frequency of musculoskeletal complications in diabetic patients. Materials and Methods: This cross-sectional study was performed on 327 diabetic patients referred to Kashan diabetes center during 2009-10. Age, the type of diabetes and clinical manifestations such as arthralgia, paresthesia, and limited range of movement of joints were obtained from the hospital medical records of patients and then musculoskeletal complaints (e.g., adhesive capsulitis, carpal tunnel syndrome, dupuytren's contracture, trigger finger, and limited range of movement of joints) were diagnosed and recorded by a rheumatologist. Results: The mean ages of type II and I diabetic patients were 54.6±12.61 and 29.7±10.36 years, respectively. Carpal tunnel syndrome (49.8%), knee osteoarthritis (45%), sclerodactyly (27.2%), dupuytren's contracture (14.1%), trigger finger (11.9%), adhesive capsulitis (11.9%), limited joint movements' syndrome (8%) and Charcot joint (0.6%) were seen in patients. There was a significant relationship between the type of diabetes and knee osteoarthritis (P<0.003 OR=1.86 CI=1.05-3.30) and also carpal tunnel syndrome (P<0.045). A significant relationship was also seen between duration of disease and trigger finger, dupuytren's contracture (OR=3.76 CI=1.9-7.41) and limited joint movements. Conclusion: The findings of this study indicated that type of diabetes and also its duration (over 15 years) may increase the risk of musculoskeletal complications. Hence, careful periodic examinations of all diabetic patients are recommended

Evaluating the correlation between serum anti-CCP level and disease activity index in rheumatoid arthritis

Background: Rheumatoid arthritis (RA), one of the most prevalent autoimmune diseases in the world, affects about 1% of population. It is shown that the titration of this antibody has some correlation with disease activity index. The goal of present study was to evaluate the correlation between anti-Cyclic citrullinated peptide (anti-CCP) titration and disease activity index. Materials & Methods: In this cross-sectional study 105 RA patients were considered for American College of Rheumatology (ACR) criteria serum anti-CCP level, and ESR of all participants were checked after venipuncture. In addition, disease activity index form and Visual Analog Scale (VAS) were completed for each patient. The correlation between disease activity index (DAS28), ESR and VAS was evaluated. The numbers of tendered and swollen joints and anti-CCP level were analyzed using Kolomogrov-Smirnov, t test, Levene and Mann-Whitney statistical tests. Results: The mean disease activity index in positive and negative anti-CCP patients was 11.5±4.7 and 8.6±1.4, respectively (P=0.023). In positive and negative anti-CCP patients the mean swelling joints was 2.3±2.1 and 1.1±0.7, respectively (P=0.031). Mean tender joints in positive and negative anti-CCP patients was 6.1±4.6 and 3.6±1.8, respectively (P=0.046). In positive and negative anti-CCP patients the mean of ESR was 36.8±24.8 and 10.3±6.7, respectively (P<0.0001). Also the mean VAS in positive and negative anti-CCP patients was 42.1±32.8 and 18.8±9.1, respectively (P=0.007). Conclusion: Considering the correlation between anti-CCP titration and disease activity index, this test can be used as a factor of disease activity in RA

A comparison between touch cytology and histology method in diagnosing Helicobacter pylori infection

Background: Touch cytology is one of the sensitive ways of diagnosing Helicobacter pylori in stomach biopsies. The current study was designed to compare touch cytology with histology method in the diagnosis of Helicobacter pylori infection. Materials and Methods: This study was performed on 150 dyspeptic patients undergoing upper gastrointestinal endoscopy in Kashan Shahid Beheshti Hospital. Antrum samples (2-4) were taken from each of 150 patients. One biopsy sample was considered for touch cytology and the remaining biopsy samples were studied for histological examination. Results: Eighty-three out of 150 patients (55.3%) were men with the mean age of 46.63±5.93 years. The sensitivity, specificity, positive predictive value and negative predictive value in the touch cytology method were 95.65%, 100%, 100% and 66%, respectively, while in the histology method they were 84.78%, 100%, 100% and 36.36%, respectively. The sensitivity of the touch cytology was more than that of the histology method (P<0.001) in the diagnosis of H. pylori. Conclusion: Since the cytology method is more sensitive with equal specificities in relation to histology method, when the histological information is not necessary, the cytology method can be considered more reliable for diagnosing Helicobacter pylori

The effect of pioglitazone and metformin on liver function tests, insulin resistance, and liver fat content in nonalcoholic fatty liver disease: A randomized double blinded clinical trial

Background: Non-alcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of insulin resistance (IR) syndrome. The effect of insulin sensitizers on liver function tests and metabolic indices in NAFLD patients is a matter of debate. Objectives: The aim of study was to compare the effects of two different insulin sensitizers, pioglitazone, and metformin, on liver function tests (LFT), lipid profile, homeostasis model assessment-IR (HOMA-IR) index, and liver fat content (LFC) in NAFLD patients. Materials and Methods: This double blind clinical trial was performed on patients who were referred to a gastroenterology clinic with evidence of fatty liver in ultrasonography. After excluding other causes, participants with persistent elevated alanine aminotransferase (ALT) levels and "NAFLD liver fat score" greater than -0.64 were presumed to have NAFLD and were enrolled. They were randomly assigned to take metformin (1 g/day) or pioglitazone (30 mg/day) for four months. Fasting serum glucose (FSG), ALT, aspartate aminotransferase (AST), alkaline phosphatase (ALP), triglyceride, cholesterol (CHOL), high and low density lipoprotein (HDL, LDL), HOMA-IR, and LFC were checked at the baseline, two and four months post-treatment. LFC was measured by a validated formula. Results: Eighty patients (68 males) with mean age of 35.27 (± 7.98) were included. After 2 months, LFT was improved significantly in the pioglitazone group and did not change in the metformin group. After four months, both medications significantly decreased serum levels of LFT, FSG, CHOL, LDL, HOMA-IR, and LFC, and increased serum level of HDL. No statistically significant differences were seen between the two treatment groups with regard to the changes of laboratory parameters and LFC from baseline to four months post-treatment. Conclusions: During the four months, the use of metformin (1 g/day) and pioglitazone (30 mg/day) were safe and might have equally affected LFT, HOMA-IR, lipid profile, and LFC in NAFLD patients. © 2013, Kowsar Corp

Relevance of serum vitamin D level and the disease activity in rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is one of the most prevalent autoimmune diseases in the world. Some of the researches have suggested that the serum vitamin D level may relate to disease activity. The current study was designed to identify the correlation between serum vitamin D level and the disease activity index (DAI). Materials and Methods: In this sectional study, 108 patients (diagnosed based on the American Committee of Rheumatology criteria) were enrolled. In all cases after determining the serum vitamin D level and ESR, complete joint examination were done. The normal range of vitamin D was 47.7 - 144 nm/lit. Then, the specified disease activity form (DAS-28) and visual analog scales (VAS) were filled out. The correlation between disease activity index, (based on VAS, tendered or swelled joints and ESR) and serum vitamin D was analyzed using Chi square, Mann Whitney and t-tests. Results: Seventy nine (73.14) out of 108 patients had normal serum vitamin D and 29 (26.86) had low serum vitamin D level. The mean age of patients with normal and low serum vitamin D level were 52.22±11.6 and 48.48±12.51, respectively (P=0.075). The mean DAI in normal and low vitamin D patients were 3.75±1.37 and 5.19±1.56, respectively (P=0.00). The mean number of swollen joints in normal and low vitamin D patients was 1.24±1.39 and 3.65±3.3, respectively (P=0.001). The mean number of tender joints in normal and low vitamin D patients were 6.84±4.41 and 9.44±3.62, respectively (P=0.042). The mean ESR in normal and low vitamin D patients were 19.40±12.40 and 37.91±21.72, respectively (P=0.002). Moreover, the mean VAS in normal and low vitamin D patients was 23.29±19.42 and 50.68±30.78, respectively (P=0.003). Conclusion: The more active the RA, the less serum vitamin D level