High prevalence of HBV, HCV, and HIV infections in gypsy population residing Shahr-e-Kord

Background - Gypsies are the groups of people who are not dependent on any special location. Because of permanent immigration, poor socioeconomic status and the special life style, gypsies might be exposed to multiple sexual partners, addiction and various kinds of infections, like hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). The aim of this study was to estimate the prevalence of these infections in gypsies of South-West of Iran (Shahr-e-Kord). Materials and Methods - This study was done in Sureshjan Pass near Shahr-e-Kord. Out of 250 gypsies, 226 of them were recruited into the study. Laboratory tests for hepatitis B surface antigen (HBs Ag), hepatitis B core antibody (HBcAb), hepatitis C virus antibody (HCVAb), and human immunodeficiency virus antibody (HIVAb) were performed in the study population. All sera with positive results of HBsAg or HBcAb were tested again for these markers together with HBsAb, HBeAg, and HBeAb. Also sera with positive HIV Ab were retested with immunoblot assay. Results - A total of 226 persons (103 males, 123 females) with a mean age of 20.7 years (range: 9 months to 78 years) were recruited. Thirty-five subjects (18, or 15.5 male) had positive HBsAg. Fifty-four persons (23.9) had positive HBcAb. Seven (4, or 3.1 male), had positive HCVAb and 4 persons (2, or 1.8 male) were HIV positive. Conclusion - Gypsies in Iran should be considered a high risk group for HBV, HCV and HIV infections. Vaccination against HBV should be considered for all noninfected subjects, and health promotional activity should be planned in order to prevent further spread of these blood born infections among them

Pancreatic hydatid cyst diagnosed on EUS-guided FNA

A 22-year-old woman presented with abdominal pain. Abdominal CT scan demonstrated a mass lesion in the pancreatic body (Fig. 1A). There was no lesion in the liver on CT scan (Fig. 1B). EUS showed a 50- × 35-mm cystic mass lesion containing numerous floating serpentine-like linear structures (Fig. 2; Video 1, available online at www.VideoGIE.org). EUS-guided FNA was performed with a 22-gauge needle

Bedside Endoscopic Ultrasound in Critically Ill patients

Background. The aim of this study was to evaluate the role and impact of EUS in the management of critically ill patients. Methods. We retrospectively identified all patients at our institution over a 68-month period in whom bedside inpatient EUS was performed. EUS was considered to have a significant impact if a new diagnosis was established and/or the findings altered subsequent clinical management. Results. Fifteen patients (9 male; mean age 58 ± 15 years) underwent bedside EUS without complications. EUS-FNA (median 4 passes; range 2–7) performed in 12 (80%) demonstrated a malignant mediastinal mass/lymph node (5), pancreatic abscess (1), excluded a pelvic abscess (1), established enlarged gastric folds as benign (1) and excluded malignancy in enlarged mediastinal (1) and porta hepatis adenopathy (1). In two patients, EUS-FNA failed to diagnose mediastinal histoplasmosis (1) and a hemorrhagic pancreatic pseudocyst (1). In three diagnostic exams without FNA, EUS correctly excluded choledocholithaisis (n = 1) and cholangiocarcinoma (1), and found gastric varices successfully thrombosed after previous cyanoacrylate injection (1). EUS was considered to have an impact in 13/15 (87%) patients. Conclusions. In this series, bedside EUS in critically ill patients was technically feasible, safe and had a major impact on the majority of patients

Clinical Study Bedside Endoscopic Ultrasound in Critically Ill patients

Background. The aim of this study was to evaluate the role and impact of EUS in the management of critically ill patients. Methods. We retrospectively identified all patients at our institution over a 68-month period in whom bedside inpatient EUS was performed. EUS was considered to have a significant impact if a new diagnosis was established and/or the findings altered subsequent clinical management. Results. Fifteen patients (9 male; mean age 58 ± 15 years) underwent bedside EUS without complications. EUS-FNA (median 4 passes; range 2–7) performed in 12 (80%) demonstrated a malignant mediastinal mass/lymph node (5), pancreatic abscess (1), excluded a pelvic abscess (1), established enlarged gastric folds as benign (1) and excluded malignancy in enlarged mediastinal (1) and porta hepatis adenopathy (1). In two patients, EUS-FNA failed to diagnose mediastinal histoplasmosis (1) and a hemorrhagic pancreatic pseudocyst (1). In three diagnostic exams without FNA, EUS correctly excluded choledocholithaisis (n = 1) and cholangiocarcinoma (1), and found gastric varices successfully thrombosed after previous cyanoacrylate injection (1). EUS was considered to have an impact in 13/15 (87%) patients. Conclusions. In this series, bedside EUS in critically ill patients was technically feasible, safe and had a major impact on the majority of patients. 1

Celiac disease as a potential cause of idiopathic portal hypertension: a case report

<p>Abstract</p> <p>Introduction</p> <p>Idiopathic portal hypertension is a disorder of unknown etiology, clinically characterized by portal hypertension, splenomegaly and anemia secondary to hypersplenism.</p> <p>Case presentation</p> <p>A 54-year-old man was admitted to our hospital for evaluation of malaise, weight loss, abdominal swelling and lower limb edema. His paraclinical tests revealed pancytopenia, large ascites, splenomegaly and esophageal varices consistent with portal hypertension. Duodenal biopsy and serologic findings were compatible with celiac disease. His symptoms improved on a gluten-free diet, but his clinical course was further complicated with ulcerative jejunoileitis, and intestinal T-cell lymphoma.</p> <p>Conclusion</p> <p>It seems that celiac disease, by an increased immune reaction in the splenoportal axis, can result in the development of idiopathic portal hypertension in susceptible affected patients.</p

Obesity and hypertension in an Iranian cohort study; Iranian women experience higher rates of obesity and hypertension than American women

BACKGROUND: Once considered as the main public health problem in developed countries, obesity has become a major problem throughout the world and developing countries, like Iran, are joining the global obesity pandemic. We determined the prevalence of overweight, obesity, and hypertension in a large cohort of Iranians and compared age-adjusted rates with the rates in the US. METHODS: Golestan Cohort Study is a population-based study of 8,998 men and women, aged 35-81 years, from urban and rural areas. Anthropometric parameters were measured by interviewers. Prevalence rates were directly adjusted to the 2000 United States standard population. RESULTS: The age-adjusted prevalence rates of overweight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) in this Iranian population were 62.2% and 28.0%, respectively. Both overweight and obesity were more common in women than men. Age-adjusted prevalence of overweight was significantly higher in Iranian women compared to the American women (68.6% vs. 61.6%), while the age-adjusted prevalence of obesity is closer in these two populations (34.9% vs. 33.2%). Iranian men—compared to American men—had significantly lower age-adjusted prevalence of overweight (53.7% vs. 68.8%) and obesity (16.2% vs. 27.5%). Age-adjusted prevalence of hypertension was higher in Iranian women than American women (35.7% vs. 30.5%). Diabetes mellitus was reported in 6.2% of participants. Mean waist-to-hip ratio (WHR) among women was 0.96. Smoking rates in men and women were 33.2% and 2.2%, respectively. CONCLUSION: The prevalence of obesity, overweight, and hypertension in Iran is as high as the US. However, Iranian women are more obese than American women and Iranian men are less obese than their American counterparts. This discrepancy might be due to the low rate of smoking among Iranian women. Iranian women have higher mean WHR than what WHO has defined in 19 other populations

Gluten sensitivity enteropathy in patients with recurrent aphthous stomatitis

<p>Abstract</p> <p>Background</p> <p>Gluten sensitive enteropathy (GSE) is an autoimmune enteropathy triggered by the ingestion of gluten-containing grains in susceptible individuals. Recurrent aphthous stomatitis (RAS) may be the sole manifestation of GSE. The aim of this study was to determine the prevalence of gluten sensitivity enteropathy (GSE) in a large group of patients with RAS and assess the efficacy of gluten free diet (GFD) on the improvement of aphthous lesions in those who were diagnosed with GSE.</p> <p>Methods</p> <p>Two hundred and forty seven patients with RAS were included. The patients had at least three aphthous attacks per year. Patients were screened by IgA anti-endomysial antibody (EMA), IgA anti tissue transglutaminase (TTG) and serum IgA level. Those with a positive serology underwent endoscopic biopsies of the duodenal mucosa and patients with negative serology were excluded. The diagnosis of GSE was based on a positive serological test and abnormal duodenal histology. For patients with GSE, gluten free diet was recommended.</p> <p>Results</p> <p>Six out of 247 RAS patients had positive TTG test alone, and one had positive EMA and TTG. All 7 patients with positive serologic tests underwent duodenal biopsies. Histological findings were compatible with GSE in all of them (Marsh I in four patients, Marsh II in two patients and Marsh IIIB in one another.). The mean age of GSE patients was 27.42 ± 10.56 (range, 13 to 40) years old. They were suffering from RAS for an average duration of 4.5 years. All of the 7 GSE patients had not responded to the routine anti-aphthae medications, including topical corticosteroids, tetracycline and colchicine. Four patients who adhered to a strict gluten-free diet showed noticeable improvement in their aphthous lesions over a period of 6 months.</p> <p>Conclusion</p> <p>A significant minority (e.g. 2.83%) of RAS patients have GSE. This could be compared with the 0.9% prevalence of GSE in the general population of Iran. This study suggests that evaluation for celiac disease is appropriate in patients with RAS. Additionally, the unresponsiveness to conventional anti-aphthae treatment could be an additional risk indicator.</p

In vitro Evaluation of Antibacterial Efficacy of Natural Honeys in Comparison with Antibiotics on Pseudomonas aeruginosa

Background and Aim: Several studies have been done that showed honey has been therapeutic effects on infection disease like Pseudomonas infections. Our aim of this study is evaluation of the antibacterial activity of mono floral and multi floral honeys from different origin of Iran on growth of Pseudomonas aeruginosa and compare their activities with artificial honey and antibiotics. Materials and Methods: Antimicrobial effect of honey was determined by disc diffusion and broth dilution method on 5 different concentration of honey. Results: The highest inhibition zone (16 ± 1/52 mm) was recorded from persimmon honey in disc diffusion method. In this study، the minimum inhibitory concentration (MIC) for manna honey and other natural honeys obtained 25% and 12.5% respectively. While P. aeruginosa was inhibited at concentration of 50% (ml/ml) of artificial honey. Conclusions: This study showed that honey has a significant antibacterial effect on P. aeruginosa. There is a direct link between the concentration of honey and inhibition zone