Seroprevalence of strongyloides stercoralis among cancer patients in an endemic region in Iran

Introduction: Strongyloides stercoralis a globally widespread human intestinal nematode. Hyperinfection mainly appears in patients with defective immune systems . This study intended to investigate the prevalence of serum positive Strongyloides stercoralis in cancer patients who have never undergone chemotherapy and those who received at least one cycle of chemotherapy. Materials and Methods: This study targeted cancer patients, referred to Rasht hospital, and assigned them to two groups of cancer patients with no history of chemotherapy and cancer patients with at least one cycle of chemotherapy. Patient’s demographic information, underlying diseases and chemotherapy regimen were recorded, and their serum sample was examined. Results: 410 patients were included in this study. the majority were female ( 51/7% ). About 40 patients tested positive for serology, out of which 14 were in the chemotherapy-treated group and 26 in chemotherapy-untreated group, indicating that the prevalence of serum positive Strongyloides stercoralis was significantly higher in patients with no history of chemotherapy. Moreover, eosinophilia significantly correlated with the prevalence of seropositivity. The chemotherapy protocol containing high doses of corticosteroids could multiply the risk of positive serology by 12.7 times. Conclusion: Before chemotherapy, in areas with a higher prevalence of Strongyloides stercoralis, especially in high corticosteroids protocols, it may make sense to study Strongyloides stercoralis . It becomes more vital in men and eosinophilic patients. Since serologic testing may display false negative rates in patients with defective immune systems, subsequently, alternative complementary methods such as fecal larval examination and fecal PCR test are highly suggested to be carried out along with serology

The survival rate of hepatocellular carcinoma in Asian countries

Hepatocellular carcinoma or Liver cancer (LC) is the sixth most common cancer and the fourth cause of death worldwide in 2018. There has not been a comprehensive study on the survival rate of patients with LC in Asia yet. Therefore, the present study was conducted to evaluate the survival rate of patients with LC in Asian countries. The methodology of the present study is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. The researchers searched five international databases including Medline/PubMed, Scopus, Embase, Web of Knowledge and ProQuest until July 1, 2018. We also searched Google Scholar for detecting grey literature. The Newcastle-Ottawa Quality Assessment Form was used to evaluate the quality of selected papers. A total of 1425 titles were retrieved. 63 studies met the inclusion criteria. Based on the random-effect model one-year, three-year and five-year survival rate of LC were 34.8 % (95 % CI; 30.3-39.3), 19 % (95 % CI ; 18.2-21.8) and 18.1 % (95 % CI ;16.1-20.1) respectively. According to the results of our study, the LC survival rate in Asian countries is relatively lower than in Europe and North America

An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran

BACKGROUND: Clinical reasoning plays a major role in the ability of doctors to make a diagnosis and reach treatment decisions. This paper describes the use of four clinical reasoning tests in the second National Medical Science Olympiad in Iran: key features (KF), script concordance (SCT), clinical reasoning problems (CRP) and comprehensive integrative puzzles (CIP). The purpose of the study was to design a multi instrument for multiple roles approach in clinical reasoning field based on the theoretical framework, KF was used to measure data gathering, CRP was used to measure hypothesis formation, SCT and CIP were used to measure hypothesis evaluation and investigating the combined use of these tests in the Olympiad. A bank of clinical reasoning test items was developed for emergency medicine by a scientific expert committee representing all the medical schools in the country. These items were pretested by a reference group and the results were analyzed to select items that could be omitted. Then 135 top-ranked medical students from 45 medical universities in Iran participated in the clinical domain of the Olympiad. The reliability of each test was calculated by Cronbach's alpha. Item difficulty and the correlation between each item and the total score were measured. The correlation between the students' final grade and each of the clinical reasoning tests was calculated, as was the correlation between final grades and another measure of knowledge, i.e., the students' grade point average. RESULTS: The combined reliability for all four clinical reasoning tests was 0.91. Of the four clinical reasoning tests we compared, reliability was highest for CIP (0.91). The reliability was 0.83 for KF, 0.78 for SCT and 0.71 for CRP. Most of the tests had an acceptable item difficulty level between 0.2 and 0.8. The correlation between the score for each item and the total test score for each of the four tests was positive. The correlations between scores for each test and total score were highest for KF and CIP. The correlation between scores for each test and grade point average was low to intermediate for all four of the tests. CONCLUSION: The combination of these four clinical reasoning tests is a reliable evaluation tool that can be implemented to assess clinical reasoning skills in talented undergraduate medical students, however these data may not generalizable to whole medical students population. The CIP and KF tests showed the greatest potential to measure clinical reasoning skills. Grade point averages did not necessarily predict performance in the clinical domain of the national competitive examination for medical school students

Living Fasciola hepatica in biliary tree: a case report

Here we report a rare case of living Fasciola hepatica in biliary tract. The patient was in acute phase of infection and treated successfully with 10 mg/kg oral triclabendazole after the fluke was extracted using endoscopic retrograde cholangiopancreatography (ERCP)

Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

Introduction. Management of upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow-Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing albumin cutoff in AIMS65 and addition of albumin to GBS add predictive value to these scores

RECTOSIGMOID INFLAMMATORY LESIONS AND ITS DETERMINANTS IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Introduction: Ankylosing Spondylitis (AS) is a chronic and systemic inflammatory disease which mainly affects the axial skeleton. There are substantial evidences that risk of rectosigmoid inflammation is increased in patients with AS. Subclinical inflammation could be associated with significant complications; understanding of its prevalence is an important step towards (developing measures to improve) both early diagnosis and selection of the most appropriate treatment strategies. We have studied the prevalence of the rectosigmoid inflammation and its associated risk factors in patient with AS. Materials and Methods: In this cross-sectional study ,110 patients who have the diagnosis of AS based on the Assessment of New York classification where enrolled. The severity of AS based on AS disease activity (ASDAS-CRP) Score was also calculated. Patients who were on biological agents or Sulfasalazine were excluded. Written informed consent was obtain from all patients. Demographic data, smoking history, time since diagnosis, disease severity, axial versus axial and peripheral involvement, HLA B27 status, latest CRP and ESR level and also fecal Calprotectin were collected. All patients underwent rectosigmoidoscopy and biopsy. Data analysis was done using SPSS software( Ver 18). Results: 87(79.1%) patients were male and 23(20.9%) were females. The mean age was 41.46±11.81. year. The mean time since diagnosis was 6.49±7.16 year.. 54.5% of patients were non-smoker. 84% of patients had other organs involvement. Out of 110 patients, 57(51.8%) had axial only and the rest had both axial and peripheral involvement. Calprotectin level was increased in 94% of patients and the mean level was92.81±40.7. The mean CRP and ESR level was 34.22±25 and 35.89±25.54 respectively. 39.1% of patients were HLA27 positive. Severity of AS in most of patients was in intermediate range (36.4%). In 37 patients( 33.6%) the rectosigmoid macroscopically looked abnormal. The microscopic assessment of the samples showed inflammatory bowel disease in 15.5%, chronic non-specific inflammationin 49.1% and was normal in 31.8%. There was a significant relationship between age,CRP,fecal calprotectin and macroscopic and microscopic findings (p value for age: 0.001 and 0.005), (p values for fecal calprotectin: 0.0001 and 0.008), (pvalues for CRP :0.0001 and 0.008). The relationship between macroscopic findings and severity of AS (p value 0.008) and time since diagnosis (p value 0.015) was statistically significant. Conclusion: This study showed that older age, severity of AS, high fecal Calprotectin level and high CRP are associated with presence of inflammatory rectosigmoid disease and could be used as a important determinant for early diagnosis of this lesion in patients with AS

Fecal calprotectin role in diagnosis of ulcerative colitis and treatment follow-up

Objective: Ulcerative colitis usually affects the rectum and potentially can involve the whole colon. Noninvasive methods such as fecal calprotectin measurement may be considered as a reliable and inexpensive approach in assessing disease severity or treatment change strategy. Methods: In this retrospective cross-sectional study, records of 56 ulcerative colitis patients who hospitalized with exacerbation between May 2016 and April 2017 were assessed based on IBD Data Bank Software in Gastrointestinal and Liver Diseases and Research Center (GLDRC), Guilan province, Iran between. A questionnaire of demographic characteristics, clinical findings and fecal calprotectin level was completed. Montreal classification severity of ulcerative colitis and Mayo disease activity index were scored. Data were analyzed for descriptive and analytical analysis. Results: Fecal calprotectin was significantly different in terms of disease severity based on both Mayo score (p = 0.007) and Montreal classification (p = 0.001). In patients with mild symptoms, no increase in fecal calprotectin was observed, but in patients with moderate and severe elevations in fecal calprotectin levels was significant. Also, C-Reactive Protein surge was related to disease severity (p = 0.02). Furthermore, regression comparison among high-chance patients based on fecal calprotectin was significantly related to higher Erythrocyte Sedimentation Rate levels and smoking, p = 0.01 and p = 0.05, respectively. Conclusion: It seems fecal calprotectin levels are related to the disease severity. Non-invasive methods, such as fecal calprotectin assay, may seem to be an alternative to aggressive, costly and time-consuming methods, such as colonoscopy and biopsy, to reduce the suffering of patients and ultimately help improve the patients’ life quality. Resumo: Objetivo: A colite ulcerativa geralmente afeta o reto, podendo acometer todo o cólon. Métodos não invasivos, como a dosagem de calprotectina fecal, podem ser uma abordagem confiável e barata para a avaliação da gravidade da doença ou da estratégia de mudança de tratamento. Métodos: Neste estudo transversal retrospectivo, os registros de 56 pacientes com colite ulcerativa que foram hospitalizados devido a exacerbação entre maio de 2016 e abril de 2017 foram avaliados usando o software IBD Data Bank no Centro de Pesquisa e Doenças Gastrointestinais e Hepáticas (GLDRC), na província de Guilan, Irã. Foi aplicado um questionário de características demográficas, achados clínicos e nível de calprotectina fecal. Foram usados o escore de Mayo de atividade da doença e a classificação de Montreal da gravidade da colite ulcerativa. Os dados foram analisados de forma descritiva e analítica. Resultados: A calprotectina fecal apresentou diferença significativa em termos de gravidade da doença com base no escore de Mayo (p = 0,007) e na classificação de Montreal (p = 0,001). Em pacientes com sintomas leves, nenhum aumento na calprotectina fecal foi observado. Entretanto, em pacientes com sintomas moderados e severos, o aumento nos níveis de calprotectina fecal foi significativo. Além disso, o aumento nos níveis de proteína C reativa foi associado à gravidade da doença (p = 0,02). A análise da regressão entre pacientes considerados de alto risco com base na calprotectina fecal indicou uma associação significativa com níveis elevados da taxa de sedimentação de eritrócitos e tabagismo (p = 0,01 e p = 0,05, respectivamente). Conclusão: Os níveis de calprotectina fecal parecem estar relacionados com a gravidade da doença. Métodos não invasivos, como o estudo de calprotectina fecal, podem ser uma alternativa a métodos agressivos, caros e demorados, tais como colonoscopia e biópsia, reduzindo o sofrimento e ajudando a melhorar a qualidade de vida dos pacientes. Keywords: Calprotectin, Inflammatory bowel disease, Ulcerative colitis, Inflammation, Palavras-chave: Calprotectina, Doença inflamatória intestinal, Colite ulcerativa, Inflamaçã

Alteration in Liver Enzymes in Aluminum Phosphide Poisoning, A Retrospective Study

Background: Aluminum phosphide (ALP) or rice tablet is a common agent used as pesticides. It is cheap, widely available and highly toxic and responsible for many cases of poisoning in the agricultural communities. There is limited evidence about change of liver enzymes in patients with ALP poisoning in this region. Therefore, we decided to evaluate alteration of liver enzymes in ALP poisoning in Rasht. Methods: In this retrospective cross-sectional study, all documents of patients with ALP poisoning admitted to Razi hospital of Rasht in 2008-2009 were assessed. Inclusion criteria were diagnostic clinical manifestation such as hypotension or metabolic acidosis, history of exposure to ALP during the past 24 hours and progressive signs and symptoms despite treatment (administration of sodium bicarbonate and vasopressor). Patients with past history of hepatic disease were excluded. Collected data were analyzed with SPSS software. Results: Of 104 patients with ALP poisoning, 66 patients (63.5%) were men. The mean age was 33.8±14.69 years, and the mean time of hospitalization was 14.94±18.28 hours. Ninety-five patients (91.3%) needed ventilation and 93 patients (89.4%) died. Statistical analysis demonstrated that elevated liver enzymes were not significantly related with gender, age, time of admission, time of hospitalization, the need for ventilation and mortality. Conclusion: It seems that liver enzymes changes is not seen widely in ALP poisoning and had lower importance than other complications. Because of limited studies in liver enzyme alterations in these patients, it is suggested that more studies with largee sample size is performed to investigate the ALP liver side effects

Effect of functional resistance training on the structure and function of the heart and liver in patients with non-alcoholic fatty liver

Abstract The current study is of the quasi-experimental type, with a pre-and post-test design, and subjects were randomly assigned to one of two groups: control (n = 8) and experimental (test) (n = 8). Based on the patient's self-report and using daily diet control tables, the patient's diet planning percentage of energy supply was managed and controlled for 3 days. The protocol for functional resistance training for these circular exercises, including the squat, lunge, bear crawl, rock press, jumping jack, and back fly lunge, was performed three times per week without specialized apparatus. Ejection fraction (EF) and fractional shortening (FS) were measured before and after functional resistance training, using echocardiography. Liver Stiffness and steatosis were measured using FibroScan, and the liver function was determined using biochemical assays. The average age of patients in the control group and the test group were 46.02 ± 5.4 and 48.6 ± 2.51, respectively. Pre-test and post-test of the body mass index were 32.06 ± 5.06 and 30.02 ± 3.97, and for the body fat percentage were 33.65 ± 6.09 and 25.41 ± 4.99. In non-alcoholic fatty liver patients, due to functional resistance training, EF (p-value = 0.003) and FS (p-value = 0.03) significantly increased, and C-reactive protein (Hs-CRP) (p-value = 0.001), steatosis (p-value = 0.04), and stiffness (p-value = 0.01) decreased. According to the results and without considering clinical trials, functional resistance training affects the structure and function of the heart and Liver in NAFLD patients

The seroprevalence of celiac disease in patients with symptoms of irritable bowel syndrome: A cross-sectional study in north of Iran

Background: Celiac disease (CD) is a common cause of malabsorption that is definitively diagnosed by abnormal bowel biopsy, symptoms and histologic changes to gluten free diet. The symptoms of irritable bowel syndrome (IBS) are common in our community as the majority of people in Guilan, north of Iran, consume rice daily. Also, a number of celiac patients are unknown, and IBS are mistakenly diagnosed. Objective: This study aimed to evaluate the prevalence of CD among IBS patients. Methods: A total of 475 consecutive patients with IBS, confirmed by Rome IV, underwent celiac serological tests antitissue transglutaminase antibodies (IgA-tTG, IgG-tTG) after obtaining a written consent form. In case of positive serological tests, biopsy was performed from small intestine after endoscopyRESULTS: Thirty-one (6.53%, 95% CI: 4.55-9.22) patients were positive for celiac serology. Based on Marsh-Oberhuber criteria, out of 9 patients with positive pathology 77.78% (95% CI: 40.19-96.05) had marsh IIIc. In IBS patients cramp (0.009) and stomach fullness (0.021) were two statistically significant IBS symptoms. Conclusions: We suggest physicians to consider celiac examinations for all patients with IBS symptoms, even for patients with no obvious celiac symptoms