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Volume 2, Number 1, January 2010
HISTORY OF MEDICINE - History of Cholera Outbreaks in Iran during the 19th and
20th Centuries
Description: MH Azizi, F Azizi ..... ABSTRACT Cholera is an acute infectious disease with
high mortality if left untreated. Historically, between the 19th and 20th centuries seven great
pandemics of cholera occurred and worldwide, thousands of people died. Based on an old
theory, cholera was considered an air-born disease and the emergence of its outbreaks were
attributed to bad weather or miasma. However later in the 18th century, British physician John
Snow (1813-1858) explained the association of a terrible cholera outbreak in London in 1849
to contamination of the drinking water supply with human excreta. Despite his finding, the
causative agent of this dreaded illness was unidentified until later in the 19th century. In 1854,
Filippo Pacini (1812-1883) an anatomist from Italy and then in 1883, Robert Koch (18431910) the German bacteriologist, discovered ‘vibrio cholerae’ as the etiologic agent.
During the major pandemics of cholera in 19th and 20th centuries this illness reached Iran and
led to vast depopulation and a crucial impact on the country’s socioeconomic status. Poor
public health conditions, lack of a well-organized public health authority for implementing
preventive and quarantine measures as well as Iran’s specific geographic location were the
main facilitating factors of the emergence of various epidemics, including cholera in Iran. The
present paper briefly reviews the cholera outbreaks in Iran during the 19th and 20th centuries.
Keywords Cholera; Pandemic; Epidemic; Iran ..... Corresponding Author: MohammadHossein Azizi, MD, Academy of Medical Sciences of the IR of Iran, Tehran, Iran Tel: +98 21
22939869 Fax: +98 21 22939869 E-mail: [email protected] Recieved: 4 October 2009
Accepted: 24 November 2009
LETTER TO THE EDITOR - Simurgh as a Medical Symbol for Iran
Description: T Nayernouri ..... Corresponding Author: Touraj Nayernouri, MD, F.R.C.S,
Academy of Medical Sciences of I.R. of Iran, Tehran, Iran Telefax: +98 21 22298838 E-mail:
[email protected] ReceIved: 1 October 2009 Accepted: 31 December 2009
CASE REPORT - A Case of Gastric Zygomycosis in a Diabetic Patient Successfully
Treated with Total Ga
Description: S Paydar, SR Baezzat, A Fazelzadeh, B Geramizadeh ..... ABSTRACT
Zygomycosis is regarded as a rare fetal infection in diabetics and other immunocompromised
patients. The usual manifestations of this infection are: rhinosinusitis, pansinusitis, rhinoorbital and rhinocerebral. Primary gastrointestinal (GI) zygomycosis is a rare disease with a
high mortality rate. The stomach is the most common site involved in GI mucormycosis. There
are few reported cases of GI zygomycosis in the literature. Here we report a case of a diabetic
woman with abdominal pain secondary to gastric zygomycosis that successfully responded to
surgical treatment. Keywords Zygomycosis; Diabetes; Gastrectomy ..... Corresponding
Author: Saeed Reza Baezzat, MD Department of General Surgery, Shahid Faghihi (Saadi)
Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98 711 2331006 Fax: +98
711 2331006 E-mail: [email protected] Received: 5 October 2009 Accepted: 26
November 2009
CASE REPORT - Surgical Management of Localized Crohn’s Disease of the Fourth
Part of the Duodenum
Description: M Mozafar, MR Sobhiyeh, N Tadayon, N Khalegnejad Tabari, N Bolouri .....
ABSTRACT Upper gastrointestinal tract (gastroduodenal) Crohn’s disease (CD) is an
uncommon condition, occurring in about 1-5% of all CD cases. Our case was an extremely
rare manifestation of CD, who presented with distal duodenal obstruction. As preoperative
diagnosis was not established he underwent segmental resection and end-to-end anastomosis.
Postoperative small bowel fistulae were not observed, and there was no morbidity during the
follow up period. There were no disturbances in digestive function. Keywords Crohn’s
disease; Surgical management; Duodenum ..... Corresponding Author: Mohamad Mozafar,
MD, Associate Professor, Department of General and Vascular Surgery, Shohada-Tajrish
Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Telefax: +98
21 22721144 E-mail: [email protected] Received: 2 September 2009 Accepted:
16 November 2009
REVIEW ARTICLE - Hepatocellular Carcinoma in the World and the Middle East
Description: H Poustchi, SG Sepanlou, S Esmaili, N Mehrabi, A Ansarymoghadam .....
ABSTRACT Hepatocellular carcinoma (HCC) is a major worldwide public health concern.
Despite recent advances, there has been little success in improving the survival of HCC
patients. Due to advances in diagnostic modalities and the increasing incidence of chronic viral
hepatitis and nonalcoholic fatty liver disease (NAFLD), both of which are well known risk
factors of HCC, the prevalence of HCC is increasing in developed countries and it is expected
that this trend will continue in the future. In Middle Eastern countries the prevalence of this
cancer is lower compared to sub-Saharan Africa and some Far East countries; however it is
documented that the prevalence of this cancer in some parts of the Middle East is also
increasing. In the current review, the prevalence and burden of this disease worldwide,
particularly in Middle Eastern countries, and risk factors for HCC are discussed. Keywords
Hepatocellular Carcinoma; Prevalence; Viral Hepatitis; Chronic Hepatitis ..... Corresponding
Author: Hossein Poustchi MD, PhD Assistant Professor, Digestive Diseases Research Center,
Shariati Hospital, North Kargar Ave., Tehran, 14117-13135, Iran Tel: +98 21 82415300 Fax:
+98 21 82415400 E-mail: [email protected] Received: 3 October 2009 Accepted: 26
December 2009
ORIGINAL ARTICLE - Prevalence of Dyspepsia and its Correlation with Demographic
Factors and Lifestyl
Description: F Khademolhosseini, D Mehrabani, N Zare, M Salehi, ST Heydari, M Beheshti,
M Saberi-Firoozi ..... ABSTRACT Background Dyspepsia is a common disorder that can
present many clinical dilemmas in patient management. Although not life-threatening, the
symptoms are long-lasting, interfere with daily activities and have a significant impact upon
quality of life. The aim of this study was to determine prevalence of dyspepsia and its
relationship with demographic and socioeconomic factors, and lifestyle in an apparently
healthy population in Shiraz, southern Iran. Methods In a population-based study, 1978
subjects aged 35 years or older were interviewed from April to September 2004. A
questionnaire consisting of demographic factors, lifestyle data and gastrointestinal symptoms
was completed for each participant. The validity and reliability of the questionnaire were
determined. Resultsts The prevalence of dyspepsia was 29.9%. The dyspeptic patients were
classified as having ulcer-like (27.9%), dysmotility-like (26.2%) or unspecified dyspepsia
(45.9%). The prevalence was higher in females, water-pipe smokers, NSAIDs users, and in
those with psychological distress, recurrent headache, anxiety, nightmares and past history of
gastrointestinal disease. Dyspepsia had an inverse relationship with consumption of pickles,
fruits and vegetables, and with duration of meal ingestion. Subjects with dyspepsia symptoms
were more likely to restrict their diet, take herbal medicine, use over-the-counter drugs, consult
with physicians and consume medication advised by their friends. Conclusion This study
reveals that dyspepsia has a high prevalence in Shiraz, southern Iran and is associated with
several demographic factors, lifestyle and health-seeking behavior. K eywords Dyspepsia;
Prevalence; Epidemiology; Lifestyle ..... Corresponding Author: Mehdi Saberi-Firoozi, MD,
Professor, Digestive Diseases Research center, Tehran University of Medical Sciences,
Shariati Hospital, North Karegar. Ave., Tehran, Iran Tele: +98 21 82415000 Fax: +98 21
82415400 E-mail: [email protected] Received: 30 September 2009 Accepted: 24 December
2009
ORIGINAL ARTICLE - Characteristics of Patients with Cystic Fibrosis: Experience in
a Large Referral
Description: GR Khatami, MM Mir-Nasseri, F Seyghali, B Allah-Verdi, F Yourdkhani .....
ABSTRACT Background Cystic fibrosis (CF) is an autosomal recessive disease caused by a
CF trans-membrane regulator (CFTR) defect. Its prevalence is 1:2500 in Caucasians, 1:15300
among African Americans and is rare in Southeast Asia. The present study aims to review
demographic data, clinical manifestations and laboratory findings of Iranian children
diagnosed with CF who referred to a Children’s Hospital Medical Center in Tehran, Iran
during a ten-year period. Methods In a retrospective study from 1991-2000, all hospitalized
patients with documented CF were reviewed. Diagnosis was based on clinical findings and
sweat chloride levels above 60 mEq/L. Resultsts A total of 233 patients [females: 91 (39.1%),
males: 142 (60.9%)] were enrolled. The onset of symptoms was before the first month of life
in 12.1%, between 1-6 months of age in 75.1%, and between 6-12 months of age in 6.9% of
patients. Consanguinity of parents was present in 42.5% of patients. Respiratory (81.5%) and
gastrointestinal (73.4%) symptoms, in addition to growth retardation were the most common
presentations Eighty-eight percent of patients weighted below the fifth percentile. Of the 207
chest radiographs performed, the most frequent finding was hyper-aeration associated with
pneumonia. Among 138 patients in whom barium swallows were performed, 102 (74%) had
gastroesophageal reflux. A total of 27 patients expired, mostly from respiratory failure
(96.3%). Conclusion CF is not a rare disease in Iran. We suggest early diagnosis and
appropriate maintenance therapy for improving morbidity and mortality amongst CF patients.
K eywords Cystic fibrosis; Epidemiology; Children ..... Corresponding Author: Mohammad
Mehdi Mir-Nasseri, MD Children’s Hospital Medical Center, Tehran University of
Medical Sciences, Tehran 14117, Iran TelFax: +98 21 66924545 E-mail: [email protected]
Received: 1 November 2009 Accepted: 20 January 2010
ORIGINAL ARTICLE - Prevalence of Non Alcoholic Steatohepatitis in Iran: A
Population Based Study
Description: AA Sohrabpour, H Rezvan, S Amini-Kafiabad, MR Dayhim, S Merat, A
Pourshams ..... ABSTRACT Background Non-alcoholic fatty liver disease/steatohepatitis
(NAFLD/NASH) is the most common form of chronic liver disease woldwide and is no longer
considered a benign disease. Its prevalence has not been determined in a large-scale
population-based study in Iran. Methods A total of 6583 individuals aged 18 to 65 were
randomly selected from three geographically distinct provinces in Iran. Blood samples were
obtained from each subject and a questionnaire was completed exploring data including selfadmitted regular alcohol use. Serums were tested for anti-HCV antibody (anti-HCV), hepatitis
B surface antigen and anti-hepatitis B core antibody. Positive samples for anti-HCV antibody
were re-tested and those positive in a repeat ELISA were confirmed by a recombinant
immunoblot assay (RIBA) test. Serums were also tested for ALT levels. Subjects with elevated
ALT defined as serum ALT ≥40 IU/L with no history of alcohol consumption and negative
HBV and HCV infection were considered as “presumed NASH―. Resultsts In this study
5589 subjects were analyzed. Two hundred and forty two individuals (4.3%) were diagnosed
with elevated ALT levels. Among individuals with elevated ALT, 15 (6.2%) were diagnosed
with either hepatitis B or hepatitis C. The overall weighted prevalence of presumed NASH was
2.9%. According to multivariate analysis, male sex, urban lifestyle, and being overweight or
obese were significantly associated with “presumed NASH―. Conclusion Obesity and
metabolic syndrome, the most predictive factors of fatty liver disease, are increasing in Iran,
therefore the prevalence of NAFLD/NASH and related complications are expected to increase
in the future. This population based study gives a crude estimate of the prevalence of NASH
around the country. Studies with more accurate surrogates of NASH need to be done. The
disparity among different provinces merits special consideration. K eywords Fatty liver;
alanine transaminase; prevalence, Iran ..... Corresponding Author: Akram Pourshams, MD,
Sharitai Hospital, N Kargar St, Tehran 14117, Iran Tel: +98 21 82415300 Fax: +98 21
82415400 E-mail: [email protected] Received: 12 April 2010 Accepted: 30 August 2010
ORIGINAL ARTICLE - Comparison of Electrotherapy, Rubber Band Ligation and
Hemorrhoidectomy in the T
Description: A Izadpanah, SV Hosseini, M Mahjoob ..... ABSTRACT Background Treatment
of hemorrhoid disease is one of the most challenging fields in general surgery in which
different methods are used to treat this condition. In this study, we compared the manometric
and clinical results of three treatment methods for hemorrhoids. Methods A total of 150
patients with symptomatic grades II or III internal hemorrhoids were randomly assigned to
three groups. Group A underwent Ferguson hemorrhoidectomy, group B were treated with
rubber band ligation (RBL) and group C were treated with direct current electrotherapy.
Resultsts Preoperatively, grade III hemorrhoids had significantly higher mean resting pressure
and mean squeezing pressure in comparison to grade II hemorrhoids. After hemorrhoidectomy,
patients in group A had a significant decrease in the maximum resting pressure (90.8 to 77.7
mmHg) and maximum squeezing pressure (130.6 to 114.8 mmHg) with a significant raise in
the volume of the first sensation. However there was no significant change in manometric
indexes after RBL and electrotherapy. Group A patients had more postoperative pain and
itching compared to groups B and C. Conclusion We conclude that electrotherapy is a safe,
effective and simple method of treating grades II and III uncomplicated internal hemorrhoids.
This procedure is associated with little postoperative pain and complications, and has the least
changes in anorectal manometric characteristics. Therefore electrotherapy may be
recommended as a treatment of choice for grades II and III uncomplicated internal
hemorrhoids. K eywords Electrotherapy; Manometry; Rubber band ligation;
Hemorrhoidectomy ..... Corresponding Author: Ahmad Izadpanah MD, Associate Professor,
Colorectal Surgery Department, Gastroenterohepatology Research Center, Shiraz University of
Medical Sciences, Shiraz, Iran. Tel: +98 711 6474263 Fax: +98 711 6474263 E-mail:
[email protected] Received: 22 September 2009 Accepted: 30 November 2009
ORIGINAL ARTICLE - The Effect of Weight Reduction on Ultrasonographic Findings
of Non Alcoholic Fatt
Description: SA Tahaei, N Sedighi, R Derogar, A Aslani, R Malekzadeh, S Merat .....
ABSTRACT ..... Background Non-alcoholic fatty liver (NAFL) includes a spectrum of
diseases ranging from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH) and
cirrhosis. NAFL is typically seen in association with obesity, diabetes and
hypertriglyceridaemia. In order to seek the role of diet therapy in treatment of NAFL, we
compared the ultrasonographic findings of patients with fatty liver disease before and after
standard diet therapy. Methods Twenty-three overweight or obese subjects with incidental
fatty liver discovered during ultrasonography were included. Subjects underwent 3 months of
diet therapy, and anthropometric data including weight, height, BMI, waist circumference, and
hip circumference were measured. Ultrasonographic findings were graded from 0 to 3.
Changes in ultrasonographic findings and anthropometric data were studied. Resultsts After
three months of dieting, the ultrasonographic grade of all patients decreased by one or two
grades. Fifteen patients decreased one grade while 8 others decreased by 2 grades. We
observed a significant correlation between the decrease in ultrasonographic grade and the
decrease in weight and BMI. Conclusion Our study indicates that standard diet therapy could
be used as an effective treatment for NAFL patients. K eywords Weight; Ultrasonography;
Nonalcoholic fatty liver - *Corresponding Author: Shahin Merat, MD, Shariati Hospital,
Tehran University of Medical Sciences, Tehran 14117, Iran TeleFax: +98 21 8801 2992 Email: [email protected] Received: 25 September 2009 Accepted: 10 December 2009
EDITORIAL - Dyspepsia: A Common Riddle in Practice, Both for Patients and Doctors
Description: F Barazandeh..... Corresponding Author: Farhad Barazandeh, MD, Fellow of
Gastroenterology and Hepatology, Digestive Diseases Research Center, Shariati Hospital,
Tehran University of Medical Sciences, Tehran, Iran Telefax: +98 21 82415000 Email:[email protected] Received: 10 October 2009 Accepted: 30 December 2009