Govaresh

Background: Chronic constipation is a common problem in children, which may last for years and cause unpleasant effects on the patients’ and their family’s lives. Timely treatment can reduce the costs and complications. Re-admissions not only have a negative impact on the quality of life of the patients and their family but also has an adverse economic impact on the health system. Therefore, this study was conducted to determine the frequency of constipation re-admissions and some related factors in Motahari Hospital of Urmia from 2013 to 2019. Materials and Methods: In this descriptive-analytical study, 1045 cases of constipated children were investigated from the beginning of 2013 to the end of 2019. At first, a checklist containing demographic information and clinical characteristics of all children admitted with constipation was prepared and completed, and then data were analyzed using SPSS software version 23. Results: Out of 1045 children with constipation, 48% were male, and 52% were female with a mean age of 5/1±2/92 years. 73.4% were urban, and 26.6% were rural residents, and 14% of the children were admitted more than once during 6 years. There was a significant relationship between age, weight, height, parental education, and place of residence with re-admissions in children with chronic constipation ( p <0.05). Conclusion: The findings of this study showed that the cornerstone of re-admissions due to chronic constipation in children might be multifactorial and needs complete evaluation of social, behavioral and health status of children.

Background : Different studies have reported the association between gastroesophageal reflux disease (GERD) and non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome. This association is considered either body mass index (BMI) related or independent of BMI. In the current study, we aimed to illustrate the correlation between GERD symptoms and NAFLD and to determine the role of BMI in this regard. Materials and Methods : This study was conducted on 332 out-patients referred to the clinics affiliated to Imam Khomeini and Imam Reza Hospitals in Kermanshah in 2015-2016 who were divided into two groups of patients with NAFLD and without NAFLD. The two groups were investigated and compared for symptoms of GERD. The confounding effect of BMI and sex were eliminated in this study by multiple logistic regression. Results: The prevalence of heartburn, belching, nausea and vomiting, and hypertension (HTN) was higher in patients with NAFLD (P<0.05). Moreover, these four variables were still associated with NAFLD after eliminating the BMI and sex confounding effect by multiple logistic regression model. Conclusion: Some GERD symptoms are related to NAFLD regardless of BMI effect.

Background: The aim of this study was to examine the prevalence of restless legs syndrome amongst patients with inflammatory bowel disease. Materials and Methods: Participants were 384 patients aged more than 18 years who had a history of admission with a diagnosis of inflammatory bowel disease (IBD) in the gastroenterology hospital in Guilan, Iran. The diagnosis of restless legs syndrome (RLS) was confirmed based on DSM-V, and its severity was identified using the International Restless Legs Scale (IRLS) questionnaire. The participants were assigned into two groups; patients with a history of IBD and RLS (n=61) and IBD without RLS (n=323). The prevalence of RLS, as well as demographic variables, have been analyzed between groups using the Chi-square test. Results: The prevalence of RLS was 15.9%. It was significantly higher in; women (P=0.042), primary/secondary, and high school graduates ( p <0.0001), married ( p =0.011), and retired ( p =0.021) patients. The prevalence of RLS in patients affected with anemia was significantly more ( p =0.043). Increasing age (OR=1.06) and the duration of IBD (OR=1.08) were associated with increased risk of RLS. Conclusion: Our findings indicate RLS frequently happens in patients with IBD. As RLS can affect sleep quality, it should be considered as one of the causes of sleep disturbance in patients with IBD.

کیفیت مقوله ای است که ارتقاء آن منجر به بهبود ارائه خدمات درمانی به بیمار می شود که در نهایت منجر به بهتر شدن پیشگاهی بیماری خواهد شد در استرالیا و نیوزیلند به عنوان کشورهایی با بیشترین شیوع سرطان کولورکتال در جهان، هزینه زیادی جهت بهبود ارائه خدمات آندوسکوپی انجام می گیرد. در این راستا بهبود کیفیت کولونوسکوپی باعث افزایش تشخیص زودرس پولیپ ها و سرطان کولون و در نهایت بهتر شدن پیش آگهی بیماران می گردد و بارمالی سرطان های کولورکتال (اعمال جراحی ,بستری در بیمارستان ,هزینه شیمی درمانی) بر سیستم بهداشت و درمان کمتر خواهد شد.

Celiac disease (CD) is a systemic disease that is triggered by gluten consumption in genetically susceptible patients, with a predominance approximating nearly 1% of the overall community. Although CD primarily involves the small intestine, it may also affect other bodily systems and present as a disease outside of the gastrointestinal tract. Therefore, individuals who have CD might visit a physician for appraisal of several hematological issues before reaching the diagnosis of CD. Secondary anemia due to vitamin B12 and folic acid deficiency or due to malabsorption of iron are frequent problems in CD. In addition, individuals may reveal thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and thrombocytosis. These hematological changes may represent the distinctive features of the disease and should cue the physician to test for CD in a suggestive clinical setting. Identification of non-typical extraintestinal manifestations, including hematologic ones, could provide a significant chance to increase the rate of CD diagnosis, as this disease is grouped with the most underdiagnosed chronic intestinal disorders throughout the world. This review summarizes new evidence concerning the hematological manifestations of CD, and concentrates on applicable recommendations for physicians.

Background: Prediction for diseases and health issues using Web information diffusion is the main aim in infodemiology studies. This study’s goal is to give a raw estimation of people with inflammatory bowel diseases (IBDs) for all provinces in Iran. Material and Methods: The data for this analytical cross-sectional study was collected using Google Trends (GTr). Three keywords of “Inflammatory Bowel Disease”, “Crohn’s Disease”, and “Ulcerous Colit” were searched through. The results were limited to the geographical region of Iran from 1/1/2010 to 12/31/2018. The retrieved data saved to a local drive in Excel and analyzed through SPSS software version 23. Results: Overall searches for IBDs showed a significant (P=0.0) trend during the studied course of time. There was no significant relationship between the number of searches, applied keywords, and various seasons. The largest number of searches for IBDs keywords came from Ardebil, Gilan, and East-Azarbaijan provinces. Conclusion: This study revealed an increasing search rate for IBDs among Iranian clients from 2010 to 2018. The increased number of searches for Crohn’s disease compared with ulcerous colitis from 2016 onward is likely a wise estimation of disease spread in the country.

Background: The present study was conducted with the aim of comparing the effects of cognitive-behavioral therapy (CBT) and emotion-focused therapy (EFT) on distress tolerance in patients with irritable bowel syndrome (IBS). Methods: The present study was conducted using a quasi-experimental method with a pretest-posttest design, follow-up, and a control group. The statistical population of the present study included IBS patients referred to Masoud Gastroenterology and Liver Clinic in Tehran, Iran. From among these patients, 35 patients were randomly selected and were assigned to 3 groups (2 experimental groups and 1 control group). The experimental groups took part in 8 weekly sessions of CBT or EFT and the control group did not receive any psychological intervention. The Distress Tolerance Scale (DTS) (Simons‎ & Gaher, 2005) was used as the measurement instrument in this study. Two-factor repeated measures analysis of variance (mixed ANOVA) and one-way analysis of covariance (ANCOVA) were used to analyze the data. Results: The results revealed that CBT and EFT were effective on the distress tolerance of IBS patients and both therapies had a lasting effect over time. There was no significant difference between the effects of the two methods on distress tolerance. Conclusion: CBT and EFT are effective interventions in enhancing the distress tolerance of IBS patients and these interventions can be used in programs designed to manage the symptoms of this disease.

Benign esophageal stricture caused by corrosive substance can be treated successfully with endoscopic dilation using bougies or balloons but approximately one-third of patients develop recurrent stenosis. We report a case of lower third benign esophageal stricture presented with severe dysphagia, passive and active regurgitation caused by ingestion of a corrosive substance (aluminium phosphide) which was refractory to multiple dilation with balloons and bougies and migration of fully covered metal stent. After two courses of intralesional 40 mg methyl prednisolone acetate injection with two weeks interval and serial dilation, symptoms improved without restenosis. So a less frequent injection-dilation schedule with longer intervals may also effective for refractory esophageal stricture induced by corrosive agents.

Background Multiple sclerosis (MS) is a common chronic demyelinating disease of the central nervous system with various potential etiology, including infectious disease. The number of studies on the association between Helicobacter pylori ( H. pylori ) infection and MS is limited. So, in this study, we aimed to assess the relation between H. pylori infection and MS in Kerman city, the center of the largest province in Iran. Materials and Methods : In a case-control study, 71 patients with newly diagnosed MS and 145 sex- and age-matched controls were included. Blood samples for IgG anti-HP antibodies were collected from all individuals. SPSS software version 22 was used for data analysis. P 25 ( p =0.074). H. pylori seropositivity was observed in 61.97% of the MS group compared with 76.55% of the non-MS group ( p =0.021). Conclusion : We concluded that patients with newly diagnosed MS had low H. pylori seropositivity, so H. pylori infection may have a protective effect against MS.

Laryngeal cysts are rare lesions and makeup about 5% of benign laryngeal lesions. These cysts are often asymptomatic in adults but they can present with dysphonia, dyspnea, dysphagia, odynophagia, stridor, cough, foreign body sensation, airway obstruction, and even hemoptysis. A 17-year-old girl complained of dysphagia a month earlier, and also a foreign body sensation in her throat, and of mild intermittent dysphonia. The patient underwent laryngoscopy, and a large cystic-like lesion measuring approximately 3.3 cm was observed on the lingual surface of the epiglottis extending to the vulva. Computed tomography of the neck was requested without contrast, in which a cystic lesion measuring 27 × 31 × 34(Mm) was found in the hypopharynx connected to the epiglottis and extending to the vulva. The patient underwent oxygenated lesions, after which the patient's symptoms greatly improved. Laryngeal cysts in adults are often asymptomatic and are accidentally detected, but in any case with dysphagia, dysphonia, cough, odynophagia, and foreign body sensation in the throat, epiglottis cysts and the laryngeal area should be considered. Such a diagnosis should be considered among differential diagnoses.

Fibrosarcoma is one of the least common primary malignant tumors of skeleto-formative tissue, compare to osteogenic sarcoma and chondrosarcoma .It is defined as a highly malignant mesenchymal tumor originating from hyper-proliferating, transformed and spindle-shaped fibroblasts.Esophageal cancer is the sixth leading causes of cancer-related mortality according to WHO report .There many different risk factors for these two distinct type of cancers which are not related to each other.This case report describes co-incidence of SCC and fibrosarcoma as rare malignancies, in a Turkish 40-year old man living in suburban of Tehran.

Background: Recognition of influential factors is necessary for predicting the severity of cholecystectomy. We aimed to evaluate the diagnostic power of the proposed scoring system for predicting the severity of laparoscopic cholecystectomy. Materials and Methods: In this cross-sectional study, there were 122 patients who underwent cholecystectomy in Shahid Beheshti Hospital during 2018. Prior to surgery, accurate history, and clinical, laboratory, and ultrasound information were recorded and scored on a checklist. Finally, the difficulty of cholecystectomy was divided into three categories of easy (less than 60 minutes, uncomplicated) and difficult (between 60 and 90 minutes, divided into controllable) and very difficult (between 90 and 120 minutes with uncontrollable complications or open surgery). Data were analyzed in SPSS software, version 22, and the indicators were calculated for the purpose of the study. Results: There were 28 (22.4%) men and 97 (77.6%) women. The mean±SD ages of the patients in easy and difficult operations were 44.71±13.56 and 44.52. 14.56 years, respectively ( p =0.939). The patients’ sex and history of acute cholecystitis attacks did not have a significant relationship with the difficulty of laparoscopic cholecystectomy ( p ≥0.05). However, between the palpable gallbladder ( p <0.0001), impacted stone ( p <0.0001), gallbladder wall thickness ( p <0.0001), and body mass index above 30 ( p <0.0001) there was a statistically significant relationship between the difficulty of operation. There was also a significant relationship between AST ( p =0.034), T Bill ( p =0.008) WBC ( p <0.0001), and the difficulty of laparoscopic cholecystectomy, but between ALT ( p =0.065), the severity of cholecystectomy was not significantly related. Sensitivity (86%), specificity (58%), positive predictive value (44%) and negative predictive value (91%) were calculated for the scoring system for the difficulty of laparoscopic cholecystectomy. Conclusions: To predict the difficulty of laparoscopic cholecystectomy, we strongly recommend the preoperative scoring system. It is also recommended to conduct further studies on the use of the scoring system during surgery.

Background: Primary liver cancer is one of the most malignant and deadly cancers, which reduces the quality of life. Health-related quality of life (HRQOL) is an important criterion for evaluating the health care, controlling diseases, outcomes, benefits, and disadvantages of treatments, quality of medical treatment and nursing care, and screening individuals at risk for physical and psychological problems. The aim of this study was to investigate the predictive factors of HRQOL in patients with liver cancer. The results of this study can improve the quality of life of the patients and the level of health care. Materials and Methods : This study was performed on 272 patients referred to Imam Khomeini Hospital in Tehran (2018-2019), by using convenience sampling method. For assessing patients, we used Function Assessment Cancer Therapy, Hospital Anxiety and Depression Scale, Fatigue Severity Scale, Edmonton Symptoms Assessment Scale, and Characteristics Demographic. Data were collected in two stages (before and one month after treatment). In order to validate these tools, previous studies were cited and their reliability was assessed by test-retest. Data were analyzed by using SPSS software version 21. Descriptive statistics, correlation test, paired t test, and linear regression were used as appropriated. Results : The mean HRQOL score in patients with liver cancer was 58.11 (±17.31). Effective factors in HRQOL was the type of treatment, physical and psychological consequences, and some demographic characteristics. Conclusion: The present study showed that many factors can predict HRQOL in patient with liver cancer. Also, awareness of these factors provides the basis for developing effective care plans to promote HRQOL and increase life expectancy in affected patients. These factors are very important because based on them HRQOL of patient with liver cancer can be estimated with 59/8% accuracy.

Background: Considering the potential role of zinc deficiency in the quality of life of patients with cirrhosis and complications of the disease, in the present study we aimed to assess the prevalence of zinc deficiency and its relation to the stage of the disease and complications in the affected patients. Materials and Methods: In this cross-sectional study, 76 patients with cirrhosis from Qom, Iran, were included during a 1-year period. Data including the level of liver stiffness, severity of the liver disease based on Child-Pugh, MELD(Model for End-Stage Liver Disease), APRI(Aspartate aminotransferase to Platelet Ratio Index), AAR( A spartate aminotransferase to alanine aminotransferase ratio), FIB-4 (Fibrosis-4), and King scoring systems, and complications including hepatic encephalopathy, were collected by a checklist and were analyzed by using SPSS software version 21. Independent samples t test and Pearson correlation coefficient were used appropriately and p <0.05 was considered significant. Results: Of the 76 patients, 50 were men and 26 were women with a mean age of 49.46 ± 14.53 years and mean liver stiffness of 28.29±16.11 kPa in fibroscan. The mean serum level of zinc was 78.4±18.1 µg/dL, which was significantly higher in patients with child A than patients with child B and C classes ( p =0.007). This finding was significant in other scoring systems including AAR ( p =0.020), KING ( p =0.000), MELD ( p =0.004), and FIB-4 ( p =0.006). No significant relation was detected between serum zinc level and hepatic encephalopathy, bleeding from esophageal varices, and spontaneous bacterial peritonitis. Conclusion: Severity of zinc deficiency is related to the severity of liver cirrhosis but is not related to complications.

Leiomyosarcoma of vascular origin is a rare malignant tumor. Inferior vena cava (IVC) is the most common site of vascular leiomyosarcomas. Leiomyosarcoma of IVC is predominantly seen in middle-aged women presenting with non-specific symptoms and clinical findings. Herein, we report a case of leiomyosarcoma of IVC in a 44-year-old woman presented with progressive abdominal discomfort and postprandial vomiting. Laboratory results were in favor of acute liver injury. Imagings revealed a retroperitoneal mass and enhancement in almost the total course of inferior vena cava with extension into both renal veins and right atrium. Histopathological examination showed a malignant spindle cell tumor and immunohistochemistry confirmed smooth muscle origin of the tumor.

This guideline was developed to assure the highest level of protection against COVID-19 for both patients and health care providers in endoscopy departments while providing high quality and timely gastroenterology care during the current COVID-19 pandemic. We electronically searched the databases of PubMed, Google Scholar, and MedRxiv up to April 10, 2020. Then, a questionnaire was designed based on available documents and international recommendations. Three Delphi rounds were conducted via online forms. Eighteen statements were developed on risk stratification of patients and procedures and recommendations for performing necessary procedures while safeguarding patients, nurses, physicians and other service providers with appropriate use of personal protection equipment, sanitizing of environments and redesigning the endoscopy suits. Considering the dynamic of COVID-19 pandemic in the world and Iran, this guideline will be updated online as needed.

Background: One of the common diseases is fatty liver disease, which can be seen significantly in patients with excessive obesity as well as patients with diabetes. Using ultrasound imaging methods, it can be possible to identify and evaluate patients affected by this disease. The aim of this study was to use advanced machine learning algorithms for better and more accurate classification of the acquired images from different patients affected by fatty liver disease. Materials and Methods: In this study, the acquired ultrasound images of 55 patients suspicious as having fatty liver disease have been used. The level of fat for different patients was labeled by biopsy sampling. Based on this experiment, the patients were predicated as having a fatty liver when more than 5% of their liver hepatocytes were accompanied by infiltration of fat. Then, we utilized some pre-trained convolutional neural networks, including Inception-ResNetV2, GoogleNet, and AlexNet to extract high-level features of the collection of the acquired images. After that, a SoftMax layer was implemented to classify the images that indicated fatty liver. Results: The resulted precisions for Inception-ResNetV2, GoogleNet, and AlexNet pre-trained convolutional networks were 0.8108, 0.9459, and 0.9932, respectively. Also, the area under the curve of receiver operating characteristics (AUC) for these networks were 0.9757, 0.9960, and 0.9963, respectively. Conclusions: The proposed intelligent algorithm can help sonography experts to recognize the liver tissues with fat automatically and accurately without the need for a specialist to assign the region of interest for evaluation.

Ascariasis is a helminthic infection of humans caused by the nematode Ascaris lumbricoides. A 25-year-old woman with a gestational age of 17 weeks presented with acute onset abdominal pain with nausea and vomiting. Clinical and sonographic evaluations were supportive of acute bowel obstruction and small intestine intussusception due to Ascaris lumbricoides who undergone treatment during pregnancy. As intestinal obstruction is a rare but serious event in pregnancy, the importance of a high index of suspicion in the evaluation of abdominal pain in pregnancy is emphasized. The usefulness of ultrasonography in the early diagnosis of intussusception in pregnancy is discussed.