Needlestick Injuries among Healthcare Workers: Why They Do Not Report their Incidence?

Background

Needlestick injuries (NSIs) among healthcare workers (HCWs) pose an important health challenge and several pieces of evidence show that in many cases HCWs do not report the injury.

Materials and Methods

This multicenter descriptive cross-sectional study was performed in eight teaching hospitals of Rasht, Iran. Using consecutive sampling methods, 1010 nurses were enrolled from October 2014 to January 2015. A three-part self-administered questionnaire was used. It included questions on demographic features, NSI-related questions, and questions on the knowledge of hepatitis B and C viruses (HCV, HBV).

Results

Among the 1010 participants, 580 (57.42%) showed a positive history of NSI; the total number of occurrences of NSI was 914. The major item causing NSI was the syringe with needle (315; 34.47%). In this way, NSIs occurred most frequently during recapping and injection [339 (37.10%) and 147 (16.10%), respectively]. Only 92 (10.07%) of all NSI positive participations had referred to the infection control units of their hospitals. The others mostly answered the question of "Why did you not report the incident?" with being too busy at work at the time of injury (140; 27.58%). The results showed that among participants with <5 years elapsed since their vaccination, the risk of NSI reduced to 60% [p < 0.02, odds ratio (OR) = 0.40, 95% confidence interval (CI) = 0.20-0.80].

Conclusions

It seems that NSI is still a major problem among nurses. Correspondingly, HCWs do not take the reporting system seriously and training them requires an ongoing activity in all hospitals.

The Incidence of Esophageal Cancer in Iran: A Systematic Review and Meta-analysis

Background: Esophageal Cancer (EC) is the eighth most common cancer in terms of incidence. Despite various studies, there is no general estimate of EC incidence in Iran. Therefore, the present study is conducted to evaluate the incidence rates of EC in Iran. Method: A systematic search was conducted on all published studies of EC incidence using Medline/PubMed, Scopus, Web of sciences, Google scholar, and four Iranian databases (Scientific Information Database, MagIran, IranMedex, and IranDoc) until November 2017. This systematic review was done according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Result: The database, grey literature searches, and hand searching yielded 346 potentially relevant studies. A total of 22 studies were included. The results of the random effect model were demonstrated the age-standardized rate (ASR) of EC was 25.05, 95% CI (20.84 to 29.26) among males and 22.93 95 % CI (18.97-26.88) among females. Conclusion: In comparison to other geographical locations, the incidence of EC is higher in Iran. However, organized system for collecting data of cancer is required to specify the incidence and trend of EC in Iran.

Intestinal tuberculosis in a 55-year-old woman with a 30-year history of rheumatoid arthritis

Introduction

Tuberculosis (TB) is one of the endemic diseases with a challenging diagnosis in the absence of pulmonary disease. On the other hand, rheumatoid arthritis (RA) is a systemic autoimmune disease with extra-articular manifestations that occur at any age after onset, such as nodules, Sjögren's syndrome, anemia of chronic disease, and pulmonary manifestations, which are more frequently seen in patients with severe, active disease. Here we present a case of RA with intestinal TB.

Case report

A 55-year-old woman with a 30-year history of RA using prednisolone and hydroxychloroquine presented with a nonpositional hypogastric pain and a weight loss of 20 kg over 7 months. No history of biological therapy was recorded. Colonoscopy revealed an ulcerated mass that was suspicious for malignancy. The pathobiological assessments confirmed ulceration and granulation tissue formation, foci of necrotizing granulomatous inflammation in lamina propria with adjacent mild crypt regenerative changes. Also, Ziehl-Neelsen staining for acid-fast bacilli in the granulomas was positive though the polymerase chain reaction assay did not detect the Mycobacterium tuberculosis. Anti-TB medication for 2 weeks eliminated the symptoms.

Conclusions

Intestinal TB in patients with vague abdominal symptoms and relevant physical findings such as pain and palpable mass should be considered to prevent late or misdiagnosis.

The role of anthropometric indices in the prediction of non-alcoholic fatty liver disease in the PERSIAN Guilan Cohort study (PGCS)

Introduction: Non-alcoholic fatty liver disease (NAFLD) is an obesity-associated health problem that causes other liver diseases for the patient. Four anthropometric indices: body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were analyzed as NAFLD predictors in the present study. Methods: From the total number of individuals who referred to the PERSIAN Guilan Cohort study (PGCS) located in the north of Iran during the period of study, a total of 960 people were enrolled in the present study. NAFLD was diagnosed using through an abdominal ultrasound exam. Height, weight, WC, BMI, WHR and WHtR were later calculated. Chi-square, ANOVA and logistic regression analyses were used to analyze the risk factors. Results: Out of the 960 individuals who were enrolled in the study, 597 (62.2%) were male and 363 (37.8%) were female (with an average age of 47.21 ± 7.29 years). There was a significant relationship between weight and NAFLD (P<0.001). There was also a significant relationship between BMI (OR= 8.41; 95% CI = 5.59-12.75), WC (OR= 2.67; 95% CI = 2.05-3.48), WHR (OR= 3.84; 95% CI = 2.26-6.52), WHtR (OR= 28.53; 95% CI = 6.94-117.31) and NAFLD (P<0.001). The results of the logistic regression analysis showed that WHtR, BMI and WC were effective predictors for the risk of NAFLD while WHtR played a more important role in the prediction of NAFLD. Conclusion: Anthropometric indices, especially WHtR, as a simple screening tool, seem to be an important criterion for the detection of NAFLD.

Green tea as a safe alternative approach for nonalcoholic fatty liver treatment: A systematic review and meta-analysis of clinical trials

This study aimed to evaluate the efficacy of green tea supplementation on nonalcoholic fatty liver disease treatment. Electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar, were systematically searched up to October 30, 2017, to identify eligible trials based on the inclusion criteria. The effect size was presented as mean difference with 95% confidence intervals (CI). The meta-analysis of data from four studies indicated significant effects of green tea supplementation in altering alanine aminotransferases (-12.81 U/L; 95% CI: -18.17 to -7.45) and aspartate aminotransferases (-10.91 U/L; 95% CI: -19.66 to -2.17) blood concentrations. Likewise, a favorable effect of green tea administration was observed on body mass index (-2.08 kg/cm² ; 95% CI: -2.81 to -1.36), triacylglycerol (-31.87 mg/dl; 95% CI: -40.62 to -23.12), total cholesterol (-27.57 mg/dl; 95% CI: -36.17 to -18.98), and low-density lipoprotein cholesterol (-14.15 mg/dl; 95% CI: -23.69 to -4.60), whereas no significant effect was detected on high-density lipoprotein cholesterol concentrations (7.41 mg/dl; 95% CI: -1.49 to 16.30) and homeostasis model assessment of insulin resistance (-4.06; 95% CI: -10.22 to 2.09). This systematic review and meta-analysis of available trials suggests that there  are potential benefits of green tea supplementation on nonalcoholic fatty liver disease.

Laboratory Tests, Liver Vessels Color Doppler Sonography, and FibroScan Findings in Patients with Nonalcoholic Fatty Liver Disease: An Observation Study

Objective

Determination of the amount of parenchymal damage in nonalcoholic fatty liver disease (NAFLD) is crucial to choose the best treatment and management.

Aim

Here, the associations between laboratory data and severity of steatosis and fibrosis plus hepatic vessel Doppler indices in NAFLD patients were investigated.

Patients and Methods

Fifty patients (20 males and 30 females) with NAFLD criteria were enrolled. Fatty liver was graded by sonography (SGFL) and FibroScan (FGFL). In addition, liver fibrosis was graded through FGLF. Damages to the portal, hepatic, and splenic veins were evaluated by color Doppler/dopplex. Serum liver enzymes and C-reactive protein (CRP) were also measured.

Results

Significant association existed between SGFL and FGFL (P = 0.006). Portal vein pulsatility index (PI) and phasicity plus the triphasic and monophasic pattern of hepatic veins significantly associated with fatty liver grade evaluated by sonography. Splenic vein Peak systolic velocity and PI showed significant association with FGFL. Eventually, elevated liver enzymes and CRP significantly correlated with FGLF.

Conclusion

We found that the severity of fatty liver is correlated with hepatic and portal veins damages; however, the degree of parenchymal fibrosis was independent to these indices and can be directly evaluated by FGFL. In addition, elevated liver enzymes and CRP correlated with the degree of fibrosis.

The PERSIAN Cohort: Providing the Evidence Needed for Healthcare Reform

In the past, communicable diseases caused the highest mortality in Iran. Improvements in socioeconomic status and living standards including access to safe drinking water, along with the inception of Health Houses in the 1980s, have changed disease patterns, decreasing the spread of and deaths from infectious and communicable diseases. The incidence and prevalence of non-communicable diseases (NCD), however, have now increased in Iran, accounting for nearly 80% of deaths and disabilities. Without interventions, NCD are predicted to impose a substantial human and economic burden in the next 2 decades. However, Iran's health system is not equipped with the necessary policies to combat this growth and must refocus and reform. Therefore, in the year 2013, the Ministry of Health and Medical Education funded a well-designed nationwide cohort study-Prospective Epidemiological Research Studies in IrAN (PERSIAN)-in order to assess the burden of NCD and investigate the risk factors associated with them in the different ethnicities and geographical areas of Iran. The PERSIAN Cohort, which aims to include 200000 participants, has 4 components: Adult (main), Birth, Youth and Elderly, which are being carried out in 22 different regions of Iran. Having an enormous dataset along with a biobank of blood, urine, hair and nail samples, the PERSIAN Cohort will serve as an important infrastructure for future implementation research and will provide the evidence needed for new healthcare policies in order to better control, manage and prevent NCD.

Stage Association of Preoperative Serum Carcinoembryonic Antigen with Gastric Adenocarcinoma in Iranian Patients

Background:

Gastric cancer is the second leading cause of cancer-related mortality and the fourth most common cancer globally. Tumor markers are needed for appropriate management and monitoring of treatment to improve quality of life. Recently, carcinoembryonic antigen (CEA) has been widely used as a tumor marker in the diagnosis and follow-up of some malignancies. The aim of this study was to evaluate the significance of CEA detection in the course of disease in gastric cancer patients at different stages.

Methods:

Seventy six cases of gastric adenocarcinoma from the Rasht Razi Hospital were studied between January 2016 and December 2016, along with a control group of 152 people. Serum CEA was measured by ELISA reader. Statistical analysis was performed using SPSS 14.0 for Windows (SPSS Inc., Chicago, USA). The two groups were also compared by cross-table analysis using Pearson’s chi-square test, with P-values <0.05 considered significant.

Results:

CEA was positive in 61.8 % of patients versus 2.6% of the control group (P = 0.0001). Some 21% of patients at stages I and II (initial disease) and 40.8% at stages III and IV (advanced disease) demonstrated positive CEA. which was significantly correlated with higher N stage and poor differentiation.

Conclusions:

Our study showed that a high preoperative CEA level was not prevalent in early stage gastric cancer patients. We recommend to design other prospective studies and meta-analyses for elucidation of claims for diagnostic efficacy.

Two center experience of capsule endoscopy in Iran: Report on 101 cases

Background: Capsule endoscopy (CE) is a minimally invasive method for the visual examination of the small intestine, which may be for the evaluation and follow-up of patients with Crohn's disease. It can also be used to look at mucosal inflammation. Methods: This cross sectional study was used to determine the diagnostic efficacy of the CE system by performing a cross-sectional study of cases from 2011-2014. This study involved a total of 101 Iranian patients who were referred to the gastrointestinal and liver diseases outpatient clinics in Guilan (northern Iran) and in Isfahan (central Iran) for complaints of gastrointestinal problems. For all patients, definitive diagnosis had failed with the use of other diagnostic tools and CE was performed. Descriptive analysis was used. The patient population was represented by men and women equally, and the mean age of the patients was 42.3 ± 17.2 years (range: 16-89 years). Results: The final diagnoses were: non-specific enteritis (30.6%), Crohn's disease (20.7%), ulcers caused by aspirin or non-steroidal anti-inflammatory drugs (8.9%), mucosal erosion (5.9%) and angioectasia (4.9%); nearly 10% of the patients had normal findings. Analysis of the distribution of chief presenting complaints with patients stratified by the final diagnosis of Crohn's disease showed that the most frequently presented chief complaint was abdominal pain 42.9% and the least frequently presented chief complaint was diarrhea (4.8%). Conclusions: Small bowel evaluation by CE was well tolerated and capable of diagnosing Crohn's disease and gastrointestinal bleeding in patients who failed other diagnostic tests.

Two center experience of capsule endoscopy in Iran: Report on 101 cases

Background: Capsule endoscopy (CE) is a minimally invasive method for the visual examination of the small intestine, which may be for the evaluation and follow-up of patients with Crohn's disease. It can also be used to look at mucosal inflammation. Methods: This cross sectional study was used to determine the diagnostic efficacy of the CE system by performing a cross-sectional study of cases from 2011-2014. This study involved a total of 101 Iranian patients who were referred to the gastrointestinal and liver diseases outpatient clinics in Guilan (northern Iran) and in Isfahan (central Iran) for complaints of gastrointestinal problems. For all patients, definitive diagnosis had failed with the use of other diagnostic tools and CE was performed. Descriptive analysis was used. The patient population was represented by men and women equally, and the mean age of the patients was 42.3 ± 17.2 years (range: 16-89 years). Results: The final diagnoses were: non-specific enteritis (30.6%), Crohn's disease (20.7%), ulcers caused by aspirin or non-steroidal anti-inflammatory drugs (8.9%), mucosal erosion (5.9%) and angioectasia (4.9%); nearly 10% of the patients had normal findings. Analysis of the distribution of chief presenting complaints with patients stratified by the final diagnosis of Crohn's disease showed that the most frequently presented chief complaint was abdominal pain 42.9% and the least frequently presented chief complaint was diarrhea (4.8%). Conclusions: Small bowel evaluation by CE was well tolerated and capable of diagnosing Crohn's disease and gastrointestinal bleeding in patients who failed other diagnostic tests.

Immune response to hepatitis B vaccine among north Iranian healthcare workers and its related factors

Introduction: Hepatitis B virus (HBV) is an important occupational risk among healthcare workers (HCWs). Vaccination is the most cost-effective method of preventing and controlling HBV infection. Several factors have been suggested to effect response to the vaccine. The present study aimed to evaluate vaccine response among north Iranian HCWs and to determine the factors influencing vaccine response. Methodology: Response to the standard three-dose vaccination regimen was evaluated in term of anti-hepatitis B surface antigen level among 1,010 HCWs using an enzyme-linked immunosorbent assay (ELISA) method. Logistic regression was applied to predict antibody response, with related factors including sex, age, years of working experience, marital status, history of transfusion, smoking, history of needle stick injury, rheumatic disease, steroid use, and elapsed time from vaccination measurement. Results: Of the 1,010 HCWs, 898 (88.9%) acquired protective levels of antibody (> 10 IU/mL). Compared with those < 30 years of age, HCWs older than 50 years and between 40 and 50 years of age were more likely to have non-protective anti-HBs levels (odds ratio = 4.48; p = 0.001 and odds ratio = 1.85; p = 0.03, respectively). Conclusions: HBV vaccine efficacy and immune response were satisfactory among north Iranian HCWs. Since it is predicted that anti-HBs levels decrease with aging, testing for anti-HBs titer is desirable for HCWs older than 50 years of age.

Nurses' Knowledge toward Hepatitis B and Hepatitis C in Guilan, Iran

Background:

Health care workers (HCWs) represent high risk population for viral hepatitis infection.

Objectives:

This study sought to assess the knowledge of HCWs regarding hepatitis B (HBV) and hepatitis C (HCV) infection.

Methods:

In a multi-center cross sectional study, all HCWs from eight teaching hospitals were invited to participate in the study and to fill in a self-administered questionnaire.

Results:

A total of 1008 eligible HCWs have responded to the study. A high proportion of the study participants (55.4% and 52.9%) had unsatisfactory knowledge about HBV and HCV. Mean knowledge score toward HBV was significantly higher among more educated staff, p <0.001 and vaccinated personnel, P=0.02. Majority of responders answered correctly to transmission questions toward HBV and HCV (90% and 80%, respectively). There was statistically significant difference in only transmission domain score between various hospitals (p<0.05). The highest scores were related to surgical hospital.

Conclusion:

Although more than ninety percent of our participants were educated about HBV and HCV, knowledge about nature of disease, prevention, treatment and vaccine availability was unsatisfactory. Continuous training program toward viral infection is a matter of necessity.

Clarithromycin versus Gemifloxacin in Quadruple Therapeutic Regimens for Helicobacter Pylori Infection Eradication

BACKGROUND Helicobacter pylori (H. pylori) infection is a major casual factor in any peptic diseases. Clarithromycin as one of the drugs recommended for the infection eradication regimen has shown different levels of resistance. The present study is comparing the effectiveness of clarithromycin- and gemifloxacin - based quadruple regimens in H. pylori eradication. METHODS This was a prospective double blind randomized clinical trial on patients with clear indication of H. pylori eradication. The patients were randomly divided into two groups: "BPAC group" treated with bismuth subcitrate (240 mg), pantoprazole (20 mg), amoxicillin (1 gr), and clarithromycin (500 mg), all twice daily, and the "BPAG group" treated with bismuth subcitrate, pantoprazole, and amoxicillin with same doses as "BPAC group" and gemifloxacin (320 mg daily) all for 10 days. Three months after the end of therapy, 14C-Urea breath test was performed to confirm the eradication. All the patients were assessed for compliance and drug side effects. Based on per-protocol (PP) and intention-to-treat (ITT) methods, data were analyzed and a P value<0.05 was considered as statistically significant. This project has been registered in the Iranian registry of clinical trials (IRCT). RESULTS Three patients were excluded from the survey and finally, 179 patients (89 patients in BPAC group and 90 patients in BPAG group) including 71(39.66%) men with the mean age of 46.4±12.3 years completed the treatment period. The incidence of side effects between the two study groups did not differ significantly. The success rate of BPAC regimen eradication was remarkably greater than BPAG regimen (ITT analysis; 89% vs 77%, respectively; CI 95%: 1.072-5.507, P<0.015 and PP analysis; 91% vs 77.8% respectively; CI 95%: P<0.015). There was no significant relationship between the demographic features and the eradication results. CONCLUSION The results showed that gemifloxacin is not a good alternative for clarithromycin in H. pylori eradication regimens in our region.

Inflammatory Myofibroblastic Tumors in a Case with Hypogastric Discomfort

Patient: Male, 68

Final Diagnosis: Inflammatory myofibroblastic tumor

Symptoms: 2–3 kg weight loss • Helicobacter pylori positive which were eradicated after treatment course • hypogastric region discomfort • no association between the pain, defecation and eating • no history of HIV, diabetes, smoking and alcohol consumption was recorded • no symptoms of nausea, vomiting, fever and shaking chills • normal vital signs • tenderness in the right lower quadrant of the abdomen with no rebound state was noted

Medication: —

Clinical Procedure: Lab examinationt-imaging-colonoscopy-surgery

Specialty: Gastroenterology and Hepatology

Innumerable Liver Masses in a Patient with Autoimmune Hepatitis and Primary Sclerosing Cholangitis Overlap Syndrome

BACKGROUND In patients with the diagnosis of autoimmune hepatitis (AIH), the presence of cholestatic features raise the possibility of an overlap syndrome with primary sclerosing cholangitis (PSC). Here, we present a unique case with AIH-PSC overlap syndrome and innumerable liver masses. CASE REPORT A 26-year-old man presented with generalized icterus. Based on the serological findings of hypergamainmunoglobulinemia and positive anti-nuclear antibody tests, together with an abnormal cholangiogram, he was diagnosed with overlap syndrome (AIH-PSC). Liver imaging revealed innumerable liver masses with a benign appearance in the pathological evaluation. To rule out the colon abnormalities that usually coexist with such liver masses, colonoscopy was performed and showed no significant changes. The liver masses were nonmalignant and were resolved after immunosuppressant therapy. CONCLUSIONS Because AIH-PSC overlap syndrome is rare, it is suggested that radiological evaluation of the biliary tree should be performed routinely in adults diagnosed with AIH to reduce the missed diagnosis of overlap syndrome and liver masses.

Dietary Patterns and Risk of Breast Cancer in Women in Guilan Province, Iran

BACKGROUND

Several studies have pointed to roles of dietary and food groups in the pathogenesis of breast cancer, but information on dietary patterns among women with breast cancer and their healthy counterparts in Iran is limited. Therefore the present investigation was conducted in Guilan province in 2014-2015.

MATERIALS AND METHODS

In a case-control study, 450 women with breast cancer and one of their relatives (third-rank) were investigated. At first the phone numbers of patients in Razi Hospital in radiotherapy and chemotherapy and oncology centers of Guilan were taken. Data were collected through telephone interviews by the researcher. The questionnaire had two parts comprising demographic clinical and food frequency data including a list of 40 food items. To analyze the variables, Chi-square test and univariate logistic regression models were used.

RESULTS

In each group, 225 subjects were investigated. The majority of samples in both groups of experiment and control were consumed than two glasses of milk and dairy products per day. Regarding consumption of meat and its products, 56% of the cancer group had more than three servings per day while 26.7% of the control group had less than 2 servings per day. The majority of subjects had less than six servings of cereal per day. Some 54. 7 % of the cancer and 62.2 % of the control group consumed less than two servings of fruit per day. Consumption of vegetables in experimental and control groups were 52.9% and 76.9% respectively, more than five servings per day. There was a meaningful difference between two groups regarding the consumption of milk and dairy items (OR=0.6,95%CI= 0.4-0.9), meat and its products (OR=0.49,95%CI=0.3-0.7), bread and cereals (OR=0.4,95%CI=0.2-0.8), vegetables (OR=0.5,95%CI= 0.3-0.9). (P-value<0.05).

CONCLUSIONS

The results of this study emphasize the importance of informing women, particularly those at higher risk of breast cancer, in relation to dietary factors.

The Investigation of Risk Factors Impacting Breast Cancer in Guilan Province

Introduction:

Breast cancer is multifactorial therefore more recognition of risk factors is important in its prevention.

Objective:

This study was conducted in order to determine the factors influencing breast cancer in women referred to health centers in Guilan province in 2015-2016.

Method:

In a case- control study, 225 women with breast cancer were investigated. The control group consisted of 225 healthy women of the relatives (third-rank) whose phone numbers were obtained from the patients. Data were collected through telephone interviews.

Results:

The risk of breast cancer raised in women who have a family history of other cancers (OR= 3.5; 95% CI= 1.96-6.6), exposure to X-Ray (OR= 2.5; 95% CI=1.1-5.5), having more than 4 children (OR= 2.695% CI=1.2-4.8), age more than 36 years at first pregnancy(OR=2.3; 95% CI=0.7-5.1), primary levelof education (OR= 5.4;95% CI=2.8-11.2) and inadequate intake of fruit (OR=1.5; 95% CI=1-2.2). Also, presence of the following factors reduced breast cancer risk: regular menstruation (OR= 0.66; CI=0.4-0.9), duration of breastfeeding more than 12 months, less than 6 months and 7-12 months (OR=0.23; 95% CI=0.09-0.59, OR=0.29; 95% CI=0.17-0.49 and OR=0.03; 95% CI=0.01-0.08) and parity (OR=0.4; 95% CI=0.27-0.83) In multiple linear regression analysis of higher education (OR=0.16; 95% CI=0.03-0.77), using contraceptives for more than 16 years (OR=2.3; 95% CI=1.4-3.9), family history of other cancers (OR=6.1; 95% CI=1.9-19.3) and a history of X-Ray exposure (OR=4.4; 95% CI=1.07-18.1) were considered as predictive factors.

Conclusion:

The results of this study emphasize the importance of informing women about breast cancer risk factors. So, identification of these risk factors is required as important means of prevention and treatment of breast cancer.

The Effect of Zinc Supplementationon the Symptoms of Gastroesophageal Reflux Disease; a Randomized Clinical Trial

BACKGROUND Currently, it has been demonstrated that gastroesophageal reflux disease (GERD) is one of the most important disorders of the digestive system and the commixture of regular diet has a significant influence on its incidence, symptoms, and prognosis. The purpose of this study was to evaluate the effect of zinc supplementation, in combination with PPIs(Proton pump inhibitors), on the improvement of GERD symptoms. METHODS In a randomized double blind clinical trial, patients with reflux symptoms, who had obtained Reflux Disease Questionnaire (RDQ) score more than 8, were included and all the demographic features were recorded. Then, using upper gastrointestinal (GI) endoscopy, all the patients were divided into two groups as having non-erosive reflux disorder (NERD),or erosive reflux disorder (ERD). At the next step, based on random block statistical method, we divided the two groups into two subgroups; the drug subgroup [treated with PPIs (40 mg pantoprazole/daily), changing life style, and 220 mgzinc capsules daily] and the placebo subgroup [treated with PPIs, changing life style, and placebo]. After 3 months, we analyzed all data and the RDQ questionnaire was filled out for each patient. This project has been registered in Iranian Registry of Clinical Trials (IRCT) and all data were analyzed using SPSS software version 2. RESULTS A total of 140 patients (81 women and 59 men) with mean age of 42.78±11.5 years were included with 70 patients in each group. The most frequent presentations were heart burn (45.7%), and acid regurgitation (39.3%). The RDQ scores decreased after intervention in both drug (p<0.001) and placebo groups (p<0.001), which were statistically significant. But the difference of RDQ scores between the drug group and placebo group was not statistically significant (p=0.086). CONCLUSION Zinc supplementation cannot improve the severity of GERD.

Suppository naproxen reduces incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial

AIM: To determine the efficacy of rectally administered naproxen for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

METHODS: This double-blind randomized control trial conducted from January 2013 to April 2014 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 324 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients received a single dose of Naproxen (500 mg; n = 162) or a placebo (n = 162) per rectum immediately before ERCP. The overall incidence of PEP, incidence of mild to severe PEP, serum amylase levels and adverse effects were measured. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and elevation of the serum amylase level to > 3 × the upper normal limit (60-100 IU/L) within 24 h after ERCP. The severity of PEP was classified according to the duration of therapeutic intervention for PEP: mild, 2-3 d; moderate 4-10 d; and severe, > 10 d and/or necessitated surgical or intensive treatment, or contributed to death.

RESULTS: PEP occurred in 12% (40/324) of participants, and was significantly more frequent in the placebo group compared to the naproxen group (P < 0.01). Of the participants, 25.9% (84/324) developed hyperamylasemia within 2 h of procedure completion, among whom only 35 cases belonged to the naproxen group (P < 0.01). The incidence of PEP was significantly higher in female sex, in patients receiving pancreatic duct injection, more than 3 times pancreatic duct cannulations, and ERCP duration more than 40 min (Ps < 0.01). There were no statistically significant differences between the groups regarding the procedures or factors that might increase the risk of PEP, sphincterotomy, precut requirement, biliary duct injection and number of pancreatic duct cannulations. In the subgroup of patients with pancreatic duct injection, the rate of pancreatitis in the naproxen group was significantly lower than that in the placebo (6 patients vs 23 patients, P < 0.01, RRR = 12%, AR = 0.3, 95%CI: 0.2-0.6). Naproxen reduced the PEP in patients with ≥ 3 pancreatic cannulations (P < 0.01, RRR = 25%, AR = 0.1, 95%CI: 0.1-0.4) and an ERCP duration > 40 min (P < 0.01, RRR = 20%, AR = 0.9, 95%CI: 0.4-1.2).

CONCLUSION: Single dose of suppository naproxen administered immediately before ERCP reduces the incidence of PEP.

Immune Responses to Single-Dose Versus Double-Dose Hepatitis B Vaccines in Healthcare Workers not Responding to the Primary Vaccine Series: A Randomized Clinical Trial

BACKGROUND

Recommendations to immunize healthcare workers (HCWs) against hepatitis B are well known. However, a proportion of individuals do not respond to the primary standard three-dose HB vaccination schedule.

OBJECTIVES

The current study aimed to evaluate whether a double-dose HB booster vaccine could induce better protective anti-HB titers than a single-dose booster in non-protected HCWs.

MATERIALS AND METHODS

This was a randomized clinical trial. A total of 91 HCWs not responding to the primary vaccine series in 2014 were enrolled. The participants were randomized into two groups that received a double dose of the HB vaccine containing 40 µg of antigen or a single dose of the HB vaccine containing 20 µg of antigen in three doses (at zero, one and six months after vaccination). Blood samples were collected before vaccinations and 28 days after the third dose to assess the seroconversion rate, according to the anti-HB antibody titer threshold of > 10 mIU/mL.

RESULTS

The seroconversion rates were 93.2% and 87.2% after the first booster doses of the double-dose and single-dose HB vaccines, respectively (P = 0.64). In the double-dose HB vaccine group, the seroconversion rate was 97.8% compared with 89.6% in the single-dose group following the second vaccine dose (P = 0.83). All of the participants in both groups were seroprotected after the third HB vaccine dose.

CONCLUSIONS

Both the single- and double-dose HB vaccines were adequately immunogenic, and the double-dose HB vaccine was not significantly more immunogenic than the single-dose vaccine in terms of the seroconversion rates of HCWs who had not responded to the primary vaccine series.

Does treatment of Helicobacter pylori infection reduce gastric precancerous lesions?

BACKGROUND

Treatment of Helicobacter pylori (H. pylori) decreases the prevalence of gastric cancer, and may inhibit gastric precancerous lesions progression into gastric cancer. The aim of this study was to determine the effect of treatment on subsequent gastric precancerous lesion development.

MATERIALS AND METHODS

We prospectively studied 27 patients who had low grade dysplasia at the time of enrollment, in addition to dysplasia atrophic gastritis and intestinal metaplasia observed in all patients. All were prescribed quadruple therapy to treat H. Pylori infection for 10 days. Patients underwent endoscopy with biopsy at enrollment and then at follow up two years later. Biopsy samples included five biopsies from the antrum of lesser curvature, antrum of greater curvature, angularis, body of stomach and fundus. RESULTS of these biopsies were compared before and after treatment.

RESULTS

Overall, the successful eradication rate after two years was 15/27 (55.6%). After antibiotic therapy, the number of patients with low grade dysplasia decreased significantly (p=0.03), also with reduction of the atrophic lesions (p=0.01), but not metaplasia.

CONCLUSIONS

Treatment of H. pylori likely is an effective therapy in preventing the development of subsequent gastric premalignant lesions.

Knowledge about Colorectal Cancer in Northern Iran: a Population-Based Telephone Survey

BACKGROUND

Colorectal cancer (CRC) is one of the most common malignancies of the gastrointestinal tract. The aim of this study was to assess the general knowledge of CRC in individuals living in Rasht, Iran, using a population-based cross-sectional telephone survey.

MATERIALS AND METHODS

A total of 1557 participants between 18 and 80 years of age were interviewed using random sampling from the telephone directory. Knowledge of risk factors, symptoms, diagnosis, and prevention of CRC was assessed using a validated questionnaire.

RESULTS

The mean knowledge level of the 1,557 respondents (average age 46 y) was 13.5 ± 4.29 (maximum possible score = 26), and 46.4% (722/1,557) of the subjects achieved grades lower than the mean score. The mean scores for knowledge of symptoms and risk factors were 3.97 ± 1.83 (range: 0-7) and 5.17 ± 1.65 (range: 0-9), respectively. Older age, higher education, and employment were significantly associated with better scores for recognition of risk factors and warning symptoms. The majority of subjects correctly identified weight loss (70.2%; 1,093/1,557) and rectal bleeding (63.3%; 986/1,557) as symptoms of CRC, and that smoking (85.9%; 1,337/1,557) and a low- fiber diet (73.4%; 1,143/1,557) were risk factors. Approximately half of the subjects noted increasing age, genetic background and fried food as other risk factors. A considerable number (54.8%; 853/1,557) identified colonoscopy as a screening method for detecting CRC in asymptomatic patients. However, a third of the subjects in the target group for screening (≥ 50 y) were not interested in undergoing screening, primarily due to a lack of symptoms.

CONCLUSIONS

Our results suggest that the knowledge of CRC is poor among the public, and therefore greater attempts should be made to increase awareness. Public education emphasizing the risk factors and symptoms of CRC, as well as the importance of regular screening regardless of the presence of symptoms, may help to reduce CRC morbidity and mortality.

Evaluations of life style factors and the severity of Gastroesophageal reflux disease; a case-control study

The incidence of Gastroesophageal reflux disease (GERD) has increased remarkably worldwide. This study focuses on the background features of these patients and evaluates the two GERD sub types; none erosive (NERD) and erosive (ERD). In a case-control study, patients with reflux symptoms who had obtained a total score of 8-18 of the GERD questionnaire were included. Control group consisted of their families with lower scores and no reflux presentations. All demographic features were recorded. Then upper GI endoscopy performed and the cases divided into two sub groups: NERD and ERD. In the next step, all demographic data analyzed for these two subgroups. The data were analyzed using the SPSS software version 21. A number of 210 subjects included in each group (210 patients with GERD and 210 control group) with normal statistical distribution of age and gender. There was a significant relationship between GERD and BMI (P=0.001), eating fatty foods (P=0.0001), lying after meal (P=0.0001), drinking beverages with meal (0.0001), eating spicy food (0.006) and NSAIDs use (P=0.0001). Then the cases divided into two subgroups; NERD (n=146) and ERD (n=64). There were a significant relationship with eating salty-smoky food (P=0.005) and eating spicy food (P=0.011). The difference of BMI between NERD and ERD was remarkable but was not statistically significant. Our results showed that obesity is an important risk factor for GERD. Other possible risk factors such as NSAIDs use and certain foods and wrong habits like lying after meal should be addressed in future longitudinal surveys.

Gallstone disease founded by ultrasonography in functional dyspepsia: prevalence and associated factors

The aim of this study was to evaluate the frequency of gallbladder stone in functional dyspepsia (FD) by abdominal ultrasonography and to determine the factors associated with this frequency in Guilan province. A total of 195 subjects who referred to outpatient clinic of Razi Hospital, a tertiary referral center (Guilan, Iran) to evaluate FD were included in this study. They were interviewed by using a questionnaire and underwent ultrasonography. Among the 195 subjects were 18.5% male and 81.5% female. The overall frequency of Gallstones (GS) was 19% (37/195) with 17% males and 83% female. In patients with dyspepsia, the presence of fatty liver evidenced by ultrasonography was 67% (131/195). From 131 patients with fatty liver disease 24 (18.3%) have been reported GS. The most frequent symptom in all participants as well as patients with GS and patients with fatty liver was abdominal pain (69.7%, 81% and 66%, respectively) followed by excess flatus. Risk factor associated with increased odds ratios (ORs) for the development of gall stones was diabetes mellitus (OR = 2.63). It also showed that gallbladder wall thickening was more common in patients with GS (OR = 36.63). GS disease was not significantly related to the age, gender, fatty liver, renal stone, history of hypertension (HTN) and hyperlipidemia (HLP), alcohol consumption and smoking status. Patients with FD especially if they have diabetes should be referred for upper abdominal ultrasonography for screening and early detection of GS disease.