GOVARESH Journal
Year:2021 | Volume:26 | Issue:1|Papers Count:8

Over the past two decades, non-alcoholic fatty liver disease )NAFLD) has progressed from a relatively unknown disease to one of the leading causes of chronic liver disease with an increasing prevalence that can lead to cirrhosis and liver failure. Due to the obesity prevalence and the increasing prevalence of metabolic syndrome, non-alcoholic fatty liver and its progressive form, Non-Alcoholic Steatohepatitis )NASH), is more common in different parts of the world. However, there is no exact and noninvasive way to diagnose this disease. It is estimated that the obesity prevalence will continue to exacerbate non-alcoholic fatty liver prevalence and its long-term complications, leading to enormous clinical and economic burdens. This article reviews the epidemiology of non-alcoholic fatty liver disease in Iran and the world and related risk factors. Google Scholar and PubMed databases were used to identify studies on the epidemiology of non-alcoholic fatty liver worldwide.

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. Conclusion: 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: The aim of this study was to compare the effectiveness of "cognitive-behavioral therapy" (CBT) and "emotion-focused therapy" (EFT) on quality of life (QOL) in patients with irritable bowel syndrome. Materials and Methods: Consenting irritable bowel syndrome patients referring to a specialized clinic for gastroenterology in Tehran, Iran (Masoud Clinic) were enrolled in a randomized, controlled study using pre-test, post-test and follow-up assessments. The participants were randomly allocated to one of the three treatment groups: the first group received eight weeks of weekly CBT, the second group received eight weeks of weekly EFT, and the third group received their usual care without any specialized psychological intervention (control). The measurement tool of this study was the specific QOL test for patients with IBS (IBS-QOL). Twofactor analysis of variance with repeated measures (mixed analysis of variance), and one-way covariance analysis were used for analysis as appropriated. Results: We found that CBT and EFT both had a significant effect on improving QOL in the post-test and follow-up phase, but CBT was not effective on the component of sexual concerns with respect to the QOL of patients with IBS. Conclusion: Therefore, CBT and EFT affect the quality of life of patients with IBS, but CBT did not affect the sexual anxiety component of QOL in these patients. EFT was a more appropriate approach and has a long-lasting effect.

Background: About one-third of patients with cirrhosis have gallstones. Gallstones in these patients are often asymptomatic and discovered incidentally, and only 1– 2% per year will develop complications. We aimed to assess the frequency of gallstone complications in Egyptian patients with cirrhosis and compare them to gallstone complications in those without cirrhosis. Materials and Methods: Our study included 120 patients with first-time discovered gallstones. They were selected from patients admitted to the outpatient clinic or the Tropical Medicine Department of Zagazig University, Egypt. They were classified into two groups. The first group comprised 60 patients with cirrhosis with gallstones and the second group comprised 60 healthy individuals with gallstones. Risk factors of gallstones were assessed. Upon admission, all patients underwent a thorough history and clinical examination. Moreover, liver function tests and pelviabdominal ultrasound were done and triglyceride and amylase levels were measured to confirm the presence of gallstones. They were followed up for five years to assess the frequency of gallstone complications. Results: The group with cirrhosis had significantly lower gallstone complications than the non-cirrhotic group (8% vs. 41%, p < 0. 001) as regard the overall complications after 5 years of follow-up. We found that there was a significant difference regarding each complication separately. Acute cholecystitis was (5% vs. 16. 7%, p = 0. 03). Acute pancreatitis was (1. 6% vs. 13. 3%, p = 0. 01). Obstructive jaundice was (1. 6% vs. 11. 7%, p = 0. 02). Conclusion: Our study revealed that the frequency of gallstones complications in patients with cirrhosis was much lower than patients without cirrhosis with gallstones after 5 years of follow-up.

Background: To the best of our knowledge, we do not have enough data on the rate of intra-abdominal sarcoma (IaS) and retroperitoneal sarcoma (RPS) in Iran compared to other countries. We aimed to report a 10-year survey on the incidence and demographic characteristics or potential risk factors of RPS and IaS in Iranian patients in a population-based study setting. Materials and Methods: This descriptive-analytic, cross-sectional study was performed during 2009-2014 to evaluate the incidence of sarcomas in Iranian patients in different provinces under the supervision of the Cancer Research Center of Shahid Beheshti University of Medical Sciences. 2142 patients were included in this study. Demographic data of the patients including age, sex, and year of diagnosis, as well as primary tumor location and recurrence tumor site, tumor morphology, and tumor grade after clinical and pathological examinations were collected. Six-digit codes for histological grading and differentiation were used to evaluate the tumor grade. Data were entered into SPSS software, version 22, and analyzed. Results: In this study, data of 2142 patients were included and evaluated. Of the patients with soft tissue sarcoma, 993 (46. 4%) were women and 1149 (53. 6%) were men. Among the patients, 109 (5. 1%) were children, 1450 (67. 7%) were adults, and 583 (27. 2%) were in the elderly age group. The peak frequency of soft tissue sarcoma was 237 (11. 1%) in the 50-54 year-old age group, with the highest rate in 40-69 year-olds and the lowest in the age range of 5 to 14 years. The morphology of soft sarcomas was evaluated, gastrointestinal stromal sarcoma (16. 9%, n = 362) being the most common, followed by sarcoma (9. 9%, n = 212), spindle cell sarcoma (9. 9%, n = 211), leiomyosarcoma (7. 7%, n = 166%) and liposarcoma not otherwise specified (6. 2%, n = 133) were the four most common types. The morphology of the tumors was also evaluated by age and sex, which was statistically significant. gastrointestinal stromal sarcoma has the highest sex-specific incidence in patients with sarcoma, in other words, during the six years of our study, the sex-specific incidence rate for gastrointestinal stromal sarcoma were 163. 14 cases per 1000 patients with sarcoma for women, and the sex-specific incidence was 174. 6 for men. In patients less than 15 years old, the desmoplastic small round cell tumor morphology had the highest specific incidence, which was 201. 83 per 1000 patients with soft tissue sarcoma in this age group. Conclusion: Our study data show that the four most common types of soft tissue sarcomas in our country are gastrointestinal stromal sarcoma, followed by sarcoma, spindle cell sarcoma, leiomyosarcoma, and liposarcoma NOS and The peak age range of this sarcomas was 50-54 years.

Background: Gastroesophageal reflux disease (GERD) is a common gastrointestinal complaint in the adult population worldwide; nevertheless, few studies have assessed this disorder among medical students. The stress, lifestyle, and burdensome educational curriculum exposes this particular population to GERD. To the best of our knowledge, there was no information about the frequency of GERD in Iranian medical students. We aimed to assess the prevalence of GERD as well as its risk factors among the medical students. Materials and Methods: In this cross-sectional study, the symptoms of GERD were investigated among 290 medical students using the frequency scale for the symptoms of gastroesophageal reflux (FSSG) at Isfahan University of Medical Sciences during 2018-2019. Additional information, including age, sex, body mass index (BMI), and studying grade, were entered in the checklist. Results: Among the studied population, 104 (36. 55%) students had GERD. Heartburn was associated with studying grade (p =0. 022) and BMI (p < 0. 001). Esophageal regurgitation was related to BMI only (p < 0. 001). The logistic regression evaluations revealed overweight (p < 0. 001; OR: 14. 49; 95%CI: 7. 29-28. 81), obesity (p < 0. 001; OR: 14. 16; 95%CI: 4. 38-45. 74), studying the physiopathology course (p < 0. 001; OR: 5. 05; 95%CI: 2. 07-12. 30) and being in the stagership period (p = 0. 007; OR: 3. 50; 95%CI: 1. 41-8. 64) were independent predictors of heartburn, while overweight (p < 0. 001; OR: 8. 33; 95%CI: 4. 26-16. 28), obesity (p < 0. 001; OR: 54. 87; 95%CI: 11. 31266. 10) and being in the stagership period (p = 0. 024; OR: 2. 89; 95%CI: 0. 87-6. 22) were the predictors for esophageal regurgitation. Conclusion: Based on this study, GERD was prevalent among the medical students, and factors, including BMI and studying grade, were predictors of its incidence.

Fibrosarcoma is one of the least common primary malignant tumors of skeleton-formative tissue. Also, primary esophagus squamous cell carcinoma (SCC) is a rare tumor accounting for 0. 05– 4% of all esophageal malignancies with aggressive behavior and poor prognosis. In this study, we aimed to present a 40-year-old man with the co-incidence of SCC and fibrosarcoma. Case presentation: A 40-year-old man presented to the gastrointestinal clinic of Imam Khomeini Hospital Complex complaining about a three-month abdominal pain and progressive dysphagia. He also complained of severe pain in both flanks, dark color urine with blood clots, and a 10-kg weight loss in the past two months. A spiral CT scan revealed a 14×15×13 cm 3 lobulated solid mass in the right side of the pelvic. The pathology described malignant neoplastic tissue composed of cells with large hyperchromatic pleomorphic nuclei. Fibrosarcoma was diagnosed according to immunohistochemistry (IHC) results and morphology. The endoscopy noted a 5 cm ulcerative mass in the esophagus, which occupied less than 50% of the lumen. The pathology showed squamous cell carcinoma from the esophageal mass biopsy. Diagnostic laparoscopy denied any peritoneal seeding and liver or kidney metastases. We planned to conduct neoadjuvant chemoradiotherapy (cisplatin plus etoposide, and 40Gy external beam radiation therapy) and surgery for his esophageal SCC and radiotherapy for Fibrosarcoma. This is the first report of the second primary esophageal SCC after fibrosarcoma in a 40-year-old man with no noticeable predisposing factor (such as smoking, immune modulator drug, radiation exposure, etc. ). Further studies are needed for developing intervention strategies to reduce the risk or to improve the treatment of multiple primary neoplasms.

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.