Gastroenterology and Hepatology from Bed to Bench

Aim: In the current study, we aimed at identifying independent laboratory parameter to predict liver damage.

Background: Although liver biopsy is frequently recommended in assessing disease severity and selecting antiviral treatment candidates, it has several limitations.

Patients and methods: A total of 527 patients with untreated chronic hepatitis B virus infection were selected. A percutaneous liver biopsy was obtained. All of the patients were graded and staged for liver fibrosis (1-6) and inflammatory activity (1-18). Complete blood count,   biochemical blood tests and   Serum viral markers were detected for these patients.

Results: 106 patients had moderate to severe necroinflammatory activity. Compared to patients with mild activity, this group was older and had significantly higher aspartate aminotransferase (AST), alanine aminotrasferase (ALT), alkaline phosphatase (Alk. P) and AST to platelet ratio index (APRI) and significantly lowers hemoglobin (Hb), fasting blood sugar (FBS) and platelet (PLT). By multiple regressions analysis Hb, AST, FBS and PLT were independently predictive of moderate to severe necroinflammatory activity. 109 patients had moderate to severe fibrosis. Compared to patients with mild fibrosis, the former patients were older. In addition, the mean of AST, ALT, PT and APRI were significantly higher, and WBC, serum Alb and PLT were significantly lower in patients with moderate to severe fibrosis. Also by multiple regressions analysis age, AST, serum Alb and PLT were independently predictive of moderate to severe fibrosis.

Emerging new medications in the treatment of HBV produces hope and promises for curing of HBV. Over the past decade, the development of oral nucleoside/nucleotide analogs (NAs) with favorable potencies and tolerabilities has led to substantial advances in chronic hepatitis B (CHB) therapy. The oral anti-HBV agents currently approved are lamivudine, adefovir dipivoxil , entecavir , telbivudine, clevudine, and tenofovir. Treatment algorithms have been developed to assist in identification of suitable candidates for treatment and to determine and initiate appropriate treatment. In this review the problem of drug resistance in the course of chronic hepatitis B treatment are discussed in detail from both aspects of clinical and genetics.

Aim: To determine the co-incidence of gallstones with upper GI disease in patients who were candidate for elective cholecystectomy.

Background: Typical pain of gallstones frequently cause special pattern which can usually be distinguished from symptoms of other organic and functional diseases. But patient with cholelithiasis and atypical pattern of abdominal pain seems to bring about a challenging clinical problem to the surgeon.

Patients and methods: We designed a retrospective study to evaluate clinically and pathologically 360 patients whom were presented to Shohadaye Tajrish hospital with sonographic documented gallstones which were selected for elective cholecystectomy by the surgeon. They have also undergone esophagogastroduodenoscopy (EGD) before their cholecystectomy operation as a part of their routine preoperational evaluations, between April 2001 and March 2006. Endoscopic examination was performed for all treated patients 1 to 4 days before their operations.

Results: Among these 360 patients, 178 patients (49.4 %) experienced atypical abdominal pain, the other 182 patients (50.6 %) presented with typical abdominal pain. These two groups were comparable in sex and age. From those with typical pattern of pain, only one had positive findings in EGD (0.54 %) while among the 178 patients with atypical pain, 148 (83 %) had abnormal findings in EGD (p<0.001). The surgery was postponed for patients with ulcer, and anti ulcer treatment was started. In 16 patients, the symptoms associated with colelithiasis subsided after healing of the ulcer. Of 178 patients with atypical pain, 11 cases (6 %) exhibited evidences of malignancy in their upper gastrointestinal (GI) pathology. Cholelithiasis in these two last patients was incidental finding, and a cholecystectomy was not performed.

Aim: To determine the prevalence of constipation and its associated factors using Rome III criteria in Iranian population.

Background: Due to the appearance of Amoxicillin-resistant H. pylori strains all over the world, the decreased efficacy of conventional Amoxicillin-containing treatment regimens has become a matter of concern.

Patients and methods: A cross-sectional study conducted in Tehran province from May 2006 to December 2007, including 18180 adult persons. In the first part of interview, characteristics and gastrointestinal symptoms were considered Those who reported at least one symptom referred for the second interview consisted of questions about different gastrointestinal disorders based on Rome III criteria.

Results: 6.33% of interviewees reported constipation and 2.41% had functional constipation (3.5% women and 1.3% men). The prevalence of constipation increases in the group older than 50 years. Constipation was more common in none or low educated than educated groups.

Aim: The aim of this study is to determine the prevalence and genotype of human caliciviruses among children suffering from acute gastroenteritis referred to Masih Daneshvari Hospital.

Background: Human caliciviruses have been recognized as the major viral cause of acute gastroenteritis in all age groups worldwide. Studies revealed that the noroviruses and sapoviruses could be divided into five genogroups.

Patients and methods: A total of 47 fecal samples were collected from children up to 17 years of age, with acute gastroenteritis from 2006 to 2008. RT nested- PCR was performed for screening. To genotype the norovirus and sapovirus isolates, some positive samples were subjected to phylogenetic analysis by sequencing of fragments of viral capsid gene region.

Results: The noroviruses and sapoviruses were detected in 21.3% and 2.1% of samples, respectively. The phylogenetic analysis revealed that isolates belong to genotype GII.4 and GII.3. The sole isolate of sapovirus belongs to GI/2 genogroup.

Conclusion: Our results show that calciviruses are indeed a major cause of acute gastroenteritis in children.

There is a worldwide concern about the existing curricula of Medical Education (ME) and its effectiveness in producing capable graduates. The current wonder is about the outcome of medical schools conducting their educational programs based on such curricula and whether they are competent enough to meet today's health problems and disease control. Knowledge, skills and attitude of the graduates compose the extent of their competence as physicians are the elements to be considered in the development of medical curriculum. Despite the fact that these essential elements of education are well realized by most academicians for almost a century, today the numbers of institutions that have incorporated these elements in their curriculum development are not very many.The majority of medical schools worldwide still lack a well defined "Reform" in their medical education curricula that can cover the abovementioned domains of effective medical education.Quite number of national, regional and international congregations emphasiz(ing)ed a serious action to be taken on the issue of "Reform" in ME. According to the currently available theories in education and effective learning the outcome of the educational process should posse two essential characteristics namely: "LONG LIFE" and "LIFE LONG" knowledge. The Quality Assurance (QA) of the learning process demands planners and designers of Educational Programs (EPs) to mastery the knowledge of education and to be more familiar with the elements that make the learners firmly informed, skilled enough and confident to make the right decisions. Learner centered EPs provide the opportunity for paced thinking strategies that help the learner to develop thinking skills hence better conceptualization of the learning issue(s). Innovative approaches in ME like Organ Based (OB) or Clinical Presentation (CP) curricula are among methods utilized in the "Reform" practice. These new approaches rely heavily on the "Horizontal" and "Vertical" integration of basic and clinical contents of the EP. Add to these issues the emphasis on the "Social Accountability" of medical schools and the way this is translated into practical and cognitive contexts.The latter will add to the quality of the graduate physicians as major players in the society's health status and promotion.It should be emphasized that reform in ME is a necessity today yet the same time a task that demands heavy efforts. An outcome based ME program and curriculum requires the gathering of large number of staff in both basic medical and clinical sciences who should be well informed in the theories of effective learning and education in order to compose a curriculum that can produce physicians who are well equipped with medical knowledge and at the same time have promotional impact on individual and society's health.

The clinical environment remains a key area for learning, and practitioners continue to make a huge contribution to the education of students. Varieties of theories of learning are available for trainers to use in medical education, it is very important to identify the principles of learning and understand how individual differences affect the learning process. It is interesting to think about your own particular way of learning and to recognize that everyone does not learn the way we do. In this review the Behaviorism and Humanism theories have been explored within the field of learning. The distinction made between these two major approaches would seem to suggest that each might be appropriate for different kinds of learning situations. This way, educators who understand the rational behind each of the two theories are provided with some key information for structuring their teaching around teaching models which can be the most successful for particular kind of learning.

Aim: The aim of study was to determine the preliminary result of treatment with pegasys in Iranian chronic hepatitis B patients (with genotype D) referred to Tehran Hepatitis center (THC).

Background: The genotype of HBV and ethnicity of the patients can affect the response rate to pegasys.

Patients and methods: During 2006-2008, 12 Patients with naïve chronic hepatitis B (genotype D) that referred to THC and candidate for treatment were consequently enrolled in this cross sectional study. All of the patients signed the written consent to enter the study. They were treated weekly with 180 microgram of pegylated interferon- alpha 2a (pegasys) subcutaneously. They were visited monthly during their treatment and follow up course in THC. The safety of treatment, the end of treatment response, the relapse rate and the sustained virologic response were measured in these patients.

Results: The end of treatment response rate was 83.3% in total. In patients who had end treatment response, the relapse rate was 50% (4/8) among HBeAg negative patients and 75% (3/4) among HBeAg positive patients. The sustained virologic response rate in this study was 41.6%.