Gastroenterology and Hepatology from Bed to Bench

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Hydatidosis, caused by Echinococcus granulosus is one of the most important zoonotic diseases, throughout most parts of the world. Hydatidosis is endemic in Iran and responsible for approximately 1% of admission to surgical wards. There are extensive genetic variations within E. granulosus and 10 different genotypes (G1–G10) within this parasite have been reported. Identification of strains is important for improvement of control and prevention of the disease. No new review article presented the situation of Echinococcus granulosus genotypes in Iran in the recent years; therefore in this paper we reviewed the different studies regarding Echinococcus granulosus genotypes in Iran.

Portfolios are increasingly used in postgraduate medical education and in gastroenterology training as an assessment tool, as documentation of competence, a database of procedure experience (for example endoscopy experience) and for revalidation purposes. In this paper the educational theory behind their use is described and the evidence for their use is discussed.

Aim: This study was performed to determine the effect of health education on the improvement of intake of fruits and vegetables aiming at preventing colorectal cancer among high school girls in the city of Shahr-e-kord.

Background: Colorectal cancer is one of the most important and most common cancers and the second leading cause of cancer death worldwide. Every year, nearly one million new cases of colorectal cancer are recognized around the world and nearly half of them lose their lives due to the disease.

Patients and methods: 130 students were randomly divided to two groups, which experimental (65) and controls (65) were chosen from the city of Shahr-e-kord for this experimental study. The instruments for data collecting were self-made questionnaire health belief model based and food frequency questionnaire. The HBM FFQ questionnaires were completed before, immediately and two months after education by participants. After pre-test, 5 educational session classes in experimental group were performed. Finally, data collected and analyzed by SPSS16 computer software (T- test, T-Paired, repeated measure ANOVA).

Results: Findings of the study showed that before the intervention there was no significant differences between the scores of different structures of HBM model in two groups (P>0.05), after the intervention there was significant differences between experimental and control groups in the levels of knowledge, structures of HBM model and performance for preventing colorectal cancer (p<0.001).

Conclusion: Performing educational programs based on health belief model increases the knowledge and improves the attitudes and practices of students regarding prevention of the colorectal cancer.

Aim: The present study aimed to investigate the influence of histological factors on survival of patients with esophageal cancer.

Background: Esophageal cancer is almost the common form of malignancy in the eastern world.

Patients and methods: Through a retrospective cohort study a consecutive series of 134 patients with definite diagnosis of esophageal cancer who had been hospitalized at the Towhid hospital, Sanandaj city, Kurdistan province western Iran during a five-year period from 2006 onward were recruited. The survival time of patients stratified by this grouping method were analyzed by Kaplan-Meier analysis and Cox regression.

Results: Overall, 127 males (55.1%), with a mean age of 65.38 ±11.62 years were included. Based on histological type of tumor, 23 patients (18.1%) had adenocarcinoma (AC) and 94 patients (74.0%) had squamous cell carcinoma (SCC). Gender was not significantly associated with survival (Log rank =0.480). Location of tumor (log rank=0.014), histological type (log rank ?0.001) and grade of tumor (log rank =0.008) had significantly influenced the survival rates variation. For patients at initial stages of the disease, the overall one-year, two years and five years survival rates were 73.2%, 52.8% and 31.2% respectively. For advanced stages, the survival ranged from 46.3% in the first year to 8.2% in the five years. The five-year survival rates (by year) were estimated to be 49%, 27%, 24%, 22% and 19% respectively.

Conclusion: Tumor grade, tumor deferential, clinical staging and location of the tumor were the prognostic factors for survival in patients with esophageal cancer.

Aim: The aim of this study was to compare the long-term effects of cognitive-behavioral treatment and mindfulness-based treatment on decreasing symptoms of patients suffering from irritable bowel syndrome (IBS).

Background: One of the most modern therapies put forward in therapy of IBS is mindfulness-based metacognitive therapy.

Patients and methods: In this quasi-experimental study, 36 people with mean age of 32 years old, including 24 patients with IBS and 12 healthy normal subjects as control group, were studied. Patients with IBS were randomly divided into two experimental groups of cognitive-behavioral treatment (n=12) and mindfulness-based treatment (n=12). Data were analysed by one-way covariance analysis.

Results: There was significant decrease of the symptoms of IBS among two treatment groups versus control group in long-term (p<0.05). Mindfulness-based therapy was the most effective technique in decreasing symptoms.

Conclusion: This study showed mindfulness-based therapy, as a modern psychotherapy technique, is an effective method to decrease symptoms of patients with irritable bowel syndrome, compared with old methods. Therefore, this technique is advised among these patients, especially those who have refractory symptoms.

Aim: The aim of this study is evaluation of molecular assay and the standard staining method.

Background: Cryptosporidium is a protozoon from coccidian subclass, which is one of the most important causes of diarrhea in children and immunocompromised individuals around the world. Diagnosis and treatment are necessary for mentioned cases. Usual diagnostic method for this parasite is fecal smear preparation, modified ziehl-neelsen staining, microscopic consideration and oocyst observation.

Patients and methods: A totally of 2510 stool samples collected from children with diarrhea of 4 pediatric hospitals. Direct smears prepared from fresh fecal samples and from the sediment of formalin-ether method of the same samples. The smears stained with modified ziehl-neelsen method then considered with microscope. The 30 positive samples with staining method considered with DNA extraction and PCR method for cryptosporidiosis infection determination and sensitivity evaluation. 114 random negative samples considered with DNA extraction and PCR method for cryptosporidiosis infection diagnosis and specificity evaluation.

Results: 30 positive cases from 2510 fecal samples detected by modified ziehl-neelsen staining and PCR method. We did not have any false positive cases by staining method but 2 cases of negative samples by staining method were positive by PCR technique, which informed us of 2 false negative . The positive samples sequenced for reconfirmation.

Conclusion: Thus, sensitivity of staining method was computed to be 94% and specificity was 100% but sensitivity and specificity of PCR method was calculated to be 100%.

Aim: The aim of this study was to investigate the frequency of betalactamase producing EAEC isolates among young children with diarrhea in Zanjan, Iran.

Background: Entero aggregative Escherichia coli (EAEC) is an emerging enteric pathogen associated with acute and persistent diarrhea and the evolution and spread of acquired extended spectrum betalactamases (ESBLs) among these strains has become a serious problem in the management of infectious diseases in developing countries.

Patients and methods: During the period from March 2011 to January 2012, 140 isolates of E. coli from diarrheal children aged 0–60 months and 90 isolates from age-matched controls without diarrhea were investigated for EAEC using PCR. Antimicrobial susceptibility testing was performed as CLSI guidelines and betalactamase genes, including bla_TEM, bla_CTX-M, bla_IMP, bla_VIM and bla_NDM-1 investigated in EAEC isolates.

Results: In this study, EAEC was detected with slightly higher frequency in children with (8%) than in children without (4.6%) diarrhea (P>0.05). Diarrheagenic E. coli exhibited high level resistance to aztreonam (80.7%), amoxicillin (74.4%) and tetracycline (69.3%). Also, 86.4% of E. coli isolates were resistant to at least three different classes of antimicrobial agents and considered as multidrug resistance. Molecular characterization of betalactamase genes showed that bla_TEM was the most frequently isolated betalactamase. It was detected in 78.9% of ESBL producing EAEC isolates. Also, the frequency of bla_CTX-M was 63.1% (12/19) and 8 (42.1%) isolates carried the bla_TEM and bla_CTX-M, simultaneously. None MBL producing EAEC was detected in our study.

Conclusion: Our results indicate that ESBLs especially bla_TEM and bla_CTX-M are widespread among EAEC isolates and appropriate surveillance and control measures are essential to prevent further dissemination of betalactamases in our country.

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