Evaluating the efficacy of mixture of Boswellia carterii, Zingiber officinale, and Achillea millefolium on severity of symptoms, anxiety, and depression in irritable bowel syndrome patients.

BACKGROUND: Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorders (FGIDs) that affects in different aspects of life and patients experienced depression and anxiety more than others. There are several herbal medicines with positive effects in these patients. The aim of this study is to evaluate the effects of mixture of Boswellia carterii, Zingiber officinale, and Achillea Millefolium on severity of symptoms, anxiety, and depression in IBS patients. MATERIALS AND METHODS: This clinical trial study was done in sixty IBS patients (with mild-to-moderate symptoms) divided into two case and control groups. Patients were assessed at the beginning, 1 month, and 3 months after by IBS-severity scoring system (IBS-SSS) and Hospital Anxiety and Depression Scale. IBS-SSS is used for quality of life evaluation too. RESULTS: Sixty IBS patients (with mild to moderate symptoms) with a mean age of 38.75 ± 11.74 participated that 55.4% of cases and 72.8% of controls were men. The most prevalent type of IBS was the mixed type of IBS. The mean score of abdominal pain severity and frequency, bloating score, and depression and anxiety score were decreased in patients administered herbal medication, but changes in these variables in controls were not statistically significant. The changes in quality of life score between cases and controls were significant in men (P = 0.01) although it was not significant in women. CONCLUSION: A mixture of B. Carterii, Z. officinale, and A. millefolium is effective in eliminating IBS symptoms and its related depression and anxiety and using herbal medicine in IBS treatment is suggested.

Translation and validation of the Farsi version of Rome III diagnostic questionnaire for the adult functional gastrointestinal disorders.

BACKGROUND: The aim of this study was to validate the Farsi version of Rome III modular questionnaire which contains all functional gastrointestinal disorders (FGIDs). MATERIALS AND METHODS: We used Rome foundation guidelines for translation of English version into Farsi, and all the steps were performed. In the first step, 2 forward translations into Farsi were completed by two authors separately, and then translators, who participated in Step 1, together with our monitor, compared the two target-language versions and made some changes. The product of Phase 2 was translated back into English by an American-Iranian physician. The final step was comparison of the two English versions and validation of the translation. In this step, we compared the final version item by item, and also we used focus groups of patients after pretesting. RESULTS: Our results showed that FGIDs questionnaire diagnosed 153 patients among 169 patients who were diagnosed to have different types of FGIDs. The sensitivity of this questionnaire was 90.5%. It was determined that the odd questions' values of Cronbach's alpha was 0.77 (very reliable), and it was 0.71 (very reliable) in other sections. The split-half test reliability of whole items value was 0.72, which is statistically significant. CONCLUSION: Our findings showed that the Farsi version of Rome III diagnostic questionnaire for the adult functional gastrointestinal disorders demonstrated good validity and reliability and could be used in clinical studies.

Significance of pulmonary nodules in multi-detector computed tomography scan of noncancerous patients.

BACKGROUND: Computed tomography (CT) scan is one the most useful devices in chest imaging. CT scan can be used in mediastinal abnormality, lungs, and pleural evaluations. According to the high prevalence and different causes of pulmonary nodules, we designed this study to evaluate the prevalence and the types of pulmonary nodules in noncancerous patients who underwent chest multi-detector CT (MDCT) scan. MATERIALS AND METHODS: This was a cross-sectional study which was in our hospital to evaluate the prevalence of pulmonary nodules in noncancerous patients who underwent MDCT. A checklist was used for data collection containing number, location, size, and shape of pulmonary nodules if present in CT scan, and we also included patient's age and history of smoking. We analyzed the data with Statistical Program for Social Sciences software (version 18). RESULTS: In this study, 115 patients (40%) had a pulmonary nodule. The mean number of a total nodule in each patient was 0.8 ± 0.07. Mean number of intra-parenchymal, sub pleural, and perivascular nodules were 0.34 ± 0.04, 0.31 ± 0.04, and 0.14 ± 0.02, respectively. The mean number of calcified nodules was 0.13 ± 0.02. There was no significant correlation between age and nodule characteristics (P > 0.05). CONCLUSION: The prevalence of pulmonary nodules was quite frequent in MDCT scan of noncancerous cases. So, it should not be overvalued in noncancerous cases.

Adding diclofenac to Helicobacter pylori eradication regimen.

BACKGROUND: Helicobacter pylori colonizes not only on the surface of mucous membrane, but also beneath the surface mucous gel layer (SMGL). As diclofenac Na decreases the secretion of SMGL, in this study we examined this drug as an adjuvant therapy to a quadruple therapy for H. Pylori eradication. MATERIALS AND METHODS: One hundred and seventy-two patients were randomly assigned to three groups. Fifty four patients received quadruple therapy, that is, azithromycine 250 mg, amoxicillin 500 mg, bismuth subcitrate 240 mg, and omeprazole 20 mg bid for 1 week (group A) and 65 patients received the same dosage of those agents plus diclofenac Na tab, 100 mg daily for 1 week (group B). Sixty two patients received the quadruple therapy for 2 weeks (group C). Eradication of the infection was assessed 4-6 weeks after completion of treatment by stool antigen assay for H. pylori. RESULTS: While the rate of H. pylori eradication in the groups A and B was 66.7% and 82.1%, respectively (P = 0.062), the rate of H. pylori eradication in groups B and C were 82.1% and 82.3% respectively (P = 0.987). CONCLUSIONS: It seems that diclofenac Na can shorten anti-H. pylori regimens for 1 week. More investigations are needed for more clarification of the efficacy of NSAIDs for successful eradication of H. pylori. (IRCT code: IRCT201204059256N2).

Normal bladder wall thickness measurement in healthy Iranian children, a cross-sectional study.

BACKGROUND: Normal bladder function is necessary for micturition. Many causes such as urinary tract infection, bladder outlet obstruction, and neuropathic bladder can influence bladder wall thickness (BWT). This study was designed to determine normal BWT in Iranian children. MATERIALS AND METHODS: This was a cross-sectional study done in Isfahan in 2012 comprising 82 children aged 2-14 years without any urinary complaint. We measured thickness of posterior and lateral walls of the bladder in all children. Mean bladder wall thickness (MBWT) and mean bladder volume (BV) were also calculated. RESULTS: In this study, we included 82 children (40 boys and 42 girls). Patients' mean age was 6.43 ± 2.89 years, mean weight was 21.32 ± 8.40 kg, mean height was 111.57 ± 20.51 cm, and mean Body Mass Index was 17.12 ± 4.93. Mean lateral bladder wall thickness (LBWT) was 1.75 ± 0.32 mm and mean posterior bladder wall thickness (PBWT) was 1.59 ± 0.34 mm. Mean BV was 111.65 ± 72.11 ml and MBWT was 1.67 ± 0.28 mm. BVW all Index (BVWI) was 1249.05 ± 701.67. CONCLUSIONS: LBWT was1.75 ± 0.32 mm and PBWT was 1.59 ± 0.34 mm.

Performance evaluation of the suggestion system.

UNLABELLED: This cross-sectional research evaluated the suggestion system of Isfahan University of Medical Sciences (IUMS) using CIPP model. METHODS: The population consisted of all members of executive committee of suggestion system and the members of professional and general committee of IUMS; regarding to some limitations, sampling was not done. The tool of gathering data was a self-constructed questionnaire that its content validity approved by the professors' ideas, and calculating Cronbach's alpha confirmed its reliability. Collected data was analyzed using SPSS software. RESULTS AND DISCUSSION: Analyzed data showed that the average score of the performance of the mentioned system was 50.47 +/- 14.8; based on this result it can be claimed that most of the participants (about 91%) evaluated the performance of the system moderate. The comparison of the average score of the four dimensions of CIPP model showed that the input dimension had the highest score and process, product and context dimensions were next on the hierarchy. CONCLUSION: Planning some programs for paying awards, facilitating and accelerating the personnel's and notifying the procedures of the suggestion system implementation are some useful strategy that could be used to increase the staff's participants.

Evaluating the efficacy of Salsalate on prediabetic and diabetic patients with fatty liver: A randomized clinical trial.

OBJECTIVE: Nearly two-third of the patients with type 2 diabetes have degrees of fatty liver; this may induce some side effects in them. This study aimed to find effect of salsalate on treatment of steatohepatitis and correlation of fatty liver with metabolic syndrome in the setting of impaired glucose metabolism. METHODS: In a double-blind randomized trial within two distinct groups, i.e., recently diagnosed diabetics and prediabetic cases allocated in two arms of the intervention to receive 3 g salsalate or placebo. All cases underwent glucose and lipid level studies and liver ultrasound study. FINDINGS: Out of 46 patients with diabetes, 34 (74%) had fatty liver in ultrasound; this ratio was 75% in 113 prediabetic cases. Relative frequency of fatty liver stages did not differ between diabetics and prediabetics. Within diabetics, mean aspartate aminotransferase (AST) level of fatty liver cases (23 ± 7 IU/dl) was higher than others (18 ± 3 IU/dl) (P < 0.05). Changes in transaminase levels following intervention did not significantly differ, comparing drug and placebo arms in two subgroups. CONCLUSION: According to the findings, if diabetes could be assumed as the logical consequence of prediabetic state, it seems that fatty liver did develop before this preliminary status. In this study, salsalate could not change biochemical markers of fatty liver significantly.

Psychological evaluation in hemodialysis patients.

INTRODUCTION: End stage renal disease has a high burden of disease affecting patient's quality of life and this may dramatically shorten their life expectancy. These patients may be faced with serious stressors which are related to the disease and its treatment. Considering psychosocial problems in hemodialysis patients, we designed this study to evaluate depression, anxiety, social support and to determine temperament, character and correlation between these factors in hemodialysis patients. METHODS: This was a multicenter cross-sectional study which was done on 218 hemodialysis patients in Isfahan during April-July 2011. Depression, anxiety, social support, temperament and character were evaluated in patients using Hospital Anxiety and Depression Scale (HADS), Persian version of Multidimensional Scale of Perceived Social Support (MSPSS-P) and Temperament and Character Inventory (TCI) questionnaires. RESULTS: 138 (63.3%) subjects were male. Mean age was 58.18 +/- 14.3 years. 95 (43.6%) participants had depression and 94 (43.1%) had anxiety. Family support had the highest score between social support subscales. Family support was significantly correlated with self-directedness (p = 0.012), cooperativeness (p = 0.03), self-transcendence (p = 0.018), reward dependence and friends support (p = 0.036) and cooperativeness and others support (p = 0.049). CONCLUSION: Physicians should be aware of depression and anxiety in hemodialysis patients. Our results showed that patients had a supportive relation with their family and it could be because of Iranian culture and religious believes. In terms of temperament and character, patients were tolerant, supportive, humble and sociable.

Chronic abdominal wall pain: prevalence in out-patients.

BACKGROUND: Chronic abdominal wall pain (CAWP) is a frequent and confusing pain. It often leads to many diagnostic tests and sometimes some surgeries before an accurate diagnosis is achieved. Numerus had reported that patients with pain in abdominal wall are frequently treated like some one who is suffering from visceral pain. METHODS: This was a cross-sectional study that is done in Isfahan in a governmental clinic. In this epidemiological study we were evaluating the prevalence of chronic abdominal wall pain. The region of the pain, patient's sex, patient's age and their associated problems such as psychiatric disorders, obesity, IBS, functional bloating has been checked in patients. RESULTS: Thirty patients with abdominal pain originating from the abdominal wall were observed between 998 patients in a period of 3 months (3% of patients who were referred to gastroenterologist used to have CAWP). CONCLUSION: There are many reasons for chronic abdominal wall pain such as nerve entrapment or lesions of surgeries. Some times this problem makes patients to push the painful area and some times we could clearly see the hematoma in that region. For treating CAWP we can use a simple method and its injection. Pain could easily be relieved after one or more that one injection.

Upper functional gastrointestinal disorders in young adults.

BACKGROUND: Functional Gastrointestinal disorders (FGID) are common disorders in gastroenterology which are common in young adults. The aim of this study is evaluating the prevalence of upper FGID in iranian young adults. METHODS AND MATERIAL: This was a cross-sectional study which was on 995 persons who were going to marry. A ROME III based questionnaire was used to determine the frequency of upper GI Syndromes among the sample population. RESULTS: Our results determined 74 subjects had functional dyspepsia (36 subjects diagnosed as postprandial distress syndrome patient and Epigastric pain syndrome was seen in 38 subjects). Functional heartburn was diagnosed in 52 participants. Globus was seen in 35 subjects and 41 had unspecified excessive belching. DISCUSSION: Many epidemiologic studies were done all around the world but there are different reports about prevalence and incidence of FGIDs. Our results were agreed with reported prevalence of FGIDs in Iran in adults. And our findings were agreed with some other Asian studies.

The impact of productivity committees being established in different hospitals of the Isfahan University of Medical Sciences in 2008.

INTRODUCTION: One of the most important issues in today's health sector is productivity, and more attention should be paid to this topic by health managers and correspondingly by those in charge. It is believed that providing a suitable culture is necessary to improve productivity. We tried to provide this culture by establishing a Productivity Committee in different hospitals and academic medical centers of the Isfahan University of Medical Sciences (IUMS). The present study aimed to explore the managers' perspectives on the influences and roles of this productivity improvement committee. METHODOLOGY: This cross-sectional study was conducted in 2008. The study population included all managers of 30 hospitals and academic medical centers of the IUMS. Data were collected by questionnaire after having tested its validity and reliability and analyzed using SPSS software. RESULTS: From the perspective of the center's managers, establishing a productivity committee had a great deal of influence on improving the quality of the services provided. Influence on increasing income and customer satisfaction was ranked second, followed by the influence on decreasing costs. CONCLUSION: Alternatives such as conducting more training courses and workshops (about productivity) for managers and other decision makers, supervising the committees and their performance, establishing central productivity committees, issuing more guidelines and regulations are suggested to promote productivity in the health sector.

Change in functional bowel symptoms after prostatectomy: a case-control study.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that up to 20% of the population is suffering from it. Also benign prostatic hyperplasia (BPH) is a common problem that approximately 90 percent of men may be affected by this condition until the eighth decade of their life. Prostatectomy as a surgery and pelvic intervention can cause IBS. METHODS: It was a case-control study including 66 patients in 2 case groups and 66 patients in 2 control groups. Case groups were patients who underwent open prostatectomy and transurethral resection of the prostate (TURP) and control groups were patients who were candidate for prostatectomy. RESULTS: Ten patients in case groups and five patients in control groups had IBS. There was no significant difference in IBS between control and case groups (p = 0.117). CONCLUSIONS: This is the first forward study regarding bowel symptom changes following prostatectomy. The main positive finding of this study is that open prostatectomy was followed by significant increase in diarrhea and bowel habit alternation associated with onset of abdominal pain. Specifically the change was found after open operation but not after TURP. Prostatectomy whether in form of open or transurethral may cause onset of abdominal discomfort and bowel habit change.