Adaptation of Clinical Practice Guideline for Colorectal Cancer Screening in People with Average Risk in Isfahan Province.

Background: Colorectal cancer (CRC) is the third most common cancer among adults in Iran. The aim of colorectal cancer screening is to reduce the cancer burden in the population by diagnosing the disease in its early stages. Methods: We adapted this guideline for the moderate CRC risk population for Isfahan to determine how to screen them and when to start and end the CRC screening. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of Iranian association of gastroenterology and hepatology. Results: In screening people with average risk for CRC who use personal resources and personally pay all the costs, colonoscopy is recommended as the first choice to be done every 10 years. In case of negative colonoscopy, we recommend FIT test to prevention of interval cancer every 5 years. In screening of people with average risk of CRC, FIT is suggested to be done every 2 years as a first-choice method test for those who use public resources and do not pay for this service personally. In screening individuals with average risk for CRC, g-FOBT is not recommended as the first method of choice. Repeating positive guaiac test is not recommended and if positive, colonoscopy is suggested.

Effects of coenzyme Q10 supplementation on C-reactive protein and homocysteine as the inflammatory markers in hemodialysis patients; a randomized clinical trial.

BACKGROUND: The most leading cause of death in end-stage renal disease (ESRD) patients are cardiovascular disease and inflammatory markers are related to coronary events. CO-Q10 (coenzyme Q10) is a protective supplement from free radical oxidative damage. In addition, hyperhomocysteinemia is an independent coronary artery disease (CAD) risk factor. OBJECTIVES: Due to increasing oxidative stress in dialysis patients, and the effect of CO-Q10 in decrease oxidative stress, in this work, we assessed the effect of CO-Q10 on C-reactive protein (CRP) level as an inflammatory marker and homocysteine in dialysis patients. PATIENTS AND METHODS: This was a single-blind, randomized cross over clinical trial. Patients with ESRD were randomly allotted to two groups. All patients received placebo and C0- Q10 100mg/d during the three months in each stage, with two week washout period. Plasma level of CRP and homocysteine from the start of the work and at the conclusion of each menses, are evaluated. RESULTS: Thirty-four patients randomized, but 26 patients complete study protocol. The treatment effect of CO-Q10 on CRP level is significant (P < 0.001) (95% CI = -20.1 to -10.5) and it was also significant for the increasing albumin level. (P = 0.044) (95% CI = 0. 0-0.6), But there was not any substantial effect on serum homocysteine level (P = 0.630). CONCLUSIONS: CO-Q10 could significantly decrease CRP level as an inflammatory marker and can protect cardiovascular events.

Secondary Sclerosing Cholangitis and Hodgkin's Lymphoma.

CONTEXT: Liver damage is relatively common in patients affected by HL, but paraneoplastic cholestasis is an uncommon presenting symptom in HL. CASE REPORT: We report the case of a 38-year-old man who came to our hospital with jaundice, pruritis, nausea, vomiting, weight loss, and recurrent episodes of fever without any hepatosplenomegaly or lymphadenopathy. Laboratory findings showed abnormal liver functioning with mixed hepatocellular and cholestatic patterns. Sonographic evaluation of the biliary tract was normal. We ruled out viral infections, autoimmune process, and hemochromatosis. The patient was put on ursobile and NAC (N-acetyl-systeine) and prednisolone treatment. In magnetic resonance cholangiopancreatography examination, there were multiple strictures in the intrahepatic and extrahepatic bile ducts with mild dilatation. Histologic finding of liver biopsy was compatible with sclerosing cholangitis or drug-induced cholestasis. General condition and laboratory examination results of the patient became better, but we found lymph-adenopathy on monthly follow-up examination. Histological finding of the lymph node was compatible with HL. CONCLUSION: This report emphasizes that HL can be presented with different paraneoplastic symptoms and that one of them is secondary sclerosing cholangitis. It has better prognosis than vanishing bile duct syndrome, and perhaps steroid treatment can be suggested.

Psychometric properties of the Female Sexual Distress Scale-Revised among a sample of non-clinical Iranian women.

OBJECTIVE: The present study aimed to investigate the psychometric properties of a Persian version of the Female Sexual Distress Scale-Revised (P-FSDS-R) among a sample of healthy Iranian women. METHODS: A total of 562 healthy Iranian women completed a battery of questionnaires, including the P-FSDS-R, Depression Anxiety Stress Scales (DASS), Positive and Negative Affect Scales (PANAS) and Locke-Wallace-Marital Adjustment Test (LWMAT). The factor structure and the convergent and divergent validity of the P-FSDS-R were examined, using exploratory and confirmatory factor analysis and Pearson product-moment correlations, respectively. To examine the discriminant validity of the P-FSDS-R, data collected from 562 healthy participants were compared with data from 108 women with sexual problems who completed the P-FSDS-R measure. RESULTS: The results of exploratory and confirmatory factor analyses indicate that the P-FSDS-R is conceptualized within a one - factor model. The results also indicate that the P-FSDS-R has good internal consistency and test-retest reliability. Significant correlations in the predicted directions between the P-FSDS-R scores and the scores of DASS, PANAS and LWMAT support both the convergent and divergent validity of the FSDS-R. The results also indicate that the scores of the P-FSDS-R tests significantly differentiated women with and without sexual problems. CONCLUSIONS: In general, these findings support the reliability and the validity of the P-FSDS-R among Iranian women.

Spironolactone in chronic hemodialysis patients improves cardiac function.

We performed this study to assess whether low dose spironolactone could be administered in hemodialysis (HD) patients with moderate to severe heart failure to improve cardiovascular function and reduce hospitalization without inducing hyperkalemia. We enrolled 16 chronic HD patients with moderate to severe heart failure and left ventricle ejection fraction :5 45%. In a double blinded randomized placebo controlled study, one group of 8 patients received 25 mg of spironolactone after each dialysis session within six months, and the rest received a placebo. Echocardiography was performed on all the patients to assess ejection fraction and left ventricular mass during 12 hours after completion of hemodialysis at the beginning and the end of study. Serum potassium was measured predialysis every 4 weeks. The mean ejection fraction increased significantly more in spironolactone group during the study period than in the placebo group (6.2 +/- 1.64 vs. 0.83 +/- 4.9, P= 0.046). The mean left ventricular mass decreased in the spironolactone group, but increased significantly in the placebo group during the period (-8.4 +/- 4.72 vs. 3 +/- 7.97. 95%, P= 0.021). The incidence of hyperkalemia was not significantly increased in the study or controlled groups. In conclusion, we found in this study that administration of spironolactone in chronic HD patients with moderate to severe heart failure substantially improved their cardiac function and decreases left ventricular mass without development of significant hyperkalemia.