Search

Introduction: Since spinal anesthesia is a suitable method for terminating pregnancy in hospitalized pregnant women with Covid-19 and this method is associated with complications that Corona virus and Covid 19 may increase their severity, this study was performed aimed to evaluate the complications of spinal anesthesia after cesarean section in hospitalized women with COVID-19. Methods: This case-control study was performed in 2020-2021 with participation of 150 pregnant women (with and without Covid-19) who are candidates for cesarean section by spinal anesthesia in the teaching hospitals of Tabriz University of Medical Sciences. The complications such as shivering, pruritus, hypotension, decreased heart rate, increased need for hypoxemia requiring oxygen therapy, urinary retention, headache during anesthesia, recovery and up to 12 hours after discharge from recovery was compared between the subjects. Data were analyzed by SPSS software (version 25) and Chi-square and t-test. P

Introduction: Knowledge of medical students is usually assessed by exams, but it is not related to their sense of readiness. Self-assessment is one of the methods for measuring medical professional readiness that has been less considered in medical education. This study aimed to determine the degree of acquisition of professional skills of medical interns in the management of inpatients through self-assessment in the internal ward. Methods: In this cross-sectional descriptive study, 115 selected medical interns of Shahid Sadoughi Medical School in Yazd participated by census in 2017. Ability to manage internal diseases was assessed by self-reported. The internist experts confirmed questionnaire validity and reliability (Cronbachchr('39')s alpha: 0.76-0.93). Data were analyzed using descriptive statistics and chi-square test by SPSS. Result: The highest expressed ability by interns was for management of gastrointestinal (63.9%), respiratory (62.3%), and cardiovascular disease (56.1%). They had the lowest ability for endocrine diseases (49.8%). The highest ability to manage gastrointestinal bleeding (65.8%), chest pain (64.3%), abdominal pain and reflux (62.5%), nausea/vomiting (61.6%), and diabetes (61.4%) was stated. 94.7% have sufficient skills to take a history and 85.6% follow medical ethics. The least expressed ability was in drug prescribing and patient decision-making. Conclusion: In 23% of common diseases, 50% of interns can manage disorders independently, which indicates that interns do not consider themselves capable of managing them. The professors must consider Self-assessment and evaluation in prioritizing internship training topics, especially clinical skills.

Introduction: The clinical features of celiac disease vary. Common classic signs and symptoms include diarrhea, weight loss, and abdominal distention. Celiac as a systemic disease may suffer people of all ages and with many races and ethnic groups.Celiac disease also has other symptoms that got less attention.These signs are constipation, bloating, oral plague, bone pain, anemia, Vitiligo, hypocalcemia, hypothyroidism and seizures. In this study, it was decided to evaluate the prevalence of gastrointestinal and non-gastrointestinal clinical signs of celiac disease. Methods: This descriptive study was conducted on 150 patients with celiac disease referred to Khatamolanbiya Clinic in 2014.The gastrointestinal and non-gastrointestinal clinical signs of the patients were studied. Patients with celiac disease were included who had both positive tissue anti-transglutaminase antibodies and some degree of mucosal atrophy on duodenal mucosal endoscopy. After collecting the data, the coded information was entered into SPSS version 22 software and the results were analyzed using Chi-Square, T and Wilcoxon tests. Results: The results showed that celiac disease in the study was 1.3 times more frequently in women than men. As well as the symptoms of anemia in the population studied (40.67%) had the highest and seizures (0.67%) had the lowest rates. After anemia, hypothyroidism with 26% prevalence was the most prevalent in the community. Diarrhea with 24.7% is the mostcommon in gastrointestinal symptoms and is the third most common after anemia and hypothyroidism. Conclusion: The results of this study showed that non-gastrointestinal symptoms (bone pain, anemia, vitiligo, hypocalcaemia, hypothyroidism, and seizures) are more common than gastrointestinal symptoms such as diarrhea, steatorrhea, weight loss, nausea, vomiting, abdominal pain, bloating, and oral thrush in patients with celiac disease.

Introduction: Pyoderma gangrenosum (PG) of the breast is a rare that present as a painful ulcer on the skin. It usually affects people in their 20s to 50s and occurs in both men and women. Typically, PG affects the legs in adults. In children, it may affect the legs, buttocks, head, and neck. Pyoderma gangrenosum is characterized by a papule, nodule, or pustule that progresses to an injured lesion with unknown boundaries. In this study, a case of Pyoderma gangrenosum is introduced after breast surgery. A 38-year-old woman with a 3 cm wound in the right breast area that has gradually grown has been examined for exudative bloody discharge for the past 2 weeks. Two weeks after breast surgery, a three-centimeter progressive wound has formed on the surface of the breast, which gradually grew larger. During treatment, several oral and injectable antibiotics were prescribed that have not been effective in healing the wound. A biopsy lesion was reported in which a non-specific skin lesion with hyperplasia and vesicle formation without malignancy was reported. The patient had no gastrointestinal symptoms. Infliximab was started and continued for the patient. Conclusion: In the differential diagnosis of resistant skin wounds, especially in the leg area, and in this case in the breast the diagnosis of pyoderma gangrenosome should always be considered. Even if the patient has no history of inflammatory bowel disease, pyoderma gangrenosum may occur before intestinal manifestations.

Objective: Diabetes Mellitus (DM) is one of the most common endocrine diseases with many systemic complications such as oral manifestations. The present study aimed to compare the oral manifestations frequency in diabetic patients and healthy subjects. Materials and Methods: This cross sectional study was conducted during 2016-17 on subjects came to Yazd Diabetic Research Center. In this study, 181 type 2 diabetic patients (T2DM) and 181 healthy individuals, based on convenient sample method, were included. Two groups were compared for basic information and oral manifestations including candidiasis, oral lichen planus (OLP), periodontitis, xerostomia, delayed oral wound healing, geographic tongue, gingival hyperplasia, fissured tongue, burning mouth and finally at least one of these lesions. Results: The frequency of candidiasis, OLP, periodontitis, delay oral wound healing, geographic tongue, xerostomia and at least one of lesions in diabetics were significantly higher than control group (P-value< 0.001). After regression analysis and adjusting for confounding factors, candidiasis, periodontitis and xerostomia in diabetics were significantly more prevalent than non-DM patients with odds ratio of 15.16 (1.80-127.57), 9.58 (4.68-19.63) and 78.639 (10.05-615.231) respectively. Conclusion: Xerostomia, candidiasis and periodontitis were significantly more prevalent in T2DM than Non-T2DM persons. Therefore, increasing awareness on oral manifestations in this group is recommended for timely diagnosis and referring to an oral medicine.

Abstract Objective: Nowadays, lifestyle modification is the best treatment recommended to patients with the nonalcoholic fatty liver disease (NAFLD). The therapeutic effects of vitamin E and silybin on liver functions were documented. The present study was conducted to examine the effect of silymarin and vitamin E on patients with NAFLD. Materials and Methods: From September 2014 to March 2015, clinical trial was conducted on 92 patients with NAFLD at 2 Shahid Sadoughi university clinical research centers. Sampling was based on convenient method. There were no randomization or blinding in this study, but two types of treatments were compared. The patients were divided in two groups of daily intake of vitamin E (400 IU) and Silymarin 280 mg for four months. Alanine aminotransferase (ALT) and liver ultrasonography were done at baseline and after four months. Results: Eighty patients completed the course of treatment successfully .After 4 months, both groups had experienced a significant reduction in their serum ALT levels. The mean change in the ALT level from the baseline was -31.6 U/L in the silymarin group vs. -15.1 U/L in the vitamin E group (P-value= 0.07). Treatment with silymarin was more effective than vitamin E (P-value< 0.0001). The mean ALT level changed to normal was 55.0% (22 of 40 patients )in the silymarin group, while it was 45.0% (18 of 40 cases) in the vitamin E group (P-value= 0.04). Conclusion: The treatment of NAFLD with silymarin appears to be significantly effective in biochemical improvement whereas treatment with vitamin E improves ultrasonographic parameters.

Background: Torque teno virus (TTV) is a non-enveloped DNA virus that its role as a helper or causative agent in hepatitis is still unclear. TTV prevalence varies in different regions of the world. This study aimed to determine the prevalence of TTV in healthy individuals and those infected with hepatitis C virus (HCV) living in Yazd city, Iran. Methods: In this case-control study, 50 healthy subjects and 68 HCV-positive individuals who referred to Yazd hospitals participated in this study. TTV DNA in serum samples were detected by nested polymerase chain reaction (PCR) using specific primers of 5΄-UTR and N22 regions. The genotypes of HCV and TTV were determined by sequencing method. Results: TTV-DNA was detected in 2 out of 50 (4℅) healthy individuals and in 4 out of 68 (5.8℅) HCV-positive persons. There was not a significant correlation between the prevalence of TTV and HCV infection. The most common TTV genotypes among HCV-positive individuals were 3, 17 and 13, respectively. There was not a significant association obtained between HCV genotypes and TTV genotypes. Conclusion: The prevalence of TTV in Yazd province was low compared with the other areas of Iran. The prevalence of TTV in HCV infected people was not significantly higher than its rate in uninfected individuals.

Introduction: Acute hepatitis has several causes. Transfusion of non-infected blood to the virus and avoidance of undesirable social contacts have reduced the prevalence of hepatitis B and C transmission. Improved socioeconomic status and access to healthy food and water have also reduced the prevalence of hepatitis E and A. The transition from Hyper Endimicity to Intermediate or Low Endimicity has increased the incidence of acute Hepatitis A especially in adults. The aim of this study was to determine the epidemiological status of patients with acute liver hepatitis referred to the Shahid Sadoughi Hospital of Yazd from 2015 to 2018 Methods: This cross-sectional study was performed on the patients referring to the gastrointestinal clinic of Shahid Sadoughi Hospital from 2015 to 2018. The sampling method was that after rule out chronic liver disease according to medical history and patient lab data, the patients imported to the category of acute liver disease. SPSS Inc, Chicago, IL; version 16 was used to determine the prevalence of each type of acute hepatitis. Results: 23 patients were diagnosed with acute hepatitis, 14 were male and 9 were female. Hepatitis A was found in 15 patients, 2 patients had acute hepatitis B, 2 patients had autoimmune hepatitis, and 4 patients had other causes for hepatitis. Conclusion: 65% of patients in this study had acute hepatitis A. Therefore, acute hepatitis A is one of the important factors in the development of acute liver disease study and is therefore one of the important factors in the development of acute liver disease.

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for the patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, and because of developments in diagnostic procedures and improvements in therapy and prevention, recently in Iran new drug direct Acting agent (DAA) was developed that may be equivalent to original drugs that will hope to treat HCV and eliminated HCV in future

Abstract Objectives Recent studies using genome-wide association studies (GWAS) have shown the strong association between polymorphisms near the interleukin-28B (IL-28B) gene and spontaneous clearance of hepatitis C virus (HCV). The present study was designed to evaluate the association of interleukin-28 gene polymorphism with interleukin-28 cytokine levels in different viral genotypes among HCV patients in Yazd, Iran. Result The most prevalent genotype in chronic cases was genotype 3a, and the lowest one was 2/3a. There were statistically significant differences in genotype frequency between the two studied groups for IL-28B rs12979860C/T. The frequency of CC genotype of IL-28B at rs12979860 SNP was higher in spontaneously cleared patients in comparison with chronic HCV patients. Significant association was found when serum levels of IL28B were compared to various IL-28 genotypes. There was a significant difference between IL-28 polymorphism and HCV genotypes (p = 0.003).

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. Evidence showed that anthocyanins might have effects on NAFLD. Protective effects of Cornelian cherry (Cornus mas L.) extract, as an anthocyanins-rich source, on liver were reported in animal studies. However, very few clinical trials were conducted in this regard. Thus, the aim of this research will be to evaluate the effect of supplementation with total anthocyanin-base standardized cornelian cherry fruit extract on liver function (Serum levels of Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), cytokeratin-18 fragment M30 (CK-18 M30), as well as steatosis and fibrosis of liver), tumor necrosis factor α (TNF-α), malondealdehyde (MDA), and adiponectin in patients with NAFLD. Methods In a double-blind randomized clinical trial, 80 NAFLD patients will be studied. The patients will be randomly assigned into two groups. The intervention group will receive the cornelian cherry extract, containing 320 mg.d− 1 anthocyanins, per day for 12 weeks. The control group will also take the placebo daily for 12 weeks. Liver function (Serum levels of AST, ALT and CK-18 M30; steatosis and fibrosis of liver), serum levels of TNF-α, MDA, and adiponectin will be measured at the baseline and the end of trial for both groups and their results will be compared. Discussion Considering evidences about the useful impacts of anthocyanins on NAFLD, the effects of supplementation with cornelian cherry extract will be investigated on the important variables related to NAFLD. Trial registration Iranian Registry of Clinical Trials (IRCT20180419039359N1).

Introduction: The present study aimed to compare the conventional and new techniques of laryngeal mask airway (LMA) insertion in terms of the rate and severity of postoperative sore throat.Methods: This clinical trial was conducted on 80 patients referring to Khatam-ol Anbia Hospitalin Mashhad, Iran for phacoemulsification. The patients underwent general anesthesia, and the conventional technique was performed by pushing down the LMA with the dominant hand with the simultaneous support of the index finger of the dominant hand. In addition, the new technique was carried out by conducting the LMA with the dominant hand and simultaneous use of the non-dominant hand to prevent the contact of the cuff with the palate and oropharynx tissues. All the variables were assessed one day after the operation. Results: The rate of postoperative sore throat was 7.5% in the conventional technique and 1.25% in the new technique. Comparison of the rate of postoperative sore throat between the study groups showed a significant difference in this regard (P=0.048). The overall rate of postoperative sore throat one day after the operation was 3.75%, while it was estimated at 3.75% in the conventional technique. However, comparison of the rate of postoperative sore throat between the study groups demonstrated no significant difference in this regard (P=0.077). Conclusion: Considering the higher effectiveness of the new LMA insertion technique compared to the conventional one technique in the prevention of preventing mucosal bleeding and postoperative sore throat, the new this technique is recommended as a can be used as a safe alternative to for the conventional technique. In the new LMA insertion technique, the this method, the rate of postoperative sore throat decreased due to the declined diminished due to reduced pressure on the tissues of the oropharynx tissues.

Background:Tenofovir is among the first-line treatments for chronic hepatitis B (CHB) virus infection. We evaluated the efficacy of Tenofovir in the treatment of Iranian adult patients with CHB. Methods: In a retrospective study, we evaluated 154 HBsAg positive patients referred to Sadoughi hospital in Yazd-Iran for treatment during 2009-2014. Forty-five patients were naive and 109 patients were treated previously with lamivudine or interferon. HBs Ag, HBeAg, HBeAb and quantitative HBV- DNA PCR were measured. The patients with HBV DNA >10,000 copy per ml in precore mutant and HBV DNA>100,000 copy per ml in wild type and ALT >two times of normal value were included. Tenofovir disoproxil fumarate 300 mg was administered and continued for three years. Data were analyzed using SPSS19. Results: We enrolled 154 (109 males 45 female) patients. Mean age of patients was 41± 8 years (18-58 year old). Forty-five of them were naive and the rest had previously experienced treatment. In this study, 113 of patients were of wild type and 41 patients were precore mutant variant. In wild type patients, 25 ones were naive and in precore mutant subtype, 20 patients were naive. HBsAg disappeared in 5 patients (3.2 percent). Forty one of 45 patients in the naive group (91 percent) and 96 of 109 patients in the previously treated group (88 percent) were cured. AST and ALT levels decreased in over 80 percent of patients and means of AST and ALT levels showed more decrease in naive and precore mutant subgroups. Serum AST and ALT and HBV DNA were higher in the wild type group than in the precore mutant group. Seroconversion occurred in 69 out of 113 patients at the end of the study. Conclusion: Treatment response rate to Tenofovir in Iranian patients with CHB was high. Tenofovir could be recommended as the first-line therapy of chronic HBV infection in Iran.

Introduction: Most common causes of lower gastrointestinal bleeding (LGIB) in young patients are benign perianal lesions, but serious colorectal disease may be underlying etiology in this group. The aim of this study was identification of LGIB etiologies in the patients under 40 years old. Materials: In this retrospective descriptive study, which has been done during 2012-2013, 333 young patients (less than 40 years old) with lower GIB referred to Endoscopy Ward of Yazd Shahid Sadoughi Hospital assessed by colonoscopy with or without histopathology. Resultus: In this study, 57% of patients were males. Majority of them were between 30-40 years old. The most common presentation was hematochezia (49%) and the most common cause was internal hemorrhoid (17%). Other causes included: inflammatory bowel disease (15%), polyp (9%), infectious colitis (8%), anal fissure (6%), colon cancer (4%), solitary rectal ulcer (4%), vascular lesion (2%), aphtus lesion (1.1%), diverticulosis (0.6%) ,anal tuberculosis (0.3%) and normal colon (33%). Considerable number of our cases had inflammatory bowel disease and malignancy. Seven patients had serious disease and simple anal disease simultaneously. Conclusion: Significant portion of LGIB in the patients less than 40 years old are due to serious colorectal disease. So, careful approach and appropriate timing for colonoscopy is recommended

BACKGROUND The number of patients with gastric cancer is growing worldwide. In Iran (in 2009) of 74067 new cases of cancer, 6886 were diagnosed as having gastric cancer. This study was conducted to investigate 5-year survival rate for gastric cancer in Yazd province, central Iran. METHODS In this descriptive study, the medical records of patients with gastric cancer were collected from the archives of Yazd hospitals from 2001 to 2008. The data gathered included age, sex, type of histopathology, site of involvement, cancer staging, and mode of treatment, which were analyzed using SPSS software version 11.5. To investigate the survival and the factors influencing the survival time of patients, which are the main objectives of this study, Kaplan-Meier method was used and Cox proportional hazards model was fitted to the data. To compare survival function in different subgroups, the log rank test or generalized Wilcoxon test was used. RESULTS 295 cases of gastric cancer were enrolled in the study. The mean age of the subjects was 59.3 ± 9 years. 5-year survival rate of the patients was calculated as 18% where the highest rate was 39% for the age group of 50-60 years and the lowest was 3% for the age group of above 80 years. 5-year survival rates in different groups were as follows: 32% in women, 13% in men; 16% in adenocarcinoma, 46% in other pathologies; 16% in gastric cardia involvement, 17% in antrum; 59% in stage 1, 31% in stage 2, 13% in stage 3, and 3% in stage 4. CONCLUSION The results of this study showed that age, stage of the cancer, mode of therapy, and type of histopathology affected the survival rate of gastric cancer. No significant association was found between the site of involvement and survival rate. In general, the survival rate for gastric cancer was low, which might be due to slow but steady progress of the disease and delayed referral of the patients.

Introduction: The importance of high-grade cervical intraepithelial neoplasia (CIN) as a precursor to invasive cervical cancer suggests a considerable need for accurate screening of the patients for the risk of these lesions. This systematic review aimed to study the diagnostic significance of endocervical curettage (ECC) at the time of colposcopy in the detection of CIN 2, 3, and preinvasive lesions.Methods: PubMed was searched to obtain the relevant articles based on the following search term: (endocervical curettage OR ECC) AND colposcopy. The most relevant articles were included after studying the title, abstract, and full text of the obtained articles at initial search. Only English language articles published after 1992 with at least 500 patients were included in this study.Result: Among 300 articles identified by the first search, only seven articles were in line with the purpose of this systematic review. Majority of the included studies were retrospective observational studies.Conclusion: Performing ECC has higher sensitivity in women older than 40 years and those with unsatisfactory colposcopy results. However exact diagnostic usefulness of ECC at the time of colposcopy needs to be investigated in further studies.

Introduction: Administration of methylene blue has been proposed as a therapeutic strategy in the treatment of vasopelgic shock following cardiac surgery. Major aims of this systematic review were to evaluate the effect of methylene blue on mortality rate, duration of vasoplegic syndrome, and further complications of patients with vasoplegic syndrome following cardiac surgery. Methods: PubMed was searched to obtain the most relevant articles. All the randomized control trials and cohort studies were included.Result: A total of 54 articles were retrieved at the initial search. After studying the titles, abstracts, and full text of the articles, only five articles consisted of two randomized controlled trials (RCTs) and two observational studies were included.Discussion: Based on included RCTs, the mortality rate and duration of the disease decreased in patients applied methylene blue in the treatment of vasoplegic syndrome compared with those did not receive this medication.Conclusions: Bbased on included articles, application of methylene blue could be suggested as a treatment for vasoplegic syndrome, but further large multicenter RCTs are needed to certainly evaluate the efficacy of methylene blue.

Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR), absolute risk reduction (ARR), and number needed to treat (NNT).Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.

Introduction: Coughing is an airway complication that could affect the outcome of surgery following general anesthesia in adults. In this systematic review, we aimed to study the efficacy of applying laryngeal airway mask (LMA) compared with endotracheal tube (ETT) in reducing the postoperative cough in adults under general anesthesia.Method: PubMed was searched for the relevant articles. Inclusion criteria were all the randomized controlled clinical trials, which used LMA and ETT in adults under general anesthesia. Only English language articles were included in this study with no time limitation.Result: Overall, 15 articles were retrieved, which were relevant with the purpose of this study. Efficacy of LMA in reducing coughing was significantly different with ETT in adults under general anesthesia in various types of surgeries. Calculated number needed to treat (NNT) showed that using LMA would significantly reduce coughing even in one adult patient.Conclusions: Coughing has shown various adverse effects on postoperative main results in some surgeries such as cataract, cranial, etc. Applying LMA could positively decrease postoperative coughing in adults.

Introduction: Coronary artery disease (CAD) is the most common type of heart disease, with a mortality rate of 385,000 person per year in the United States. There are two main methods for CAD treatments: angioplasty and bypass surgery. Coronary Artery Bypass Grafting (CABG) is one of the greatest surgical operations of the 20th century and it is presented as most effective and long-term therapies in the treatment of ischemic heart disease. There are two different methods of CABG; on-pump and off-pump. While off-pump CABG is a newer method, it decreases stroke and maintains higher mental function. We conducted the assessment of patients’ outcome that underwent on- or off-pump CAGB with hemodynamic instability. Materials and Methods: In this cross-sectional study, we evaluated cardiogenic shock patients with CABG who referred to Ghaem hospital for emergency operation from January 2012 to November 2013. We collected medical records archive from this hospital and all patients' information including demographic data, clinical variables, and past medical history separately. We performed on and off-pump CABG surgery for the patients. In on pump group, we performed beating on pump method, without aortic cross clamping. Results: Twenty-eight patients who underwent CABG in two forms: on-pump and off-pump were studied. The minimal age of the patients was 34 and the maximal was 78. Patients’ weight had a range between 60 to 95 kg. The minimum used graft were two and the maximum were five. Ejection fraction was diversified between 15% (min) and 50% (max). Operation time ranged 1.50 to 5.50 hours. The ICU stay time was between 2(min) to 11 (max) days. Finally death was occurred in 5(17.9%) of patients. Conclusion: Our findings showed that CABG with beating heart could increase the survival of hemodynamic unstable patients in comparison with off-pump CABG

Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography (ERCP) was performed for patients with suspicious to biliary colic and common bile duct (CBD) stones. Ultrasonography, Aspartate Aminotransferases (AST), Alanine Aminotransferases (ALT), Alkaline Phosphatase (ALP) and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter (OR: 20; P=0.00) and elevated serum level of ALT (OR: 2; P=0.04) were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP.

Background: Tenofovir is among the first-line treatments for chronic hepatitis B (CHB) virus infection. We evaluated the efficacy of Tenofovir in the treatment of Iranian adult patients with CHB. Methods: In a retrospective study, we evaluated 154 HBsAg positive patients referred to Sadoughi hospital in Yazd-Iran for treatment during 2009-2014. Forty-five patients were naive and 109 patients were treated previously with lamivudine or interferon. HBs Ag , HBeAg ,HBeAb and quantitative HBV- DNA PCR were measured. The patients with HBV DNA >10,000 copy per ml in precore mutant and HBV DNA>100,000 copy per ml in wild type and ALT >two times of normal value were included. Tenofovir disoproxil fumarate 300 mg was administered and continued for three years. Data were analyzed using SPSS19. Result: We enrolled 154 (109 males 45 female) patients. Mean age of patients was 41± 8 years (18-58 year old). Forty-five of them were naive and the rest had previously experienced treatment. In this study, 113 of patients were of wild type and 41 patients were precore mutant variant. In wild type patients, 25 ones were naive and in precore mutant subtype, 20 patients were naive. HBsAg disappeared in 5 patients (3.2 percent). Forty one of 45 patients in the naive group (91 percent) and 96 of 109 patients in the previously treated group (88 percent) were cured. AST and ALT levels decreased in over 80 percent of patients and means of AST and ALT levels showed more decrease in naive and precore mutant subgroups. Serum AST and ALT and HBV DNA were higher in the wild type group than in the precore mutant group. Seroconversion occurred in 69 out of 113 patients at the end of the study. Conclusion: Treatment response rate to Tenofovir in Iranian patients with CHB was high. Tenofovir could be recommended as the first-line therapy of chronic HBV infection in Iran. [ABSTRACT FROM AUTHOR]