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Mesenteric ischemia is a rare disease with a high rate of mortality because of the non-specific symptoms which leads to delay in diagnosis and intervention. The main symptom is abdominal pain; which has a broad list of differential diagnosis. This study introduces a 17 years old girl who presents to the emergency department with severe abdominal pain and hematemesis. Further evaluations revealed thrombosis in the mesenteric vein which leads to ischemia and gangrene of the small intestine. Her past medical history and drug history was negative, except she was taking Levonorgestrel and cyproterone acetate for a 5 months period. Since long-term treatment with oral contraceptive pills, counts as a risk factor for venous thrombosis, this case seems to be uncommon.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in children. With increasing prevalence of childhood obesity, NAFLD is increasingly seen in children. The prevalence varies according to the population studied (race and ethnicity) and the definition of NAFLD used in the study. In Iran, the prevalence of NAFLD in obese children ranges from 50% to 55% and in the general population of children is about 17%. Most patients with NAFLD are asymptomatic. However, abdominal pain may be present in the right and upper extremity, and hepatomegaly or non-specific symptoms such as abdominal discomfort, weakness, fatigue or attention disorder may also be seen. Diagnostic methods of NAFLD include laboratory tests, biomarkers, biopsy, and imaging studies such as ultrasound, CT, MRI. There is no definitive treatment for non-alcoholic liver disease. Modification of some risk factors such as obesity, diabetes, and hyperlipidemia are often recommended, but weight loss is more beneficial. Early diagnosis of NAFLD in children and its management can reduce further complications. Therefore, in this study, we reviewed the articles published on NAFLD in children (until 2017) using electronic databases, including PubMed, ProQuest, Scopus, and Google Scholar. We reviewed the signs of NAFLD, its epidemiology, etiology, complications, laboratory findings, different diagnostic methods, treatments, and follow up procedures.

Accumulation of free fluid in the peritoneal cavity is called ascites. The first step in identifying its etiology is to determine the serum-ascites albumin gradient (SAAG). According to this parameter, a high SAAG is regarded as a gradient greater than 1.1 g/dL. This condition has some differential diagnoses such as liver cirrhosis, Budd-Chiari syndrome, heart failure, and idiopathic portal fibrosis. In the present article, we present a young man with abdominal distention due to a high SAAG. Further evaluation of the abdominal and thoracic cavity revealed a mass in the posterior mediastinum, which had compressed the inferior vena cava and left atrium and led to Budd-Chiari syndrome. Evaluation of the biopsy sample showed fibrosarcoma. Mediastinal fibrosarcomas, though rare, should be considered in the differential diagnosis of mediastinal masses.

Background and Objectives: Percutaneous endoscopic gastrostomy (PEG) is a common method for maintaining enteral nutrition in patients who, for any reason, have dysphagia for more than 30 days. With respect to widespread application of this method, the present study was carried out with the aim of determining its outcomes and complications. Methods: This cross-sectional study was conducted by Gastroenterology and Hepatology Diseases Research Center of Qom University of Medical Sciences using information of patients who underwent PEG tube placement in Qom Shahid Beheshti Hospital during 2014-2017. Data were analyzed by using Chi-square test. Results: Out of 717 patients, 402 (56.07%), were male with the mean age of 47±8 years, and 315 subjects (43.93%), were female with the mean age of 53±11 years. The most common indication of PEG placement was cerebrovascular accident. Seventy-nine (11.01%) patients had complications, and the most observed complication was reported to be leakage (21.52%), which in most cases was delayed (in 3 month follow-up). Displacement of the PEG tube, obstruction, and infection or bleeding of the site, were expressed as common complications. There was also no significant difference between the two genders in terms of the incidence of complications, and mortality rate was reported 0 in the 3 month follow-up. Conclusion: Based on the results of this study, PEG placement can be a safe method for maintaining enteral nutrition with low rate of complications and mortality.

Background and Objectives: Chronic viral hepatitis B is a global health problem, which, if not treated, can lead to some serious complications, such as liver cirrhosis and hepatocellular carcinoma. In this study, the effect of antiviral therapy with tenofovir, was investigated on reduction of liver fibrosis and improvement of liver function in patients with chronic hepatitis C. Methods: In this clinical trial, 40 patients with chronic hepatitis B underwent antiviral therapy with tenofovir 300 mg daily. Demographic information and results of laboratory tests (before treatment and 6 months after the start of treatment), were collected using a checklist. Liver stiffness was measured and recorded using a fibroscan device (before and 6 months after the treatment). Data were analyzed using Wilcoxon and paired t- tests. The level of significance was considered to be p

This study aims to empirically test the effect of budgetary participation on budgetary slack and managerial performance. The study aims to empirically examines whether budget emphasis moderates budget participation on budget slack and managerial performance of Municipality Government of Ternate. Using moderated regression analysis, this study found that, 1) budgetary participation negatively affect budgetary slack 2) budget participation influences managerial performance and 3) budget emphasis moderates the relationship between budget participation on budgetary slack and managerial performance. The theoretical implications of this study indicate that agency and contingency theory could be used as a complement to a more effective budget participation process by integrating the expected performance measurement framework.

A 52-year-old woman with a history of laparoscopic cholecystectomy within the past 2 weeks, presented to the emergency department with abdominal pain and icter from 2 days earlier. She complained of an epigastric pain with radiation to the back, which was aggravated after taking a meal and did not change with position.

Background: Today, chronic diseases have spread all over the world. The World Health Organization (WHO) mentions air pollution as the biggest environmental health hazard, attributing 7 million premature deaths every year to this pollution, which includes suspended particles and gases with concentrations that are detrimental to human health. Factors of interest in this field are micrometer diameter particles, tropospheric ozone, sulfur dioxide, nitrogen dioxide, and carbon monoxide. The purpose of this research is to increase public awareness of air pollution and its side effects on different parts of the digestive system. Methods: A narrative review was done using several databases, including PubMed, Magiran, Web of Science, and Google Scholar. Relevant studies published from 1990-2021 were identified. Results: Globally, ecological studies have demonstrated a relationship between shortterm exposure to air pollution and several gastrointestinal diseases. Conclusion: The results of these studies showed that pollutants have a direct effect on the increased prevalence and number of cases of chronic gastrointestinal diseases. The results of this research can inform policymakers in making comprehensive decisions to solve the problem, individuals who are exposed to pollutants, and the public in raising awareness and promoting the use of protective equipment. [ABSTRACT FROM AUTHOR]

There are several elements which influence the manners of users in cyber space especially in mobile apps all of which are minor branches of such space.This article seeks to study the tendency of users’ written language in cyber space to an encoded and symbolic language.From this point of view, the researchers will study the type of users’ manner in cyber space (especially in mobile applications) through studying issues such as the activities of users in groups and private chats.The outcome of researches showed that after using these applications the manner of users will affected by some factors that lead to creating a kind of encoded and symbolic language.The reason could be that there are just writing and written relations in such communications; some parts of body beside oral and aural relations are omitted; and an especial kind of orthography and labels are used.Innovation in this article is contemplating about changes in orthography and written language of Farsi in mobile applications and also studying about the elements which are influential in these changes.

Background and Objectives: Gastrinoma is a rare cause of peptic ulcers and should be suspected when manifestations, ulcer site, and response to treatment are not normal. Gastrinomas are mostly malignant and liver is the most common site of their metastasis. Arterial chemoembolization (obstruction by blood clotting with chemicals) and arteries that feed metastases, is used as a method to reduce the symptoms. Appropriate response is seen in more than half of the patients, although it is short term. Case report: The patient is a 42-year old man, who was healthy until 4 years ago that experienced acute abdominal pain due to duodenal ulcer rupture and two episodes of acute upper gastrointestinal bleeding due to perforation of two separate duodenal ulcers within 2 months of each other. He also complained of mild diarrhea and loss of appetite at that time. Laboratory examinations showed increased serum level of gastrin. Abdominal CT scan showed a small pancreatic head mass and three hepatic mass with increased contrast medium absorption. In CT-guided biopsy report, pancreatic head mass and uniform and apparently benign cells similar to islet cell tumor, were seen. Chemoembolization of liver metastasis arteries was performed, which after 6 months, CT scan showed almost complete regression of metastases and also primary pancreatic lesion.

Background and Objectives: ERCP is a specific technique, which allows bile and pancreatic duct imaging along with a variety of therapeutic interventions. The complexity of this technique has led to a challenge between its benefits and its serious or even mortal complications, among which, pancreatitis is the most common. The aim of this study was to assess the incidence, risk factors, and protective factors of this complication. Methods: In this cross-sectional study, the research population was 310 individuals who referred to Gastroenterology and Hepatology Research Centre of Qom city. At the beginning of the study, demographic characteristics, medical history, and necessary laboratory results of the participants, were recorded and then they underwent ERCP. After 6 hours, physical examination was performed and serum amylase level was evaluated. Six hours after the procedure, the results of examination and amylase test were recorded. Data were analyzed using non-parametric Chi-square and parametric paired t-test. Results: The incidence of pancreatitis was 8.1% and mortality rate was 0.9%; %34 of the patients had hyperamylasemia. Cannulation was difficult, and the number of pancreatic duct cannulation was reported as a risk factor. The mean serum amylase level after ERCP, showed a significant increase in patients with pancreatitis. Conclusion: In this study, the incidence of pancreatitis was 8.1% and the mortality rate was 0.9%, which were similar to previous studies, but the protective role of pancreatic duct stenting was not confirmed. Also, pancreatic duct cannulation and its multiplicity was obvious risk factors. The serum amylase level had a definite association with clinical pancreatitis. More experience of endoscopist and improvement of device function reduced the risk of pancreatitis. Therefore, the serum level of amylase is a reliable factor for diagnosis of this complication.

This study aimed to provide empirical evidence that investment opportunities,ownership concentration, leverage, firm size and quality of external audit influenced the qualityof corporate governance. The study also observed companies that listing in BEI and participatinga survey which was conducted by IICG. The observation period range was 2006-2008. Thesample selection was using purposive sampling method. The companies matched the criteriawere 53 companies, and the analysis method used was multiple regression. The results of thestudy showed that investment opportunities, ownership concentration, and leverage did notinfluence the quality of corporate governance whereas the firm size and the quality of externalaudit influenced the quality of corporate governance.

BACKGROUND Intestinal mast cells may cause gastrointestinal symptoms in patients with diarrhea-dominant irritable bowel syndrome (IBS). The objective of this study was to determine the effect of mesalazine on the number of lamina propria mast cells and clinical manifestations of patients with diarrhea-dominant IBS referred to Shariati Hospital affiliated to Tehran University of Medical Sciences. METHODS This was a randomized placebo-controlled double-blind trial conducted on 49 patients with diarrhea-dominant IBS. The patients were randomly assigned to one of the experiment or control groups. The patients in experiment group took 2400 mg mesalazine daily in three divided doses for 8 weeks and the patient in control group took placebo on the same basis. Our first targeted outcome was an assigned downturn of mast cells number to the safe colonic baseline and the next one was a marked palliation of disease symptoms. Data were analyzed conforming intention-to-treat method. We used MANCOVA test to compare our both assigned outcomes in the two groups. We also compared the data with baseline values in both groups. All statistical tests were performed at the significance level of 0.05. RESULTS There was no significant difference between Mesalazine and placebo groups regarding the number of mast cells (p value=0.396), abdominal pain (p value=0.054), bloating (p value=0.365), defecation urgency (p value=0.212), and defecation frequency (p value=0.702). CONCLUSION Mesalazine had no significant effect either on the number of mast cells or on the severity of disease symptoms. This finding seems to be inconsistent with the hypothesis indicating immune mechanisms as potential therapeutic targets in IBS. The possible difference in this effect of Mesalazine should be evaluated in further studies among populations varying in race, ethnic, and geographical characteristics.

Introduction: Nonalcoholic fatty liver disease (NAFLD) is raising prevalence among children, and adolescence population in developed and developing countries as a major public health concern. The present study aims to determine the relationship between serum ferritin level and transient elastography findings in patients suffering from NAFLD. Materials and Methods: The demographic and biochemical profile of included individuals such as body mass index, age, level of serum transaminases, fasting blood sugar, lipid profile, and serum ferritin level were determined and a transient elastography was performed for all of them. Results: The mean serum ferritin level among men with mild and advanced liver stiffness was 154 ± 97 and 244 ± 214, respectively (P < 0.001), which showed a meaningful relationship. These figures among female patients with mild and advanced liver stiffness included 79 ± 91 and 161 ± 103, respectively (P = 0.003) and again revealed a significant relationship. The cutoff values of ferritin with 90% accuracy for differentiation of mild from advanced liver stiffness among male and female patients were determined as 255 ng/ml and 135 ng/ml, respectively. These cutoff values for ruling out of advanced liver stiffness with 90% accuracy among both sexes were 72.5 ng/ml and 65.5 ng/ml, respectively. Conclusion: The finding of this study revealed a significant relationship between serum ferritin level and liver stiffness among NAFLD patients, and if these results repeated in further investigations, it could be advisable to measure serum ferritin level for predicting possibility of advanced liver fibrosis.

Background: Nausea, vomiting, and anxiety are common complications during and after spinal anesthesia. Auriculotherapy as a complementary medicine can be useful for reducing nausea, vomiting, or anxiety. This study was performed to evaluate the effects of auriculotherapy on nausea, vomiting, and anxiety in patients undergoing elective Cesarean Section (CS) with spinal anesthesia. Materials and Methods: The present study was a clinical trial study that was performed on 56 pregnant women selected as CS candidates in Ommolbanin Hospital in Mashhad during the years 2016-2017. In the intervention group, 1 h before spinal anesthesia, auricular acupoint stimulation was performed at four points bilaterally, for 20-30 seconds at each point. Evaluations were done by the following questionnaires: State Trait Anxiety Inventory (STAI), Visual Analog Scale (VAS), and Vomiting Assessment Form. Results: The mean anxiety (SD) before the intervention in the intervention group and the control group was 47.88 (8.67) and 47.84 (10.49), respectively, and 4 h after the intervention, it was 40.23 (10.19) and 42.88 (12.18) in the intervention and control groups, respectively. These results were significant in the intervention group (p = 0.008). 30-40 min before and 4 h after the surgery, the severity of nausea and vomiting was low in both groups and no significant difference was observed between the two groups during the surgery and in the recovery room (p > 0.05). Conclusions: According to the results, auriculotherapy could reduce anxiety in CS patients with spinal analgesia. The results also showed that auriculotherapy reduced the severity of nausea and vomiting, but these changes were not significant. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pseudomembranous colitis is an advanced form of infection with clostridium difficile, which damage epithelial cells following colonization in the intestine and production of toxins A and B. Diarrhea is the most common clinical manifestation caused by C. difficile, which in these cases, blood is never observed macroscopically in the stool. Antibiotic exposure is the main risk factor for this infection and is especially associated with ampicillin, clindamycine, and 2nd and 3rd generation cephalosporins, such as ceftriaxone, cefotaxime, and ceftazidime. To confirm the diagnosis of infection, assessment of the microorganism toxins in the stool by PCR as well as observation of pseudomembrane in colonoscopy, was performed. In this article, a case of an old patient with diarrhea (pseudomembranous colitis) was presented in this article. Case Report: The patient is an 85-year-old man with signs of weakness, fatigue, fever and chills, and non-productive cough and diagnosis of pneumonia underwent antibiotic therapy, and in the course of treatment, he demonstrated massive watery diarrhea. Laboratory colonoscopy findings was indicative of infection with C. difficile.