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BACKGROUND This clinical investigation aimed to compare the efficacy of treatment of peptic ulcer hemorrhage by argon plasma coagulation (APC) via contact heat probe method (heater probe) along with epinephrine injection. METHODS 100 patients who underwent endoscopic treatment, were randomly divided into two groups consisting of 50 patients each. In the first group, an intervention was performed using foot pedal and 2.3 mm and 3.2 mm argon probes placed in a 2 to 8 mm distance of delivery place leading to plasma coagulation, sufficient necrosis and hemostasis. In the second group, wound press contact probe was used for wound healing with 15 watts of heat for about 25 degrees, causing coagulation and hemostasis. To evaluate and compare the ulcer treatment in both groups, the patient progress results were monitored for a period of one month from the day of discharge. Statistical analyses of data were performed using SPSS software version 22 along with Chi-square test and T-test. RESULTS No significant difference observed in two groups in term of age, sex and clinical symptoms, but patients treated with APC method had higher hemoglobin levels (p < 0.001). The duration of intervention and abdominal bloating in APC group was significantly higher with two cases of readmission. In HP group, 3 cases (6.3%) had treatment failure and an average transfused blood was significantly higher in the HP group (p < 0.001). CONCLUSION Endoscopy treatment duration was significantly lower in patients treated with the HP method due to separate washing route. HP method seems to be more appropriate for treatment of cases with abdominal bloating, distal gastric lesion and HP bulbs. [ABSTRACT FROM AUTHOR]

Background : The most common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is acute pancreatitis. A number of therapeutic trials have been studied due to reduce the occurrence of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) but many of them were unsuccessful. Periampullary corticosteroid injection was proposed to use as prophylactic agents for PEP because of its anti-inflammatory property with relative low systemic side effects. Materials and Methods : By conducting a double blinded clinical trial study in a single center university hospital, all patients undergoing therapeutic or diagnostic ERCP in our gastrointestinal endoscopy ward, enrolled the study. During ERCP, we randomly assigned the patients in blocks of 40 to undergo a locally injection of methylprednisolone acetate (corticosteroid group) or saline (control group) on the major papilla and prospectively evaluated the occurrence of PEP pancreatitis in each groups. Clinical and laboratory findings of acute pancreatitis were collected by means of a validated questionnaire during the procedure and before discharge. At baseline and end of the study, were compared pancreatitis prevalence and also its severity by using Chi-square and t -test statistics. Results : The frequency of moderate to severe PEP pain was not significantly between the placebo and corticosteroid receiving group (13.7% ± 3.2% vs. 9.3% ± 2.1%, respectively; P = 0.8). There is no significant difference in the mean concentration of lipase and amylase between corticosteroid receiving group and placebo receiving group at the first, second, and third time. In the corticosteroid receiving group, 3 patients (10.3%) while in the control group, 11 patients (11.3%) developed pancreatitis. Conclusion: We found no significant difference in PEP rates and also severity between the corticosteroid and placebo groups. The mean increase in serum amylase and amylase level in pancreatitis patients and the frequency of abdominal pain were not significantly higher in the placebo group. Besides, there were no cases of severe PEP pancreatitis in either group. [ABSTRACT FROM AUTHOR]

Background: Hyponatremia has poor outcomes in other cardiopulmonary disorders, but its predictive value in predicting mortality of patients with acute pulmonary embolism is unknown. So, we evaluate the mortality of inpatients diagnosed with pulmonary embolism (PE) who had hyponatremia at the time of admission. Materials and Methods: By conducting a cohort study in patients with acute pulmonary embolism admitted in Al-Zahra Hospital during the 24 months of the date of March 2012 to March 2014. We evaluated 224 patients admitted with a primary diagnosis of PE. We used logistic regression analysis to evaluate the independent relation among serum sodium levels at the time of presentation and 30 days mortality, with severity of illness and other patient risk factors were adjusted. Results: 109 patients (48.7%) had normal sodium level (serum level >137 mmol/L). 115 patients had sodium level bellow 137 mmol/L. Of these, 56 (25%) had a sodium level 135-137 mmol/L and 59 (26.3%) had a sodium level <135 mmol/L. Patients with a serum sodium of >137,135-137, and <135 mmol/L had a cumulative 30-day mortality of 14%, 21%, and 42% (P< 0.0001), respectively. The mortality of patients with lower serum sodium was significantly increased. When the pulmonary embolism severity index and also its simplified form were replaced in the model and while some confounding variables such patients with a history of cancer, chronic pulmonary disease, heart failure, and chronic renal failure were excluded from statistics, the findings still remained similar. Conclusion: Among patients presenting with PE, hyponatremia is common and is an independent risk factor that increasing short-term mortality. This result could be encountered as a variable in determining of PE severity and mortality. [ABSTRACT FROM AUTHOR]

Background: After discontinuing oral anticoagulant therapy (OAT), the recurrence of venous thromboembolism (VTE) is greatest in the 1st year and gradually diminishes. D-dimer assay was proposed to be effective in selecting patients with idiopathic DVT. The aim of this study was to determine the rate of VTE recurrence after discontinuing OAT according to the results of D-dimer. Materials and Methods: This prospective study was conducted in patients with a first episode of symptomatic proximal deep vein thrombosis (DVT) who had received OAT for at least 3 months. Patients were re-evaluated at 1st, 6th and 12th months of their follow-up. At the first (T0) and 30-day (T1) visits, venous blood samples were taken for D-dimer test. At each follow-up visit, we examined patients for clinical symptoms or signs of recurrent VTE, bleeding, postthrombotic manifestations, adherence to treatment, and concomitant analgesic or antiinflammatory therapy. The endpoint outcomes were VTE recurrence and complete of this survey follow-ups. Results: A total of 68 eligible patients was enrolled. Four patients (two patients need to use long-term oral anticoagulation, and two patients lost their first follow-up) were excluded. At T0, D-dimer and compression ultrasonongraphy (CUS) was normal in 28 patients (44%). Moreover, 36 patients had abnormal D-dimer but normal CUS. A follow-up of 12 months was available in 44 patients. During the follow-up, three recurrent events were recorded. All Recurrent events were ipsilateral DVT. Among these index cases, all had an abnormal D-dimer at either T0 and/or T1. The recurrence rate was higher in males than in females (8.6% vs. 2.2%, P = 0.04) with an abnormal D-dimer at T0 and/or T1 with a multivariate hazard ratio of 2.1 (95% confidence intervals [CI]: 1.2-5.2; P = 0.02). Patients older than 65 years had a higher rate of events than younger and hazard ratio was about 3.8 (95% CI: 2.1-4.2; P = 0.02). Patients with recurrences had higher mean D-dimer at both T0 and T1 when compared with those without recurrences, but the difference was significant only for D-dimer at T1 (P = 0.03). During the follow-up, two patients died (3%). Conclusion: Within 12 months follow- up, the risk of recurrence with an abnormal D-dimer, either during or at 1-month after discontinuing OAT, was 4.6% which is much lower to the annual risk of recurrence in most studies with idiopathic and provoked VTE. D-dimer has an acceptable prognostic value in detecting recurrence of idiopathic VTE before discontinuing the anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Hemophagocytic syndrome (HPS) is an uncommon manifestation in systemic lupus erythematosus (SLE). Clinical features of HPS include fever, pancytopenia, abnormal liver enzyme, hepatosplenomegaly, lymphadenopathy, and coagulation disorder. HPS comprises primary and reactive forms. Herein, we describe a case of untreated SLE with HPS as one of the first manifestations of systemic Lupus. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Recommendations for patients with diabetes mellitus during hajj pilgrimage" by M. Siavash and S. Haghighi in a previous issue.

Background: This study was done to evaluate the relationship between the time of endoscopy in patients with upper gastrointestinal bleeding with morbidity and mortality rates of patients at the Al Zahra Hospital emergency room., Materials and Methods: In a cohort study, 1152 patients at 2014 and 2015 have been hospitalized due to gastrointestinal bleeding in Al Zahra Hospital, were selected and demographic and clinical information and day and time of endoscopy and hospital mortality and fewer deaths than a month after discharge were studied, and prognosis was analyzed in terms of day and time of endoscopy., Results: Nine hundred and seventy-three cases (84.5%) of endoscopy were performed during the working days and 179 (15.5%) were performed on holidays. Moreover, 801 cases (69.5%) of endoscopy were done in the morning and 351 cases (30.5%) were performed in the evening and night shifts. The day and time of endoscopy had no significant effect on mortality in hospital and less than a month after but hospital death in whom underwent endoscopy by fellowship was significantly higher ( P = 0.004)., Conclusion: Endoscopy in nonholiday and holiday days and the time of endoscopy has no significant effect on hospital mortality 1 month after discharge. However, other factors such as endoscopy by attendant or fellowship, time between admission to endoscopy, age and sex of the patients, etc., were significantly effective on in-hospital mortality and death 1 months after discharge. Also faster and sooner endoscopy cannot reduce rate of blood transfusions or reduce the length of hospital stay but faster endoscopy of patients can reduce the risk of in-hospital death., Competing Interests: There are no conflicts of interest.