[Diagnostic values of fibrosis index in ultrasonography for differentiation of chronic viral hepatitis from liver cirrhosis]

Fibrosis index is a new index used for differentiation of cirrhosis from chronic hepatitis. If fibrosis index appears efficient in Doppler ultrasonography, it can be considered a good alternative for liver biopsy. Therefore, in this study we evaluated the diagnostic values of fibrosis index in ultrasonography for differentiation of chronic viral hepatitis from hepatic cirrhosis. This cross-sectional study included 104 patients, 19 patients with cirrhosis and 85 patients with chronic hepatitis. The diagnoses of cirrhosis and chronic hepatitis had been confirmed by biopsy. PSV, RI, EDV, PPFV and FI indices were calculated and compared between the two groups. Then, using ROC curve, we determined the cut-off-point for FI. The median of PSV and RI in the cirrhosis group was significantly higher than those in the chronic hepatitis group [p<0.05] but EDV median did not show any difference and PPFV was significantly lower in the cirrhosis group in comparison to the hepatitis group [p<0.001]. A fibrosis index of 3.365 or higher with a sensitivity of 94.7% and a specificity of 83.5% was the best cut-off-point for differentiating cirrhosis from chronic hepatitis. The area under curve was estimated at 0.948. Based on the results of this study, fibrosis index in the above- mentioned method could be a highly efficient index for differentiation of cirrhosis from chronic hepatitis and its sensitivity and specificity were higher than those of previously used indices.

[Correlation of psychiatric disorders with CD4 counts in HIV/AIDS patients in sina hospital, kermanshah]

CD4 count is the most important indicator of the degree of immune deficiency in HIVpositive patients. The goal of this research was to study the relationship between CD4 count and psychological disorders in these patients. In this cross-sectional study, subjects were studied from June 2004 for one year in Sina hospital in Kermanshah. HIV infection was confirmed with positive double ELISA and Western Blot, CD4 counts by flow-cytometery. SCL-90-R questionnaire was used for selection of patients. In the second stage diagnostic symptom checklist based on DSM-IV criteria was used for patients with unconfirmed diagnosis of psychological disorders. All data were then analyzed. From 59 studied patients, 58 patients were males; all being addicts with prison records. Mean age of patients was 34.26 +/- 7.4 [range 23 to 50], years. Mean CD4 count was 312 +/- 216 per micro liter. The incidence of psychological disorders was 62.7%; multiple disorders 22%, mood disorder%22, anxiety disorder%8.5, psychotic disorder 5.1%, cognitive disorder 3.4%, and personality disorder 1.7%. The least CD4 count was found in single cognitive disorder [129 cells/ul]. There was a significant statistical relationship between cognitive disorder, [apart from it combination with other disorders], and CD4 count of lower than 200 per micro liter [p=0.021] and CD4 percent lower than 15 [p=0.032]. Also, relation between single anxiety disorder and CD4 count of lower than 200 per micro liter was significant, [p=0.033]. In addition, there was a significant relationship between pneumonia syndrome and mood disorder [p=0.009], and between soft tissue infection and psychotic disorder [p=0.017]. Prison settlement of over 60 months was related to anxiety disorder [p=0.045]. In this research psychiatric disorder incidence was higher than other studies that could be due to the high rate of addiction and imprisonment. Relation between CD4 count with cognitive and anxiety disorders indicated that with the progression of HIV infection, there is an increase in the occurrence psychological disorders with social problems having additional adverse effects on the psychological status

Immune response to standard dose of hepatitis B vaccine in HIV positive clients of Kermanshah behavioral diseases counseling center

Coinfection eventuality of HIV and HBV infection and having common transmission ways has turned Hepatitis B into a major health concern among HIV positive cases. The increasing number of HIV infected patients and their relevant problems, especially opportunistic infections, demands for Hepatitis B vaccination. This study, therefore was conducted to evaluate the immune response against hepatitis B vaccine and related factors among HIV positive cases and probable approaches to improve its level. In this cross -sectional study, 169 HIV positive cases who were Kermanshah's Behavioral Disease Counseling Center's clients, with negative HBsAg and HBcAb, were vaccinated against hepatitis B virus with a 20 micro g of recombinant HBsAg at 0-1-6 month schedule in deltoid region. A month after the last shot, their HBsAg titer was measured. Titers higher than 10 Iu/ml were considered as a suitable immune response. Data included in this study were: age, gender, CD4 count, antiretroviral treatment history, hepatitis C coinfection and injecting drug abuse. Then these data were analyzed through X2 test. Among 169 under study cases, immune response was overally 52.7% and this rate was 51.9% for males and 66.7% for females [P=0.313]. Immune response was 54.3%, 44.3%, 45.3% in CD4 count>500, 200-499, and <200/mm3 respectively [P=0.039]. In cases with and without antiretroviral treatment the immune response was 81.8% and 50.6%, respectively [P=0.045%]. In this study the CD4 count and history of antiretroviral therapy correlation with immune response level was significant, but other factors like age, HCV co-infection, drug abusing, and gender were ineffective factors in immune response to HBV vaccine. Therefore, early vaccination among cases with higher CD4 count and cases under antiretroviral treatment seems necessary

Serologic response to hepatitis B vaccine in health care workers, Kermanshah, Iran

Hepatitis B is a major infectious risk factor for health-care workers [HCWs] and public- safety workers. Although seroconversion rate following hepatitis B vaccination is estimated to be more than 90%, serologic response to Heberbiovac HB vaccine currently given in our center in Kermanshah province has been varied in different experiences, So, this study was conducted to determine serologic response in HCWs. In a descriptive-cross sectional study, in 138 HbcAb from 10 health care centers, HbcAb negatives and vaccinated with Heberbiovac HB [Cuba made, available vaccine in Iran], HbsAb titer was assessed by ELISA. Serologic response as antibody titer equal or more than 10mIU/ml considered protective level [serologic responder]. The data were analyzed by SPSS software, using X 2 and Fisher exact test. Within 138 HCWs [60.1% female and 39.9% male], 69.6% had serologic response. The age had significant role in serologic response rate, but sex, weight, smoking and interval from the last time of vaccine reception were not effective factors. Serologic response rate to HBV vaccine in Kermanshah was much lower than other experiences. We need more information about the efficacy of Heberbiovac HB in high-risk groups and general population, the reasons of low efficacy and increasing serologic response