Seroepidemiology of hepatitis E virus infection in 2-25-year-olds in Sari district, Islamic Republic of Iran

The seroprevalence of hepatitis E virus infection [HEV] in children and young adults was determined in a community-based survey in an area of northern Islamic Republic of Iran. Serum samples were taken from 1080 randomly selected apparently healthy 2-25-year-olds from urban and rural regions of Sari district. Anti-HEV IgG antibodies were detected in 25 individuals [2.3%]. Seroprevalence increased significantly with age from 3/255 [1.2%] in children < 10 years to 8/110 [7.3%] in those aged 20-25 years. No differences in HEV status were noted between the sexes. Earlier age at exposure to infection and a higher infection rate were found in people residing in rural areas than in urban areas

Combination therapy with interferon and ribavirin for chronic hepatitis C infection in beta-thalassaemia major

Treatment of chronic hepatitis C virus [HCV] infection in transfusion-dependent betathalassaemia major patients is complicated by existing hepatic siderosis and the fear of ribavirinassociated haemolysis. We evaluated the efficacy and side-effects of combination interferon-alpha [INF] and ribavirin therapy for HCV-infected thalassaemia patients. A total of 17 patients were enrolled [10 nonresponders to INF monotherapy, 7 naive to treatment, mean age 23.1 years] and they received 12 months of combination therapy. The sustained virological response rate 6 months after treatment was 58.8%. Blood transfusion requirements during treatment temporarily increased by 36.6%. Combination therapy was tolerated by, and may be useful for, HCV-infected thalassaemia major patients

[Clinical and endoscopic prognostic factors in peptic ulcer bleeding]

Bleeding ulcer represent the most common cause of upper gastrointestinal hemorrhage. This study aims to evaluate the prognostic factors of recurrent bleeding and mortality in patients presenting with high risk of peptic ulcer bleeding. A cohort study with 88 patients was designed to investigate prognostic factors to the occurrence of new episodes of bleeding. Endoscopic hemostasis was performed in 32 cases [36%]. Recurrent bleeding and death occurred in 30 [34, 1%] and 3 cases [3, 4%] respectively. The predictors factors of rebleeding were hypovolemia at admission and the localization of the ulcer in bulb. The only predictor factor of death was the anticoagulant therapy. The identification of patients with risk of death by bleeding peptic ulcer remains as a challenge, once few factors are capable of predicting the severity of the evolution. The identification of such factors will allow the choice of the better therapeutic conduct improving the diagnosis and decreasing the rate of rebleeding and the mortality

[Overlap syndrome autoimmune hepatitis=primary biliary cirrhosis. Comparative study with isolated autoimmune hepatitis results of a multicentric Tunisian]

Autoimmune hepatitis [AIR] and primary biliary cirrhosis [PBC] are two autoimmune diseases affecting the liver. Suggestive signs of the two diseases can however occur simultaneously or consecutively in the same patient leading to an overlap syndrome. The aim of our multicentric retrospective study was to study clinical, biological, immunological and histological features of 17 patients with overlap syndrome and to compare them with those of 62 patients with isolated autoimmune hepatitis. Overlap syndrome "AIH-PBC" accounts for 20,5%of patients with autoimmune hepatitis in our series. Our two groups were similar in age and gender. Clinically, in overlap syndrome group, a significantly higher prevalence of pruritus arid significantly lower prevalence of ascites were observed as compared to isolated AIH group. No significant differences were observed between the two groups of patients with regard to frequency of concurrent immune diseases. Biologically, serum alkaline phosphatase and garnma-glutamyl-transpeptidase were significantly higher in overlap syndrome than in patients with isolated AIH. Significantly more overlap syndrome patients were positive for anti-mitochondrial antibodies than isolated AIR patients. The patients with isolated AIR had a higher frequency of cirrhosis at presentation that the patients with overlap syndrome. The histologic profile was not different between isolated AIR and Overlap syndrome. Overlap syndrome "AIR-PBC" is not rare. Compared with isolated AIH, it is characterised by a higher frequency of clinical and biological signs of cholestasis, a higher frequency of antimitochondrial antibodies and the rarity of cirrhosis at the diagnosis of the disease

[Occult hepatitis B among hemodialysed patients]

The rate of hepatitis B infection remains high in hemodialysis units despite preventive measures. This could be attribuated to the presence of occult hepatitis B among hemodialysis. To study the prevalence of occult HBV infection in haemodialysis patients with negative Hbs Ag. A group of patients Hbs Ag [-] [n=173] followed in hemodialysis units in Monastir has been tested by the hepatitis B virus Amplicor Monitor test to detect hepatitis B virus viremia [virus hepatitis B DNA] in serum. A total of 173 patients HBs Ag [-] were included in the study [mean age: 60 years [13-74 years] sex ratio: 1, 98]. 11EV vaccination was made in 93%of patients. Twenty percent of patients were infected with HCV. The rate of transaminases was always normal even in patients anti HCV [+]. No dialysis patients had detectable hepatitis B virus-DNA by polymerase chain reaction technology. Multivariate analysis demonstrated an independent and significant relationship between anti-HCV antibody and anti-hepatitis B virus core antibody in serum. occult hepatitis B virus was absent in our study group. This could be explained by the high prevalence of patients hepatitis B vaccinated

Antibacterial susceptibility of uropathogens in 3 hospitals, Sari, Islamic Republic of Iran, 2002-2003

To determine the frequency and pattern of antibiotic susceptibility of uropathogens in urinary tract infection [UTI] from 3 university hospitals we carried out a retrospective review of urine culture and antibiotic sensitivity testing from symptomatic outpatients and inpatients during 2002-2003. Of 5600 samples, 703 [12.6%] were culture positive, 38.7% of which were from hospitalized patients. Escherichia coli was the leading cause of UTI in both groups of patients. The rates and roles of other pathogens, including Pseudomonas spp. [5.3%-10.4%], Enterobacter spp. [0%-5.7%], Staphylococcus spp.] 5.4%-26.4%], differed in each hospital. Differences in antibacterial susceptibility patterns were observed. Ampicillin [82%-100%] and co-trimoxazole [50%-90%] resistance were the most frequent. Methicillin resistance in Staphylococcus spp. ranged from 17% to 60%

[Diphtheria and tetanus immunity in placenta and two months infant]

Abstract Introduction: Maternal immunization provides potential means for protecting infants against some infections with universal application

Objective: This study was designed to determine the levels of immunity against Diphtheria and Tetanus in mothers and their two mounths old infants who reffered for vaccination, and evaluate the relation of mothers vaccination on their infants immunity and determine the ratio of mothers who didn't observe the vaccination during pregnancy

Materials and Methods: Sera were collected from 110 mother-infant pairs before DTwP vaccination and from 69 infants after receipt of three doses of DTP vaccine. Anti diphtheria, anti tetanus toxins IgG levels were measured by ELIZA. History of DT vaccination of mothers at pregnancy was recorded. The mean concentration of antibodies against diphtheria and tetanus in mother and their infants before vaccination and in infants after receipt of 3doses of DTwP vaccine were measured and compared by paired t-test

Results: Of 110 mothers, 22 [20%] did not receive dT vaccine. Of these 22 unvaccinated mothers, one [4.5%] and six [27.2%] were serologically susceptible to tetanus and diphtheria respectively. The mean concentrations of antibodies titers of unvaccinated mothers were significantly lower than vaccinated mothers. All infants acquired immunity against both infections after receipt of three doses of DTP vaccine. Infants' immune response to DTP was not affected by maternal immunization

Conclusion: Diphtheria - tetanus toxoids components of DTP vaccine were highly immunologenic, According to lack of vaccination in pregnancy, more effort must be made to increase the coverage rate of this highly immunogenic vaccine to sustain protection against diphtheria and tetanus

[Intrahepatic cholestasis of pregnancy]

Intrahepatic cholestasis of pregnancy is a pregnancy specific hepatic disorder. It occurs mainly in the third trimester of pregnancy by pruritus and elevated serum levels of aminotransferases and total bile acid which completly regresses few days or weeks after delivery. Intrahepatic cholestasis of pregnancy is regarded as a benign disease with meaningful consequences to the mother but associated to increased perinatal risk with increased rates of preterm birth and perinatal mortality. The pathogenesis of disease is unclear yet but likely involves a genetic hypersensitivity to estrogen or progesteron metabolites. Treatment is focused on reducing symptoms in mother and to provide an adequate obstetric management in order to prevent fetal distress. Currently, only ursodeoxycholic acid treatment has been proven to be useful and safe and should be the first choice treatment

[Massive lower intestinal bleeding from colonic tuberculosis case report]

Colonic tuberculosis is an uncommon presentation of gastro intestinal tuberculosis. We describe a 46-year-old patient who presented with massive rectal bleeding. The patient had required a surgical resection following which the patient died to complications. This case emphasizes the need to include colonic tuberculosis in the diagnosis of lower intestinal bleeding

[Response to extra dose of hepatitis B vaccine in non-seroprotected children 10 years after primary immunization]

The aim of the present study was to identify the true extent of non-responsiveness in children vaccinated against Hepatitis B virus [HBV] ten years ago at birth whom were serologically susceptible to HBV,and had poor antibody response to booster HBV vaccine. Twenty low-and non-responding 11.5 years old children recuited in by another study received three additional doeses of HB vaccine 4-6 weeks apart. Anti-HbS antibody titers were assessed before and 4-6 weeks after each dose of vaccine by using ELISA method. All children showed anamnestic antibody responses after receiving the first additional dose of vaccine. There was no significant differences between the mean concentration of antibody after the first, second and third doses of vaccine. Study results showed that those children who did not respond to booster does of the HB vaccine may not be real non-responder.HB vaccine at infancy induces long-time immunologic memory which provides seroprotection by exposure to HBs-Ag

[Sternal osteomyelitis: an exceptional osteo-articular lesion in inflammatory bowel disease: a case study]

Primary sternal osteomyelitis is a rare condition. It's association with ulcerative colitis is exceptional. We report a case of a 34 years old woman with multiple extra-intestinal manifestations presenting sternal osteomyelitis successfully treated with combined surgical intervention and intravenous antibiotics

[Chronic HBS antigen carriers casually discovered - evolutionary aspects about 221 adults]

Hepatitis B virus infection constitutes a health public problem notably in our country where the frequency of chronic HBs antigen carriage is about 5%. Most of these patients are asymptomatic and so underestimated. Study epidemiological characters and clinical, biological and virological profile of chronic HBs Ag carriers whose discovery was fortuitous. retrospective study of 221 patient's files where HBs Ag was casually discovered: blood donors [128], pregnant women [40], exposition to risk factor [24], familial inquiry [23] and prenuptial examination [6]. average age was 31 years with a male predominance. Among the hepatitis risk factors found: high frequency of multiple syringes use and scarifications. All patients were asymptomatic with a normal physical exam. Prevalence of anti-HCV antibodies was 0,28% and that of anti-HDV 9,3%. A moderate cytolysis was noted in 14 patients [6,3%] and about 2/3 of them had positive markers of viral replication [HBe Ag+ and/or DNA+]. HBe antigen was positive in 12,7% of cases. Average duration of follow-up was 20,7 months. Three patients made spontaneous conversion HBe Ag/anti-HBe, and one conversion HBs Ag/anti-HBs. Hepatic biopsy was practised in 8 patients with cytolysis and showed 3 cirrhosis and 5 chronic hepatitis. Conclusion : despite favorable evolution of these patients, a clinical and biological supervision is necessary to search cytolysis and/or viral replication requiring then more agressive management