association between angiotensin II type 1 receptor gene A1166C polymorphism and non-alcoholic fatty liver disease and its severity

Background: Genetic predisposition may have important role in pathogenesis of non-alcoholic fatty liver disease [NAFLD]. Angiotensin II type I receptor [AGTR1] has been known to involve in the process of liver steatosis and fibrosis. This study aimed to investigate the association between AGTR1 A1166C polymorphism and NAFLD

Methods; A cross-sectional study was conducted during May 2014-May 2015 among healthy adults referring to our radiology clinic for abdominal sonography. AGTR1 A1166C polymorphism was evaluated in subjects with NAFLD and healthy individuals using allelic discrimination method

Results: 58 subjects with NAFLD were compared with 88 healthy individuals without NAFLD. The frequency of AA and CC genotypes of AGTR1 was significantly higher in patients with NAFLD compared with controls [p=0.029 and 0.042, respectively]. C allele was more detected in subjects with NAFLD compared with the healthy controls [OR: 2.1; 95% CI: 1.23-3.61, p =0.006]. CC genotype [OR: 10.62; 95% CI: 1.05-106.57, p =0.045] and C allele [OR: 6.81; 95% CI: 1.42- 32.48, p =0.016] were also predictors of severe fatty liver disease in our study population

Conclusion: Our results provide the first evidence that AGTR1 gene A1166C polymorphism not only is associated with NAFLD and but also may predict its severity

Anatomical variations of the biliary tree found with endoscopic retrograde cholagiopancreatography in a referral center in southern Iran

Background: Anatomical variations in the biliary system have been proven to be of clinical importance. Awareness of the pattern of these variations in a specific population may help to prevent and manage biliary injuries during surgical and endoscopic procedures. Knowledge of the biliary anatomy will be also of great help in planning the drainage of adequate percentage of liver parenchyma in endoscopic or radiological procedures

Methods: All consecutive patients undergoing endoscopic retrograde cholangiopancreatography [ERCP] from April 2013 to April 2015 at Nemazee Hospital, a referral center in the south of Iran, were included in this cross-sectional study. The patients with previous hepatic or biliary surgery, liver injury or destructive biliary disease were excluded from the study. All ERCPs were reviewed by two expert gastroenterologists in this field. The disagreed images by the two gastroenterologists were excluded. Huang classification was used for categorizing the different structural variants of the biliary tree, and the frequency of each variant was recorded

Results: Totally, 362 patients [181 men and 181 women] were included in the study. 163 patients [45%] had type Al Huang classification [right dominant], which was the most prevalent type among our patients. 55% of them had non-right dominant anatomy. The result of the Chi-square test revealed that there was no statistically significant difference between the men and women regarding the anatomical variations [p = 0.413]

Conclusion: The anatomical variation in the biliary system among Iranian patients is comparable to other regions of the world. Significant proportions of our patients are non-right dominant and may need bilateral biliary drainage

Outcomes of liver transplantation for patients with acute liver failure

Liver transplantation is a treatment for patients who have acute liver failure [ALF]. This study aims to evaluate the outcomes following liver transplantation in patients with ALF and compare them with cirrhotic patients who underwent liver transplantation. This retrospective cross-sectional study was conducted at Shiraz Organ Transplant Center between June 2004 and March 2011 to evaluate the clinical presentation and underlying etiology of patients with ALF and their outcomes following liver transplantation. Out of 750 patients who underwent liver transplants, 12 [8 males and 4 females] had a diagnosis of ALF. The cirrhotic group [control] consisted of 20 transplanted patients. ALF patients were younger with a mean age of 18.7 +/- 12.9 years compared to 37.4 +/- 13.6 years in the cirrhotic group [P = 0.001]. In the ALF group, 5 [41.66%] underwent partial living related liver transplantation compared to 1 [5%] in the cirrhotic group [P = 0.018]. There were significantly more early post-transplant complications observed among patients with ALF compared to the cirrhotic group [P = 0.002]. Liver transplantation is safe, effective and should be considered in patients diagnosed with ALF

Endoscopic cyanoacrylate injection for the treatment of bleeding gastric varices: the first Iranian series

Gastric varices are a major cause of gastrointestinal bleeding and death in patients with portal hypertension. N-butyl-2-cya-noacrylate injection is a new method for controlling bleeding gastric varices. This study aims to investigate the prognosis and complications of cyanoacrylate therapy for bleeding gastric varices. We conducted a prospective study between May 2009 and January 2010 at our center affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. All patients with gastric variceal bleeding were enrolled in the study. N-butyl-2-cyanoacrylate injection was performed for treatment of the bleeding, and patients underwent monthly endoscopies to determine the outcomes. There were 13 patients with portal hypertension and gastric variceal bleeding included in the study. Initial hemostasis was obtained in all patients but more than one injection was needed in seven patients. Two patients developed re-bleeding and two died of advanced cirrhosis and other accompanying diseases. No major complications were observed after treatment with N-butyl-2-cyanoacrylate. This method can be safely used in treatment of gastric variceal bleeding

Outcomes of kidney transplantation in patients with systemic lupus erythematosus: a single-center study

This study aimed to compare outcomes of kidney transplantation in patients with systemic lupus erythematosus [SLE] and a matched control group of non-SLE kidney recipients. In a case-control study, 33 patients with kidney transplantation due to end-stage renal disease caused by SLE were matched to a control group consisted of 33 non-SLE patients who had been transplanted during the same period of time in our center. The clinical characteristics, complications, and patient and graft survival were compared between the two groups. In each group, 12 patients [36.4%] received a kidney from a deceased donor, 15 [45.4%] from a living unrelated donor, and 6 [18.2%] from a living related donor. There was no significant difference between the outcome in SLE patients and duration of dialysis before transplantation. The mean duration of hospital stay was 23.4 +/- 18.1 days in the SLE group, while it was 13.0 +/- 7.3 days in the controls [P = .006]. One-year graft survival was 79.0% in patients with SLE and 90.9% in non-SLE patients [P = .17]. One-year patient survival was 93.9% in patients with SLE versus 81.8% in the controls [P = .26]. Nine patients in the SLE group versus 11 patients in the control group developed posttransplant complications [P = .59]. Although hospital stay after transplantation was longer in the SLE kidney recipients than controls, safety of kidney transplantation was comparable. Graft failure in the SLE patients was not significantly different between patients with different sources of kidneys

Seroprevalence study of hepatits A virus in Fars province, southern Iran

There are several studies on seroprevalence of hepatitis A virus [HAV] in adults in the Middle East. To determine seroprevalence of HAV among adult population in Fars province, southern Iran. In a cross-sectional study, we checked anti-HAV antibody [IgG] in subjected refereed to our health care centers to perform laboratory tests before getting determined. Some risk factors like level of education, type of residence, job, numbers of family members, and access to treated water were also evaluated in these participants. From 1050 subjects studied, 927 [88.2%] had ant-HAV antibody; 123 [11.8%] were antibody negative. Among subjects aged <20 years, the anti-HAV seroprevalence was the lowest [79.3%] followed by subjects aged 20-30 years [91.3%] and those >30 years [99%] [p= 0.01]. 85.1% of studied individuals in urban areas had anti-HAV IgG while 95.9% of subjects in rural regions were anti-HAV positive [p=0.001]. The seroprevalence of HAV antibody was significantly associated with number of family members [p=0.001]. HAV is highly prevalent in our region especially in rural areas. It is better to vaccinate the children for HAV by the time they receive HBV vaccine or when they are five years