importance of hepatitis B virus genome diversity in basal core promoter region

Hepadnaviruses employ an unusual strategy for the production of enormous number of virions during replication which makes rapid and substantial genetic sequence changes and alterations. The pathogenesis and clearance of hepatitis B virus [HBV] infection are engaged by the selection and expression of viral mutants during virus-host interactions. Mutations in regulatory regions such as the basal core promoter [BCP] which is thought to be related to lower production of hepatitis B "e" antigen [HBeAg] directly affects the clinical presentation of liver disease. However, the molecular structure of these mutations in chronic carriers has not been adequately evaluated. In this review we evaluate the molecular aspect and pathologic basis of basal core promoter mutations

Hepatocellular carcinoma in the world and the Middle East

Hepatocellular carcinoma [HCC] is a major worldwide public health concern. Despite recent advances, there has been little success in improving the survival of HCC patients. Due to advances in diagnostic modalities and the increasing incidence of chronic viral hepatitis and nonalcoholic fatty liver disease [NAFLD], both of which are well known risk factors of HCC, the prevalence of HCC is increasing in developed countries and it is expected that this trend will continue in the future. In Middle Eastern countries the prevalence of this cancer is lower compared to sub-Saharan Africa and some Far East countries; however it is documented that the prevalence of this cancer in some parts of the Middle East is also increasing. In the current review, the prevalence and burden of this disease worldwide, particularly in Middle Eastern countries, and risk factors for HCC are discussed

[Clinical and paraclinical symptoms in Dementia]

Dementia is basically the disease of old people which is usually caused by a primary degenerative lesion or by a structural disease in the brain. In terms of etiology, dementia is associated with reversible and irreversible causes. Determination of the underlying causes of dementia may facilitate its treatment and prognosis. The purpose of this study is to evaluate clinical and paraclinical symptoms of dementia as well as to determine the most common causes. This is a cross sectional descriptive study on 100 patients with dementia who referred to Shahrivar 17[th] Hospital in Mashhad. First, the patients who were diagnosed as being infected by dementia were evaluated according to DSM-IV criteria. They were also enrolled in history taking and physical examinations as well as paraclinical managements like EEG, CT Scan and MRI. The obtained data were then recorded down in the questionnaires. 36% of the patients were females and 64% were males. Of this population, 43% had Alzheimer Disease [AD], 40% had Vascular Dementia [VaD], 9% Parkinson disease [PD] and 8% had other types of dementia while there was no case of Ferontotemporal dementia [FTD]. HTN, DM and Hyperlipidemia were found to have a fully significant effect on VaD. 100% with the history of TIA and 88% with the history of CVA had VaD which was meaningful, too. 55% of the VaD patients were identified with Gait disorder and 65% with Incontinence which is ststistically significant. Based on the results of MRI and CT Scan, 100% of the AD patients, 47.5% of the VaD patients and 88.9% of the PD patients were identified with cortical atrophy. In addition, it was found that hypocampus atrophy was present in 53.5% of the patients with AD and in 15% of the patients with VaD. In 90% of the VaD patients, hypodense foci was observed which is statistically significant, too. As the findings of the study suggest, the results of CT Scan and MRI was notably related to the type of dementia. Thus, it seems that using these two techniques can determine the existence of dementia in the early stages which can help with improving the quality and quantity of life in these patients. According to the frequency rate of VaD in our patients, it seems that the lack of or poor control of the risk factors like HTN, DM and hyperlipidemia can lead to the high frequency rate of vascular dementia

[HCV in intravenous drug users]

Hepatitis C [HCV] is increasing worldwide including Iran. HCV is more prevalent among intravenous drug abusers [IDU], especially if imprisoned, mostly due to needle sharing. We determined the rate of HCV seropositivity among IDU prisoners and compared it with those of non prisoners. A cross-sectional survey was done on consenting IDU inhabiting two prisons and attending three rehabilitation centers in Tehran, Iran. A questionnaire was completed for each subject and 5mL blood drawn. The samples were kept at 2-8°C until the sera were separated and stored at -70°C. HCV Ab [ELISA 1, third generation, DIA. PRO, Italy] with a sensitivity and specificity of 98% was checked by a single technician. Chi-square, Fisher's exact test and multivariable analysis were used where appropriate. Four-hundred and sixty seven subjects [346 [74.1%] prisoners; 425 [91%] male] were enrolled. Overall 66% tested positive for HCV Ab [287 male [67.5%], 21 female [50%], p<0.02]. HCV seropositivity was higher among prisoners [78.3% vs. 30.6%, p<0.001] and older IDU [76.9% vs. 62.9%, p=0.002]. Multivariable analysis showed association between HCV seropositivity and imprisonment [OR= 9.32, 95%CI: 5.60- 15.51], sharing syringes [OR=2.00, 95%CI: 1.27-3.17], duration of intravenous drug use annually [OR=1.16, 95%CI: 1.08-1.24] and male sex [OR=4.18, 95%CI: 2.02- 8.67]. HCV is rather common among IDU prisoners. Imprisonment is an independent risk factor. The infected IDU going back to the community may be an important source of HCV. Taking effective strategies [high risk group education, provision of sterile syringes, identification and treatment of infected IDU] to reduce the risk of this public health problem is needed urgently

[HCV in intravenous drug users]

Hepatitis C [HCV] is increasing worldwide including Iran. HCV is more prevalent among intravenous drug abusers [IDU], especially if imprisoned, mostly due to needle sharing. We determined the rate of HCV seropositivity among IDU prisoners and compared it with those of non prisoners. A cross-sectional survey was done on consenting IDU inhabiting two prisons and attending three rehabilitation centers in Tehran, Iran. A questionnaire was completed for each subject and 5mL blood drawn. The samples were kept at 2-8°C until the sera were separated and stored at -70°C. HCV Ab [ELISA 1, third generation, DIA. PRO, Italy] with a sensitivity and specificity of 98% was checked by a single technician. Chi-square, Fisher's exact test and multivariable analysis were used where appropriate. Four-hundred and sixty seven subjects [346 [74.1%] prisoners; 425 [91%] male] were enrolled. Overall 66% tested positive for HCV Ab [287 male [67.5%], 21 female [50%], p<0.02]. HCV seropositivity was higher among prisoners [78.3% vs. 30.6%, p<0.001] and older IDU [76.9% vs. 62.9%, p=0.002]. Multivariable analysis showed association between HCV seropositivity and imprisonment [OR= 9.32, 95%CI: 5.60- 15.51], sharing syringes [OR=2.00, 95%CI: 1.27-3.17], duration of intravenous drug use annually [OR=1.16, 95%CI: 1.08-1.24] and male sex [OR=4.18, 95%CI: 2.02- 8.67]. HCV is rather common among IDU prisoners. Imprisonment is an independent risk factor. The infected IDU going back to the community may be an important source of HCV. Taking effective strategies [high risk group education, provision of sterile syringes, identification and treatment of infected IDU] to reduce the risk of this public health problem is needed urgently