Hepatitis C virus infection among multi-transfused patients and personnel in haemodialysis units in central Islamic Republic of Iran

A cross-sectional study was made of the prevalence of HCV and associated risk factors in 382 multi-transfused patients and haemodialysis staff in Yadz province in 2006. Of those tested for anti-HCV antibodies, 50.6% of patients with inherited bleeding disorders, 11.8% with thalassaemia and 5.0% undergoing haemodialysis were seropositive. First transfusion before 1996 [when blood donor screening started] was the common risk factor associated with HCV infection. Only 1/52 haemodialysis staff members was HCV infected [an intravenous drug user]. Infection control measures were poor in all centres. In patients with inherited bleeding disorders genotype 1 [65.0%] was the predominant followed by genotype 3 [35.0%]. The results provide evidence that blood donor screening and use of virus-inactivated factor concentrates have lowered the risk of HCV infection among multi-transfused patients

Halothane: How should it be used in a developing country?

The anaesthetic agent halothane is still widely used in developing countries including the Islamic Republic of Iran because of its low price. Because of halothane-induced hepatitis, a rare complication, it has been replaced by other inhalation anaesthetics in Western countries; it has been suggested by some Iranian professionals that the Islamic Republic of Iran should do the same. We evaluated various dimensions of this replacement through a literature review to assess the incidence of halothane-induced hepatitis and costs of anaesthetics in the country. We also conducted a questionnaire survey of 30 anaesthesiology/gastroenterology experts about their views on the subject. The results indicate that the incidence of halothane hepatitis in the Islamic Republic of Iran is very low and could mostly be avoided by strict adherence to guidelines. Complete withdrawal of halothane in the Islamic Republic of Iran might not be appropriate at present. Comprehensive cost-effectiveness studies are needed before a decision is made on complete replacement of halothane with other anaesthetics

Seroepidemiology of HBV infection in South-East of Iran; a population based study

Hepatitis B virus [HBV] infection is a major risk factor of cirrhosis and hepatocellular carcinoma affecting billions of people globally. Since information on its prevalence in general population is mandatory for formulating effective policies, this population based serological survey was conducted in Sistan and Baluchistan, where no previous epidemiological data were available. Using random cluster sampling 3989 healthy subjects were selected from 9 districts of Sistan and Baluchistan Province in southeastern Iran. The subjects' age ranged from 6 to 65 years old. Serum samples were tested for HBcAb, HBsAg. Screening tests were carried out by the third generation of ELISA. Various risk factors were recorded and multivariate analysis was performed. The prevalence of HBsAg and HBcAb in Sistan and Baluchistan was 3.38% [95% CI 2.85; 3.98] and 23.58% [95% CI 22.29; 24.93] respectively. We found 8 cases of positive anti-HDV antibody. Predictors of HBsAg or HBcAb in multivariate analysis were age, marital status and addiction. The rate of HBV infection in Sistan and Baluchistan was higher than other parts of Iran. Approxi-mately 25% of general population in this province had previous exposure to HBV and 3% were HBsAg carriers. Intrafamilial and addiction were major routes of HBV transmission in this province

protective effect of medicinal herbs extracts including cynara scolymus L., cichorium intybus L. taraxacum officinal L. and berberis vulgaris L. in single and in combination form in CCI4 induced rat liver toxicity

Several herbal remedies are used in traditional medicine for treatment of liver disorders, but their efficacy, safety, and dosage have not been investigated so far. The present study was aimed to evaluate the liver protective effects of medicinal herbs extracts such as Cynara scolymus leave [artichok], Cichorium intybus roots [chichory], Taraxacum officinale root [dandelium], Berberis vulgaris [barberry] root and stems extract in single and in combination form against carbon tetrachloride [CCl4] induced liver toxicity. Total 70 wistar male rat, aged 5 months were divided in 7 groups of 10 rats each. One group kept as normal and out of six CCl4 intoxicated groups one served as control, one received mixture of four extract and four groups received artichok, chichory, dandelium, and barberry in the dosage of 150, 300, 300 and 250 mg/kg/day respectively. The plant extracts were injected intra peritoneal simultaneously with intoxication for three days. Three days after intoxication and extract treatments the serum liver enzymes levels such as ALT, AST and ALP as well as serum gluthathion and catalase were determined. In group receiving mixture of 4 herbal extract the blood level of ALT, AST and ALP were reduced significantly as compared to control group. In all the groups receiving herbal extracts the serum glutathione and catalase levels did not differ as compared to control groups. In the present study administration of chichory, artichoke, dandelium and barberry in combination form prevent liver intoxication withought influence on serum antioxidant properties

Identification of hepatitis B virus surface antigen [HBsAg] genotypes and variations in chronic carriers from Isfahan province, Iran

Hepatitis B virus [HBV] gene and protein variations are frequently been seen in chronic patients. The aims of study were to determine the genotypes as well as the patterns of variations distribution in chronically-infected patients from the central part of Iran. The surface gene was amplified, sequenced and subsequently aligned using international and national Iranian database. All strains belonged to genotype D, subgenotype Dl and subtype ayw2. Of all 62 mutations occurred at 39 nucleotide positions, 31 [50%] were missense [amino acid altering] and 31 [50%] were silent [no amino acid changing]. At the amino acid level, 30 substitutions occurred, however, 3 were in positions 122 and 127, corresponded to subtypic determination. 22 [73%] out of 30 amino acid mutations occurred in different immune epitopes within surface protein, of which 12 [54.54%] in B cell epitopes in 10 residues; 5 [45.45%] in T helper epitopes in positions; 5 [22.73%] in inside CTL epitopes in 4 residues. The distribution of amino acid mutations as well as the ratio between silent and missense nucleotide mutations showed a narrowly focused immune pressure had already been on the surface protein in these patients, led to the emergence of escape mutants in these patients

effects of cynara scolymus L. leaf and cichorium intybus L. root extracts on carbon tetrachloride induced liver toxicity in rats

Cynara scolymus and Cichorium intybus are popular herbal remedy in folk medicine for liver disorders. Although many experimental studies carried out, scientifically reliable data needed to verify minimum effective dosage and efficacy of these medicinal plants. In present investigation, the effects of C. scolymus leaf and C. intybus root extracts at different doses were tested against CCl[4] induced rats liver toxicity. The C. scolymus leaf and C. intybus root extracts at the doses of 300, 600 and 900 and 150, 300 and 450 mg/kg/day were prepared respectively. Liver intoxication was induced in 7 groups of rats by intraperitoneal injection of 1 ml/kg of 1:1 CCl[4] in olive oil for two successive days. One group kept as control and six different doses of plant extracts were administered to six groups simultaneously with CCl[4] administration. The serum levels of ALT, AST and ALP, liver tissue glutathione and catalase activity as well as liver tissue microvesicular steatosis [MVS] and pericentral coagulation necrosis [PCN] were determined after three days. The serum ALT, AST and ALP and liver tissue MVS were significantly reduced in both the C. scolymus and C. intybus groups at the doses of 900 and 450 mg/kg/day respectively while liver tissue PCN significantly reduced in C. scolymus 900 mg/kg/day group only as compared to control group. In present study administration of the C. scolymus leaf [900 mg/kg/day] and C. intybus root [450 mg/kg/day] extracts ameliorated CCl[4] induced rat serum liver enzyme changes and liver tissue histopathological damage

HIV/HBV Co-infections: epidemiology, natural history, and treatment: a review article

Hepatitis B virus [HBV] infection, one of the major health priorities, accounts approximately for 350 million chronic cases and a global total of 33 million people were living with human immunodeficiency virus [HIV] in the world. Co-infection with HIV and the HBV presents a significant challenge to health care providers, with different prevalence rates in different parts of the world. It is important to screen all HIV infected individuals for HBV infection and reverse. Infection with HBV becomes more violent in patients co-infected with human immunodeficiency syndrome. HIV/HBV co-infected individuals are at increased risk of chronic hepatitis, cirrhosis, and hepatocellular carcinoma, and of experiencing HAART toxicity. In this review, the latest statistics on epidemiology of HIV, HBV and their co-infection has been presented along with prominent characteristics of HBV. Transmission routes which are the common between HBV and HIV are described and the most important ones are described according to the regional and age features. Also, there is a series of actions being performed once HBV infections occur to prevent HIV or to diagnose if the HBV-infected individuals are also infected with HIV. As in treatment case, some of the frequent treatment methods including applying interferon and using nucleoside and nucleotide analogues have been discussed. Finally, we would explain the new recommendations for treating patients who were co-infected with HBV and HIV, including staging HBV and HIV treatment, based on the stage of each disease. It also outlines the optimal treatment options, whether the patient is treated for HBV first, HIV first, or HIV and HBV together

effects of Taraxacum officinale L. and Berberis vulgaris L. root extracts on carbon tetrachloride induced liver toxicity in rats

Taraxacum officinale and Berberis vulgaris have long been used as herbal remedies for treatment of a variety of complaints including liver dysfunction and gallbladder disease. However scientifically reliable data are needed to verify their minimum effective doses. In present study, the effects of Taraxacum officinale L. and Berberis vulgaris L. root extracts at the different doses 10, 20 and 30 times higher than average dose [THD] used in traditional systems of medicines were tested against carbon tetrachloride [CCl4] induced liver toxicity in rats. Methods: The root extracts of T. officinale at doses of 250, 500 and 750 mg/kg/day and B. vulgaris at doses of 300, 600 and 900 mg/kg/day, relative to 10, 20 and 30 THD average doses used in traditional systems of medicines were prepared by dissolving dry extracts in 5% dimethyl sulfoxide in distilled water. Eighty male Wistar rats, 5 months old, were divided in 8 groups of 10 rats each. Liver intoxication was induced in 7 groups by intraperitoneal injection of 1 ml/kg of 1:1 CCl4 in olive oil for two successive days. One group was kept as control and six different doses of medicinal plants extracts were administered to six groups simultaneously with CCl4 administration. After three days the serum levels of ALT, AST and ALP, liver tissue glutathione level and catalase activities as well as liver tissue microvesicular steatosis and pericentral coagulation necrosis were determined. In control group the blood levels of ALT, AST, ALP and liver tissue injury were increased whereas the serum GSH level and catalase activity decreased significantly after 3 days of beginning of carbon tetrachloride liver toxicity as compared to normal group. In T. officinale treated group at the dose of 750 mg/kg/day, the serum ALT and ALP levels and in B. vulgaris at the dose of 900 mg/kg/day, the serum ALP levels reduced significantly as compared to control group. The liver micro vesicular steatosis was inhibited significantly in both groups at the doses of 30 THD as compared to control group. In the present study administration of T. officinale and B. vulgaris root extracts at with 30 THD ameliorated CCl4 induced liver damage

impact of hepatitis b infection on outcome of kidney transplantation: a long-term study

With the success of kidney transplantation, liver disease has emerged as an important cause of morbidity and mortality in kidney recipients. To determine the impact of hepatitis B virus [HBV] infection on patients and graft survival in both short- and long-terms. 99 renal transplant patients infected with HBV on follow-up in two major transplant centers were included in a retrospective study. These patients were grafted between 1986 and 2005 and divided into two groups: [1] those only positive for hepatitis B surface antigen [HBsAg] and [2] those who were also positive for hepatitis C virus antibodies [HCV Ab]. There were 88 patients with HBsAg[+] and 11 with both HBsAg[+] and HCV Ab[+]. The mean +/- SD age of patients was 38.8 +/- 13.2 years, and the median follow-up after transplantation was 19 months. Although not significant, the allograft survival rate in the first group [HBV[+] was better compared to that in the second group [HBV[+] and HCV[+]; 1, 5 and 10 years graft survival rates were 91, 77 and 62 in the first group and 70, 56 and 28 in the second group, respectively [P=0.07]. The overall mortality was 5% [4 of 88] in the first and 27% [3 of 11] in the second group [P=0.02]. Renal allograft recipients with HBV and HCV infections has a poor survival rate compared to pa- tients with only HBV infection. However, there is no significant difference in terms of renal graft survival between the two groups

Hepatitis A prevention strategies, Haiti case: should rescuers be immunized

Hepatitis A virus [HAV], a small non-enveloped RNA virus from Picornaviridea family, causes approximately 1.5 million cases of acute hepatitis each year, and is still a major world health problem especially in developing countries. As the risk of getting infected by HAV increases at the time of crisis such as earthquakes, we tried to perform a brief review on current situation of HAV in Haiti, a country that experienced an earthquake measuring 7.0 on the Richter scale recently, and that it might be in danger of experiencing outbreaks of enterically transmittable infective agents such as HAV

Epidemiology of HCV infection among thalassemia patients in Eastern Mediterranean countries: a quantitative review of literature

Hepatitis C infection [HCV] is the major co-morbidity in thalassemia patients; however, literature lacks data from many EMRO counties. There is also enormous heterogeneity in the available study results in this region, and distribution of HCV infection among these patients living in this region is still unknown. This study provides a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for hepatitis C virus [HCV] infection in thalassemia patients in eastern mediterranean countries. A systematic review was carried out based on the computerized literature database. 95% confidence intervals of infection rates were calculated using the approximate normal distribution model. Pooled Odds ratios and 95% CI were calculated by fixed or random effects models. The heterogeneity was assessed by either Q or X[2] statistics. Publication bias was evaluated by either Harbor's modified or Egger's test. We identified 40 studies that fulfilled our inclusion criteria involving 8554 thalassemia subjects. Pooled HCV seroprevalence was 18% [95% CI 14-21], 45% [95% CI 43-48], 63% [95% CI 56-69] and 69% [95% CI 58-80] in Iran, Pakistan, Saudi Arabia and Egypt, respectively. Among Iranian thalassemia patients, splenectomy OR=4.1 [95% CI 1.5-11.2], high transfusion OR=3.5 [95% CI 1.8-7], high age OR=6.1[95% CI 1.2-31.2] and first transfusion before 1996 OR=7.6 [95% CI 4.7-12.3] were major risk factors of HCV infection. There are no data from many EMRO countries. Among major EMRO countries, Iran has the least seroprevalence of HCV infection among thalassemia patients. This underscores more advanced blood safety in this country compared with other countries with comparable population in this region

Tailoring of interventional procedures for HCC patients-review article

One of the most frequent primary malignant tumors in the world is hepatocellular carcinoma [HCC]. Currently, the optimal treatment methods for HCC are hepatic resection and liver transplantation. Unfortunately, surgical therapies are suitable for 20% of patients and those who are not eligible for surgery should undergo interventional therapies. In the past decade, a variety of interventional procedures have been employed for local control of hepatocellular carcinoma [HCC] including transcatheter arterial chemoembolization [TACE] and many tumor ablation techniques, such as percutaneous ethanol injection [PEI], radio-frequency ablation [RFA], percutaneous microwave coagulation therapy [PMC], laser-induced interstitial thermotherapy [LITT], cryoablation, and acetic acid injection. By development of new technologies in imaging and drug delivery, it is likely that in the future patients with HCC will be treated by combination therapies to improve patient survival. Computed tomography [CT] and magnetic resonance imaging [MRI] have a crucial role in diagnosis and also follow-up of HCC patients treated by interventional procedures, by which the treatment efficacy, recurrence of disease and certain complications are evaluated. In this review article, we discuss the imaging modalities and also tailoring of interventional procedures for HCC patients

Nationwide report on the findings of integrated school health screening program in Iran

Screening of students' health problems could lead to timely prevention and control of many health disorders. This study aimed to determine the nationwide prevalence of common disorders through school health screening program in Iran. This cross-sectional national screening program was conducted in 2007-2008 among first-and third-grade-students in primary schools, first-grade-students of middle and high schools of all provinces in Iran. Data were obtained from 3,124,021 [81.9%] students reported from the whole country classified into 33 geographical zones. Of total students studied, 12.48% had weight abnormalities, 4.77% had visual disorders, 3.95% had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders. Among students studied, 0.4%, 0.7%, 0.4% and0.8% had endocrine, psychological, neurological and genitourinary disorders, respectively. In addition, 2.1%, 1.9%, 1.8%, 0.8%0.5%, 0.3% and 0.3% of students had ear, nose and pharynx disorder, anemia, skin and hair, cardiac, abdominal, vertebral and lung problems, respectively. In elementary schools, 57.6% of first-grade-students with at least one disorder were managed in outpatient settings and 6% of them were hospitalized for more investigation. Among third-grade-students of elementary schools, these values corresponded to 13.2% and 1.1%, respectively. Among first grade students of middle and high schools, this prevalence was 58.5% and 44.6% and 1.2% and 0.3% of students were hospitalized for more investigation. This integrated school screening program revealed a considerably high prevalence of health disorders among school students. These results might help health policy makers to design future health promoting programs

Distribution of hepatitis C virus genotypes in iranian patients with congenital bleeding disorders

Chronic hepatitis C virus [HCV] infection is the major cause of liver disease related morbidity and mortality in hemophilic patients who needs regular blood product administration. Although genotype of infecting HCV is one of the prime predictors of response to antiviral therapy however, its distribution in hemophilic patients is still unclear and just few studies with low sample sizes have investigated this issue. Therefore, in this study, we aimed to identify this distribution in 367 Iranian hemophilic patients. Blood samples were received from 367 hemophilic patients with chronic hepatitis C detected during a nationwide screening program who referred to our center for therapeutic measures. HCV RNA viral load was detected using Amplicor test [Version 2]. Genotyping was performed by genotype specific primers. HCV genotype distribution was 1a in 58%, 3a in 18.5%, 1b in 14.7%, 4 in 1.1%, 2 in 0.8% and mixed in 6.2% and finally 0.5% of isolates were non-typable. Serum liver enzymes were not associated with HCV viral load and genotypes. Patients with severe bleeding tendency had significantly lower serum liver enzymes than those with a mild bleeding tendency. Genotype 1a followed by 3a and 1b were the most frequently detected HCV genotypes in Iranian hemophilic patients and there was no association between splenomegaly and viral markers and liver enzymes in these patients

Occult hepatitis B infection and its possible impact on chronic hepatitis C virus infection

As a well-recognized clinical phenomenon, persistent detectable viral genome in liver or sera in the absence of other serological markers for active hepatitis B virus [HBV] replication is called occult HBV infection. The main mechanism through which occult infection occurs is not completely understood and several possible explanations, such as integration into human genome and maintenance in peripheral mononuclear cells, exist. Occult HBV infection has been reported in different populations, especially among patients with Hepatitis C [HCV] related liver disease. The probable impact of occult HBV in patients with chronic HCV infection has been previously investigated and the evidence suggests a possible correlation with lower response to anti-viral treatment, higher grades of liver histological changes, and also developing hepatocellular carcinoma. However, in the absence of conclusive results, further studies should be conducted to absolutely assess the impact of occult HBV contamination on the HCV related liver disease

[Frequency of fatty liver and some of its risk factors in asymptomatic carriers of HBV attending the Tehran blood transfusion organization hepatitis clinic]

Liver steatosis causes progression in liver damage and accelerates liver fibrosis. There is lack of data in Iran regarding the prevalence and risk factors of fatty liver in carriers of HBV. The current study was performed to assess the prevalence and risk factors of fatty liver in carriers of HBV in Iran. This study was conducted between 1995 and 2006, as a cross sectional study, on 1120 asymptomatic HBV carriers, selected from the hepatitis clinic of the Tehran Blood Transfusion Organization. Age, sex, marital status and paraclinacal data including CBC, LFT, PT, lipid profile, FBS, and alcohol consumption were recorded using a checklist. Fatty liver, found in 106 subjects, showed a significant correlation with sex [p=0.001], job [p=0.01], cigarette smoking [p=0.009], and previous history of liver disease [p=0.007]; liver disease also had a significant correlation with Hg levels [p=0.001], AST [p=0.001], ALT [p=0.001], total bilirubin [p=0.004], direct bilirubin [p=0.032], and TG [p=0.002]. FBS and total cholesterol levels were not significantly correlated with fatty liver [p>0.05]. Fatty liver is seen in 10% of asymptomatic HBV carriers; considering the negative impact of fatty liver on liver damage, it is essential to screen HBV carriers for the presence of fatty liver. Male, smokers, and those with disturbances in lipid profile are at a higher risk

[Serum iron, hepatic iron deposition, and inflammatory hepatic necrosis/fibrosis in chronic hepatitis C]

We studied the effects of serum iron level, hepatic iron deposition and other metabolic disorders i.e., insulin resistance in hepatic fibrosis development. Among 60 patients with chronic hepatitis C, we measured serum iron, ferritin and transferring level. Meanwhile, hepatic biopsies were obtained from 43 patients for whom iron deposition, inflammatory necrosis/fibrosis score and steatosis were determined. Hepatic iron deposition was significantly associated with waist circumference, ferritin level >200ng/ml, fasting C-peptide >1.9ng/ml, AST/ALT ratio >1, and fasting triglyceride >200mg/dl. On the other hand, it was not correlated with the following: grading, preportal-precital hepatitis [A], necrosis [b], focal lytic necrosis [C], focal apoptosis [C], and portal inflammation [D]. Our findings suggested an interaction between hepatic iron deposition and waist circumference, ferritin, fasting C-peptide, AST/ALT, and fasting triglyceride