Short term outcome of patients with hematochezia and normal initial colonoscopic findings: do they really need further screening?

In a significant number of the patients with hematochezia, colonoscopy turns out to be normal and therefore is unable to determine the cause of bleeding. This study investigates outcomes and possible necessity for further work up in cases of hematochezia with normal colonoscopy. Ninety-seven patients with normal colonoscopy were followed for at least one year from the time of colonoscopy by regular visits and phone calls. Mortality and recurrent bleeding were recorded as primary end points. Those with recurrent or continued hematochezia were invited for a new visit and further work up. Among the ninety seven patients, nine cases [9.3%] were lost at follow ups, 10 experienced rebleeding [10.3%], and the remaining 78 [80.4%] were apparently healthy and had no further complaints. There were two mortalities during the follow up, one due to gastric cancer and the other due to cerebrovascular accident. It is unusual for the cases of hematochezia with a normal initial colonoscopy to have recurrent bleeding as a result of a significant missed lesion in the colon

Outcome and characteristics of patients on the liver transplant waiting list: Shiraz experience

The only curative therapy for end-stage liver disease is transplantation but due to a shortage of available donor livers the waiting list mortality is high. This study aimed to evaluate the outcome and characteristics of patients on the waiting list for liver transplantation in Shiraz, southern Iran during the period from April 2004 to March 2007. Medical records of all chronic liver disease patients >/= 14 years that were on the waiting list for liver transplantation at the Nemazee Hospital Organ Transplant Center during April 2004 to March 2007 were reviewed. Hospital records were used to retrieve demographic, clinical and laboratory data. Records of the referring gastroenterologists provided information about the etiology and complications of liver disease. The patients were followed at the end of the study period by clinic visits or telephone contact. There were 646 patients on the waiting list for liver transplant during April 2004 to March 2007. Hepatitis B was the most common etiology of liver disease [31.2%]. Of those on the waiting list, 144 patients 22.3%] underwent liver transplant and 166 [25.7%] died while waiting for a transplant. The mean waiting period for transplant was 6.6 months. Receiving a transplant was correlated with the etiology of liver disease and Rh blood group [p<0.05] but had no significant association with gender or ABO blood type. Among non-transplanted patients, survival was lower in those who had a history of encephalopathy, SBP or uncontrolled ascites and in patients with a Child-Turcotte-Puph [CTP] class C and/or a Model of End-stage Liver Disease [MELD] score >/= 15. Hepatitis B virus is the most common cause of end-stage chronic liver disease amongst patients on the waiting list for liver transplant in Shiraz, southern Iran. Patients with a MELD score >/= 15 particularly those with a history of SBP, hepatic encephalopathy or uncontrolled ascites are recommended for waiting list enrollment

[Relation between C.32 A>T Polymorphism in TLR7 and response to treatment in Chronic HCV-infection]

Hepatitis C virus [HCV]-infection leads to development of chronic hepatitis, liver cirrhosis and hepatoma. Both the liver damage and extrahepatic manifestation of HCV are immune-mediated. Since HCV is an RNA virus, a role for toll like receptor 7 [TLR7] in the immune response against HCV is likely. The aim of the present study was to determine the frequency of C.32T allele of TLR-7 in general and chronic HCV hepatitis, and its effect on treatment of HCV. This case -control study was carried out on 154 patients of chronic hepatitis C in 2008-2009. The patients were selected from referrals to Hepatitis clinic at Shahid Motahari Polyclinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran which had indication of treatment. The patients were randomly selected according to inclusion and exclusion criteria. Control group consisted of 225 healthy subjects. The frequency of C.32T allele of TLR-7 was determined in154 patients with chronic HCV-infection, and in 225 healthy controls. Treatment with interferon-alpha and ribavirin was performed after genotype determination. Sustained virologic response [SVR] and end treatment response [ETR] were determined and effect of C.32T allele of TLR-7 on outcomes of treatment was evaluated. The frequency of C.32T allele of TLR-7 in patients with chronic hepatitis C was 15.33% in male, 14.67% in female and totally 15.2%. The frequency of C.32T allele of TLR-7 in healthy control group was 16.24% in male, 10.3% in female and totally 14.67%. The rate of Sustained Virologic Response [SVR] was 75%, but in patients that had C.32T allele of TLR-7, SVR was 55% [p=0.046]. c.32A>T single nucleotide polymorphism of TLR-7, by impairment of TLR-7 function, can be considered among host factors that had unfavorable effect on response rate to treatment of patients with chronic HCV hepatitis

Introduction of an indirect haemagglutination test as a rapid diagnostic method in comparison with ELISA using antigen B for diagnosis of human hydatid disease

Early diagnosis of human hydatid disease by detecting the specific antibodies in patients' sera is considered as an important step in treatment of infection. But the diagnostic efficiencies of assays greatly depend on the characteristics of antigen that is used and various conditions in performance. In present study, we tried to st and ardize an indirect haemagglutination test, using antigen B for diagnosis of hydatid disease. Sera from 80 patients with surgically confirmed hydatidosis and 40 sera from healthy donors were examined. To detect the cross-reactant antibodies, 53 sera from patients with other parasitic infectious and diseases were applied in this study. IHA was performed with sheep RBC that was sensitized by various concentrations of crude antigen and antigen B. The best results were obtained by IHA with applying antigen B [10 micro g/ml] for 40 min at 37°C or 60 min at room temperature. Diagnostic value of antigen B [sensitivity 93.75%, specificity 100% and efficiency 97.12%] was significantly higher than related value of crude antigen [sensitivity 65%, specificity 100% and efficiency 83.81%] in IHA under the optimum condition. Sensitivity and specificity of ELISA using crude antigen [10 micro g/ml] were obtained 80% and 94.62%, respectively. Corresponding values of ELISA using antigen B were also obtained as 72.5% and 98.92%, respectively. It is suggested that the IHA, as a serological assay, is a valuable method with high diagnostic efficiency for serodiagnosis of hydatid disease, when is performed by purified antigen B. It is a rapid diagnostic assay with any needs neither for expensive instruments nor expert personnel so is useful for seroepidemiological studies and field trial in endemic areas