[Seroprevalence of hepatitis C in hemophilia patients refering to iran hemophilia society center in Tehran]

Hemophilia is a congenital disease resulting in deficiency of clotting factors. For this reason they have a constant need of clotting factors which makes them one of the largest consumers of blood products. Through this blood product use, many of these patients have become infected by hepatitis C virus [HCV]. We have studied the seroprevalence of anti-HCV antibody and HCV infection in hemophilic patients refereeing to Iran Hemophilia Society center in Tehran. In a cross-sectional study we reviewed files of all hemophilic patients registered in Iran Hemophilia Society center in Tehran from 2003 to 2005. Subjects with available results of anti-HCV antibody were included. Among the 1170 files examined, 1095 contained data on HCV infection status. From these, 802 subjects [72.3%] had anti-HCV antibodies. Genotype 1 was most common [60%] followed by genotype 3 [38%]. Almost 10% of patients with anti-HCV antibodies had a negative HCV RNA by PCR. HCV is very common among hemophilic patients and considering the risk for the patients and their contacts it is necessary to screen all hemophiliacs for HCV and treat if indicated

Flutamide-induced hepatotoxicity: a case report

Flutamide is a non-steroidal antiandrogen commonly used in the treatment of prostate cancer. Severe hepatotoxicity occurs in few patients, yet may be fatal. To date, none of the reported cases of fiutamide hepatotoxicity has demonstrated thrombocytopenia and chronic liver disease. We report the case of a 55-year-old male with prostatic adenocarcinoma who developed liver failure after six months of fiutamide therapy. The patient was referred with complaints of drowsiness, weakness, fatigue, and nausea in addition to jaundice, ascites, leg edema, splenomegaly, and bilateral pleural effusion. Laboratory findings included thrombocytopenia, hypoalbuminemia, and prolonged prothrombin time, with elevated aminotransferase and bilirubin. Abdominopelvic spiral computed tomography [CT] scan showed ascites and bilateral plural effusion. He discontinued flutamide and ursodeoxycholic acid [UDCA] was started. The patient completely recovered within four months. This was a rare case of flutamide-induced hepatotoxicity in a patient who referred with signs of advanced liver disease and thrombocytopenia. It appeared that UDCA was an effective therapy for fiutamide hepatotoxicity

population-based seroepidemiological study on hepatitis E virus in Iran

Little is known about HEV seroprevalence and its determinants in Iran. Considering the fact that Iran is among the countries in which HEV infection is endemic, a large-scale population-based study in this regard is justified. This survey was conducted in 2006 in Tehran and Golestan Provinces, Iran. Stored sera of subjects were tested for serological markers of anti-HEV. The baseline data were recorded in structured questionnaires. Weighted seroprevalence and weighted logistic regression coefficients were calculated. A total of 1423 samples were included. The overall seroprevalence in two provinces was 7.4%. Age with an odds ratio equal to 1.59 [95% CI: 1.26-2.02] and history of traditional phlebotomy with an odds ratio equal to 2.28 [95% CI: 1.13-4.60] were independent predictors of HEV seropositivity. Considering the high rate of HEV seroprevalence in Iran, further studies on the cost-effectiveness of vaccination among vulnerable groups are mandator

case with a fistula draining into the stomach due to retained surgical gauze

Retained surgical gauze is occasionally observed in general practice. Herein, we report a case with surgical gauze retained for over 13 years that created a fistula which drained pus into the stomach

effect of weight reduction on ultrasonographic findings of non alcoholic fatty liver

Non-alcoholic fatty liver [NAFL] includes a spectrum of diseases ranging from simple hepatic steatosis to nonalcoholic steatohepatitis [NASH] and cirrhosis. NAFL is typically seen in association with obesity, diabetes and hypertriglyceridaemia. In order to seek the role of diet therapy in treatment of NAFL, we compared the ultrasonographic findings of patients with fatty liver disease before and after standard diet therapy. Twenty-three overweight or obese subjects with incidental fatty liver discovered during ultrasonography were included. Subjects underwent 3 months of diet therapy, and anthropometric data including weight, height, BMI, waist circumference, and hip circumference were measured. Ultrasonographic findings were graded from 0 to 3. Changes in ultrasonographic findings and anthropometric data were studied. After three months of dieting, the ultrasonographic grade of all patients decreased by one or two grades. Fifteen patients decreased one grade while 8 others decreased by 2 grades. We observed a significant correlation between the decrease in ultrasonographic grade and the decrease in weight and BMI. Our study indicates that standard diet therapy could be used as an effective treatment for NAFL patients

Prevalence of non alcoholic steatohepatitis in Iran: a population based study

Non-alcoholic fatty liver disease/steatohepatitis [NAFLD/NASH] is the most common form of chronic liver disease woldwide and is no longer considered a benign disease. Its prevalence has not been determined in a large-scale population-based study in Iran. A total of 6583 individuals aged 18 to 65 were randomly selected from three geographically distinct provinces in Iran. Blood samples were obtained from each subject and a questionnaire was completed exploring data including self-admitted regular alcohol use. Serums were tested for anti-HCV antibody [anti-HCV], hepatitis B surface antigen and anti-hepatitis B core antibody. Positive samples for anti-HCV antibody were re-tested and those positive in a repeat ELISA were confirmed by a recombinant immunoblot assay [RIBA] test. Serums were also tested for ALT levels. Subjects with elevated ALT defined as serum ALT >/= 40 IU/L with no history of alcohol consumption and negative HBV and HCV infection were considered as [presumed NASH]. In this study 5589 subjects were analyzed. Two hundred and forty two individuals [4.3%] were diagnosed with elevated ALT levels. Among individuals with elevated ALT, 15 [6.2%] were diagnosed with either hepatitis B or hepatitis C. The overall weighted prevalence of presumed NASH was 2.9%. According to multivariate analysis, male sex, urban lifestyle, and being overweight or obese were significantly associated with [presumed NASH]. Obesity and metabolic syndrome, the most predictive factors of fatty liver disease, are increasing in Iran, therefore the prevalence of NAFLD/NASH and related complications are expected to increase in the future. This population based study gives a crude estimate of the prevalence of NASH around the country. Studies with more accurate surrogates of NASH need to be done. The disparity among different provinces merits special consideration

[ effect of interleukin 28 B polymorphism on sustained virology response [SVR] in Patients with chronic hepatitis C]

The effect of IL 28 B polymorphism on sustained virology response [SVR] in patients with Hepatitis C genotype 1 varies among races. Multiple studies have shown that the SVR is two or three times higher in patients with CC genotype compared to those with TT genotype. This study aims to assess the relationship between IL 28 B polymorphism and SVR in Iranian patients. Materials and In a cross-sectional study, 48 patients with Hepatitis C genotype 1 who underwent PCR testing six months following treatment were divided into two groups, SVR positive and negative in order to compare IL 28 B polymorphism. The SVR rate was higher in patients who presented with high baseline ALT levels, independent of IL 28 B genotype [p=0.023]. Logistic regression analysis showed a higher SVR rate in patients with CC genotype compared to TT genotype [p=0.007, OR=29.333, CI=2.558-336.387], however no significant difference was noted between TC and TT genotypes [p=0.177, OR=2.887, CI=0.618-13.496]. Additionally, there was a significant difference between CC and non-CC groups [TC, TT] in SVR rate [p=0.017, OR=13.750, CI=1.602- 118.061]. A high SVR rate was seen in the C group [CC, TC] when compared with the TT genotype [p=0.036, OR=4.923, CI=1.111-21.816]. The sensitivity, specificity, PPV and NPV of the IL 28 B genotype in predicting SVR was 88.8%, 38%, 64.8% and 72.8%, respectively. In addition; although the CC genotype was positive, the sensitivity and NPV were increased to 91.6% and 95.2% respectively. This study confirms the relationship between IL 28 B genotype and SVR rate in the patients with Hepatitis C genotype 1. It seems; IL 28 B genotype could be the reasonable Lab. test for treatment plan of the problematic cases of the patients with Chronic Hepatitis C

Digestive and liver disease statistics in Iran

Gastrointestinal and liver diseases [GILD] are among the most common causes of morbidity in Iran and constitute a substantial proportion of mortality which imposes enormous economic consequences. Our purpose is to collect information and report current statistics on physician visits, hospitalizations, and deaths due to common GILD in Iran. Data on the leading causes of death were obtained from the Iranian Ministry of Health, Office of Health Statistics. A total of 213,322 deaths were reported from March 2003 to February 2004 [excluding mortality from the Bam earthquake] which equaled 4.4 deaths per 1000 population. Of these, 36,575 were due to accidents. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases [ICD-10; 1992]. The leading causes of hospitalization were obtained from the database of the GILD ward in Shariati Hospital, one of the largest and best known gastroenterology referral hospitals in Iran. Similarly, leading causes of out-patient referrals were identified from a large multi-physician outpatient clinic in Tehran. The five leading gastrointestinal causes of death in order of frequency were: gastric cancer, hepatobiliary cancer, liver cirrhosis, esophageal cancer, and colorectal cancer. The five leading causes of hospitalization in the GILD ward of Shariati Hospital were: liver cirrhosis, hepatitis, peptic ulcer disease, cholycystitis and cholangitis, and colorectal cancer. The most common outpatient diagnosis was gastroesophageal reflux disease followed by irritable bowel syndrome [IBS], duodenal ulcer [DU], non-ulcer dyspepsia, and chronic hepatitis B [HBV]. Gastrointestinal and liver malignancy along with chronic liver disease constitute the main GILD reasons for hospitalization and deaths in Iran. Gastroesophageal reflux disease, IBS, and chronic HBV are the most common GILD outpatient diagnoses

Prevalence of fatty liver disease among type 2 diabetes mellitus patients and its relation to insulin resistance

A substantial proportion of the mortality in patients with type 2 diabetes mellitus [T2DM] is related to non-alcoholic fatty liver disease [NAFLD] and its complications. Insulin resistance is a major etiologic factor for the development of fatty liver. We aimed to study the prevalence of NAFLD among T2DM patients and its relation to insulin resistance. Patients with T2DM that were referred to a tertiary referral center in Tehran from February 2003 to August 2005 were evaluated. Patients with characteristic findings on ultrasonography were considered as having fatty Livers. The Homeostasis Model Assistant - Insulin Resistance [HOMA-IR] and Quantitative Insulin Sensitivity Check Index [QUICKI] were calculated as measures of insulin resistance. Of the 172 patients included in the study, 96 [55.8%] had evidence of fatty livers, 6 of which [3.5% of total] presented with elevated liver enzymes. BMI and triglyceride levels in the fatty liver group were significantly higher than patients with normal livers [p=0.002 and 0.036, respectively]. The HOMA-IR and QUICKI indexes were not significantly different between the two groups. Fatty liver is a common finding among T2DM patients. The degree of insulin resistance does not appear to be predictive of fatty liver among this population

Treatment of non-alcoholic fatty liver disease [NAFLD]: a systematic review

No treatment has been proven to be effective in nonalcoholic fatty liver disease [NAFLD] and/or steatohepatitis [NASH]. Numerous studies have addressed this issue. However conclusive recommendations cannot be drawn solely from the currently available studies. Hence we performed this systematic review to determine which of the available therapeutic modalities are supported by adequate evidence in terms of decreasing the adverse clinical outcomes of interest. A specific strategy was utilized to perform a computerized literature search in MEDLINE; of which, a total of 375 studies were retrieved. According to current literature, modifying the potential risk factors such as obesity, hyperlipidemia, and poor diabetic control in all patients is considered the treatment of choice. Certain treatments can be recommended under special circumstances and some medications, although used clinically, are not supported by adequate evidence to be recommended for the treatment of NAFLD/NASH