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

[Comparison of effect of EMLA cream and injection of methyl prednisolone acetate relief of pain associated with carpal tunnel syndrome]

A standard treatment option for carpal tunnel syndrome [CTS] is local injection of anesthetic-corticosteroid. This clinical trial was designed to compare the safety and efficacy of daily application of the EMLA cream with that of a single injection of methyl prednisolone acetate. This is a clinical trial which was performed in the clinics of Shiraz medical school in 1386. Sixty five participants with clinical and electrodiagnostic evidence of mild to moderate CTS were randomized to receive either the EMLA cream [group 1] or one injection [40 mg] of methylprednisolone acetate at wrist [group 2]. Visual analog scale was used to assess the patients' pain acuity. Collected data were statistically analyzed by SPSS software using Chi-Square test. Pain intensity before and after treatment and also 4 weeks after treatment in group A was 5.8 +/- 0.98, 0.7 +/- 0.82 and 2.1 +/- 1.2 and 5.7 +/- 1, 2.4 +/- 1.5 and 1.6 +/- 1.4 in group B. The differences in pain intensity in both group were significant [p<0.001]. EMLA cream was effective in reducing pain associated with CTS. It can be an effective, noninvasive symptomatic treatment for the patients with mild to moderate CTS

Sympathetic skin response in patients with carpal tunnel syndrome

Median nerve entrapment in the wrist is the most common entrapment neuropathy and is called carpal tunnel syndrome [CTS]. Conventional electrophysiologic studies evaluate only the myelinated fibers. Sympathetic skin response [SSR] is a wellestablished test for evaluation of the unmyelinated sympathetic fibers. This study was designed to evaluate the sympathetic fibers in CTS. Fifty four patients with carpal tunnel syndrome and 78 healthy subjects were enrolled in this study. Conventional electrodiangostic studies and SSR were performed in all the subjects with standard method. Latency of the SSR in healty subjects was 1520.21 +/- 87.25 ms and 1637.11 +/- 281.13ms in patients. Unmyelinated sympathetic fibers are involved in CTS and SSR which may, along with other conventional electrophysiologic tests, help in diagnosis of CTS

Correlation between cortical somatosensory evoked potentials and MRI in patients with lumbosacral radiculopathy

MRI and somatosensory evoked potentials [SEP] have been used in evaluation of different aspects of radiculopathies. Investigators have been interested in comparative values of these tests. To determine the clinical value of truncular and dermatomal SEP in diagnosis, localization and prognosis of lumbosacral radiculopathy and its sensitivity relative to MRI. The lower extremity SEP studies were done in 34 patients with definite clinical and MRI findings of lumbosacral radiculopathy. The findings were compared with those obtained from the control group which consisted of 35 healthy individuals. Among 33 patients with abnormal MRI, 29 had abnormal SEPs [87.8%]. The concordance of SEP with MRI regarding the level and side of affected roots was 65.5%. MRI overestimates disc bulge in some patients. As a low-cost and sensitive tool, SEP is recommended to be used in addition to MRI in evaluation of lumbosacral radiculopathy