Serum albumin level as an indicator of response to Hepatitis B vaccination in dialysis patients: A systematic review and meta-analysis.

BACKGROUND: Hepatitis B (HB) vaccination is a recommended procedure in all dialysis patients, but its efficacy has not been perfect. In the current study, we aimed to conduct a comprehensive review of the literature to find and pool data of the randomized trials evaluating the impact of serum albumin levels on the immunogenicity of HB vaccination in dialysis patients. METHODS: Literature searches were conducted by the Medline and Google Scholar. The key words used included 'Hepatitis B', 'Vaccine', 'Dialysis', 'Hemodialysis', and 'Albumin'. Data of serum albumin levels regarding seroresponse to HB vaccine in clinical trials have been achieved and analyzed. Finally, data from 17 clinical trials have been pooled and analyzed. RESULTS: One thousand six hundred eighty-two dialysis patients (1212 seroconverted) were included in the meta-analysis. Analysis of response to HB vaccination in our dialysis population showed a significant relationship to their serum albumin levels (p<0.001, z= 5.23). Regarding the dialysis mode, serum albumin level was only a significant interfering factor in hemodialysis patients versus continuous ambulatory peritoneal dialysis (CAPD) (HD group: p<0.001, I2=88.5%, χ2=95.28 (d.f. = 11); CAPD (±HD) group: χ2= 2.21; P=0.697, I2= 0%, d.f.= 4). CONCLUSION: The data showed a significant effect for the levels of serum albumin on the immunogenicity of HB vaccine in dialysis patients. Moreover, stratification of data upon dialysis mode showed that this association is only available for hemodialysis patients, and not those on peritoneal dialysis.

Sex bias in response to hepatitis B vaccination in end-stage renal disease patients: Meta-analysis.

AIM: To systematically review the literature for studies investigating the potential effect of gender of dialysis patients on the immunogenicity of hepatitis B virus vaccines. METHODS: Literature searches were conducted by the MEDLINE and Google Scholar. The key words used included "hepatitis B (HB)", "vaccine", "dialysis", "hemodialysis", "sex", "male" and "female". Data of seroresponse to HB vaccine in clinical trials regarding sex of the recipients have been achieved and analyzed. Finally data from 19 clinical trials have been pooled and analyzed. RESULTS: Analysis of response to HB vaccination in our dialysis population showed males significantly respond less to hepatitis B vaccination (P = 0.002, Z = 3.08) with no significant heterogeneity detected [P = 0.766; heterogeneity χ(2) = 14.30 (df = 19); I (2) = 0%]. A reanalysis of the pooled data was conducted regarding the dialysis mode to evaluate potential differential impact of sex on HB vaccine response. Hemodialysis was the only subgroup that showed a significant difference regarding dialysis mode in response to HB vaccination regarding sex (P = 0.042, Z = 2.03). CONCLUSION: This Meta-analysis showed significant effect for the sex of chronic kidney disease and dialysis patients on the immunogenicity of HB vaccine. This sex discrimination was most prominent among hemodialysis patients.

Effect of Aerobic and Resistance Exercise Training on Liver Enzymes and Hepatic Fat in Iranian Men With Nonalcoholic Fatty Liver Disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has different prevalence rates in various parts of the world and is a risk factor for diabetes and cardiovascular disease that could progress to nonalcoholic steatohepatitis, cirrhosis, and liver failure. OBJECTIVES: The current study aimed to investigate the effect of Aerobic Training (AT) and resistance training (RT) on hepatic fat content and liver enzyme levels in Iranian men. PATIENTS AND METHODS: In a randomized clinical trial study, 30 men with clinically defined NAFLD were allocated into three groups (aerobic, resistance and control). An aerobic group program consisted of 45 minutes of aerobic exercise at 60% - 75% maximum heart rate intensity, a resistance group performed seven resistance exercises at intensity of 50% - 70% of 1 repetition maximum (1RM ) and the control group had no exercise training program during the study. Before and after training, anthropometry, insulin sensitivity, liver enzymes and hepatic fat were elevated. RESULTS: After training, hepatic fat content was markedly reduced, to a similar extent, in both the aerobic and resistance exercise training groups (P ≤ 0.05). In the two exercise training groups, alanine amino transferase and aspartate amino transferase serum levels were significantly decreased compared to the control group (P = 0.002) and (P = 0.02), respectively. Moreover, body fat (%), fat mass (kg), homeostasis model assessment insulin resistance (HOMI-IR) were all improved in the AT and RT. These changes in the AT group were independent of weight loss. CONCLUSIONS: This study demonstrated that RT and AT are equally effective in reducing hepatic fat content and liver enzyme levels among patients with NAFLD. However, aerobic exercise specifically improves NAFLD independent of any change in body weight.

Pancreatitis developing in the context of acute hepatitis: a literature review.

Despite strong evidence suggestive of associations between hepatic diseases and pancreas injury, a potential relationship between acute hepatitis and acute pancreatitis has not been a matter of review; which we focused on in the current paper. Some of the main findings of this review article are: fulminant hepatitis failure represents the highest incident rate of hepatitis-related acute pancreatitis; so a screening program might be indicative in these patients. Specific characteristics of HAV-related pancreatitis are that it is a benign condition with no reported mortality; and a male preponderance in the incidence, with females developing in older ages and having shown the signs of both conditions simultaneously. The incidence of acute pancreatitis in HBV infection is the lowest, but the mortality was the highest. HEV-related acute pancreatitis was most likely to represent pseudocysts and there was an apparent ethnic-priority with Indian descents, the only reported cases in the literature. Hepatitis-related pancreatitis in liver transplant recipients was most frequent in HBV infected patients; and in IFN-induced pancreatitis, cessation of the drug was most effective in treatment, with no catastrophic event reported.

A meta-analysis of potential relationship between Epstein-Barr-Encoded-RNA (EBER) and onset time of post-transplant lymphoproliferative disorders.

Epstein-Barr virus (EBV) encodes two non-polyadenylated RNAs termed EBV-encoded RNAs (EBERs). In this study, we tried to find series in which data of EBER and onset time of post-transplant lymphoproliferative disorder (PTLD) for patients have been documented to conduct a meta-analysis. A comprehensive search of the literature was performed by Pubmed and Google scholar to find reports indicating test results for EBER and PTLD onset in transplant patients. PTLD was considered "early onset" when it develops within the first post-transplant year. Finally, 265 patients from 15 studies have been included in the meta-analysis. The overall meta-analysis also showed a significant relation between EBER test positivity and early-onset PTLD development [relative risk (RR): 1.36; 95% CI: 1.16-1.59; P <0.001]. The i2 index was 49.8%. Our study suggests that PTLD lesions with positive EBER test are more likely to develop within the early post-transplant period. Since early-onset PTLD is supposed to have better prognosis, having a positive EBER test might not be a bad news. However, for having a precise conclusion, prospective studies are needed to be conducted.

Unfavorable survival rates in Iranian patients with gastric cancers: a single center experience from Tehran.

We examined the effect of potential interfering factors that play major roles in the outcome of our patients with stomach cancer. 100 consecutive patients diagnosed with gastric cancers were prospectively observed, treated and followed from November 2009 to January. Absence of Helicobacter pylori infection (P=0.027), absence of vascularisation (P<0.001), and undetermined histopathological type of adenocarcinoma (P=0.003) were factors significantly associated with higher grade of gastric lesions. Life tables were used to define survival of gastric cancers. Survival rates of these patients at 1st week, 1st month, 2nd month, 3rd month, and 6th month were 97%, 96%, 91%, 90%, and 82%, respectively. The only determinant of 6 months of survival was age over 68 (P=0.039). Our study confirms our previous knowledge that gastric cancers have unfavorable outcome in Iran.

Colorectal involvement by post-transplant lymphoproliferative disorders: a review of 81 cases.

The reported number of patients representing post-transplant lymphoproliferative disorders (PTLD) within the colorectal region is quite limited. In this study, we sought to analyze and compare the characteristics, predictors and prognosis of colorectal localization of PTLDs arising in transplant recipients. A comprehensive search was performed through Pubmed and Google scholar to find case reports and series of colorectal localization of PTLD. Data of each individual patient from different studies were entered into a database and analyzed. Colorectal PTLD was significantly more prevalent in male patients (19.3% vs. 8.5%, respectively; P = 0.002) and represented a significantly shorter time to diagnosis than other localizations (P = 0.044). Multi-organ involvement (75% vs. 46%, respectively; P < 0.001) and disseminated disease (43% vs. 26%, respectively; P = 0.014) were more frequently observed in the colorectal PTLD. There was no survival difference between the two groups. Organ recipients representing colorectal involvement by PTLD are significantly at higher risk for metastasis, especially in their small intestine. Moreover, patients who underwent surgical intervention had low mortality, and, accordingly, we suggest using surgery to manage colorectal PTLD when it is applicable. Prospective studies with larger patient populations are needed to confirm these results.

Localization of post-transplant lymphoproliferative disorders to the stomach might be associated with favorable outcome: a systematic review.

Gastric localization of post-transplant lymphoproliferative disorders (PTLDs) is very rare. In this study, we aimed to accumulate existing data in the current literature to reveal the clinical, histopathological and prognostic specificities associated with gastric PTLDs and to find the best treatment strategies in this patient population. A comprehensive search was conducted for the available data in the current literature using Pubmed and Google scholar search engines for reports on gastric PTLD in renal transplant recipients. Data of different studies were standardized and entered into a database and analyzed. No statistically significant difference was found between gastric and non-gastric PTLD. Gastric PTLD was relatively more prevalent in female patients (P = 0.08) and showed a trend toward better outcome (P = 0.1) and less metastasis (P = 0.07). Surgical intervention and rituximab therapy were associated with a more favorable outcome (17% mortality). Our study showed that organ transplant recipients having gastric PTLD develop metastasis less frequently and tend to have a relatively more favorable outcome. Prospective studies with larger patient populations are needed to confirm or modify our results.

Hepatitis C virus infection in dialysis patients.

Despite the introduction of strict hygienic precautions preventing infection spread of hepatitis C virus (HCV) in dialysis settings, this infection is still prevalent among dialysis patients due to procedures making the patients vulnerable to infection through blood contamination. Treatment of HCV infection in dialysis patients is also less successful than that in the non-uremic population due to contraindication of using ribavirin, a main drug, in the infected patients. In this review article we aim to investigate the feasibility of the current antiviral therapies in dialysis patients infected with HCV infection.

Estimation of diagnosis and treatment costs of non-alcoholic Fatty liver disease: a two-year observation.

BACKGROUND: There are insufficient data available on utilization and health care costs of non-alcoholic fatty liver disease. The cost data for different health conditions and services is a major gap in Iranian health system. So this study is the primary or first step towards filling this gap. OBJECTIVES: This study aims to estimate the diagnosis and treatment costs of Non-alcoholic Fatty Liver. PATIENTS AND METHODS: This cross-sectional study was conducted on 528 subjects. The subjects had been diagnosed with non-alcoholic fatty liver. All the subjects had been referred to the Tehran Fatty Liver Clinic, a clinic of the Baqiyatallah Research Center for Gastroenterology and Liver Diseases, in 2009 and they had been observed for 2 years to determine the frequency of health care utilization (physician visit, laboratory tests, medication and cost of sonography). The costs of diagnosis and treatment for each person were estimated in Purchasing Power Parity dollars (PPP$). RESULTS: The average total cost was 5,043 PPP$ per person in the 2 years of observation. Majority of these 528 patients (87.9%) had a BMI ≥ 25 (kg/m2). Also, 33.9% were diagnosed with comorbid diseases such as Diabetes Mellitus (DM), Coronary Artery Disease (CAD), hypertension (HTN) and hypothyroidism (HYPO). CONCLUSIONS: The results confirmed that the total costs for non-alcoholic fatty liver among the Iranian adult urban population alone exceeded 1 billion PPP$ per year. These costs can be saved or reduced by effective disease management and early prevention.

More benign lymphoproliferative disease after liver transplant in infants.

CONTEXT-Despite the high frequency of liver transplants in infants, few data are available on the characteristics of posttransplant lymphoproliferative disorders in liver transplant patients (PTLD). OBJECTIVE-To analyze special features and behavior of PTLD arising after liver transplant in infants. METHODS-A comprehensive search of the literature was conducted for the available data on PTLD in infant liver transplant recipients through PubMed and Google scholar. An infant was defined as a liver recipient who was less than 2 years old at the time of transplant. Overall, 205 cases of PTLD were found in 24 reports, and the 100 infants with PTLD were compared with children and adults with PTLD. RESULTS-PTLD lesions in infants were more likely to be polymorphic whereas monomorphic lesions were more prevalent among older patients (P= .05). Remission rates, metastasis frequency, and organ involvement did not differ significantly between the groups. Survival analysis showed that the infants had a significantly better outcome than did older patients (P= .05). CONCLUSION-PTLD is more benign and may have a better outcome in infant liver transplant recipients than in older recipients. A prospective multicenter approach is needed for future research studies.

Predictive value of having positive family history of cardiovascular disorders, diabetes mellitus, dyslipidemia, and hypertension in non-alcoholic fatty liver disease patients.

In the present study, we examined the relationship between family history of cardiovascular diseases (CVD), dyslipidemia, hypertension, and diabetes with laboratorial abnormalities and syndromes in Iranian patients with non-alcoholic fatty liver disease (NAFLD). A total of 332 NAFLD patients from our outpatient clinic were consecutively entered into analysis. Exclusion criteria were having diabetes mellitus and fasting blood glucose over 126, active hepatitis B virus infection, having HCV positive serology, and to be under corticosteroid therapy. Family history of CVD, diabetes, dyslipidemia, and hypertension were taken from patients and related to the study variables. Family history of cardiovascular diseases (CVD) was associated with low HDL levels (P=0.05). Patients with positive family history of diabetes mellitus were significantly more likely to have AST/ALT levels proportion of higher than one (P=0.044). Family history of dyslipidemia was a predictor for hypertriglyceridemia (P=0.02), higher prothrombin time levels (P=0.013), lower albumin (P=0.024) and T4 (P=0.043) levels. Family history of hypertension was associated with dysglycemia/diabetes (P=0.038), high ALT (P=0.008), and low TIBC (P=0.007) and albumin levels (P=0.001). Family history for CVD, diabetes, dyslipidemia, and hypertension were of clinical importance in the Iranian patients with NAFLD. We therefore recommend that physicians should precisely get family history of main disorders in all NAFLD patients; and to pay more attention to those having the mentioned family histories. Further studies with larger patient population and prospective approach are needed for confirming our findings.

Famotidine in the treatment of functional dyspepsia: a randomized double-blind, placebo-controlled trial.

AIM: In the present study, we aimed to investigate patients with a documented diagnosis of functional dyspepsia (FD) who had been admitted to our outpatient Gastroenterology Clinic and provided consent to participate in this randomized, double-blind, placebo-controlled trial of the therapeutic impact of famotidine on the symptoms and quality of life of FD patients. PARTICIPANTS AND METHODS: A total of 160 patients attending our outpatient clinic with a diagnosis of FD according to Rome III criteria were enrolled in this double-blind study. They were randomized into case (famotidine treatment) and placebo groups; patients were asked to refill the Honk Kong dyspepsia index (a self global assessment tool) before the start of the study as well as after 3 months of treatment. RESULTS: Both famotidine and placebo led to significant improvements in dyspepsia symptoms, except for vomiting in both groups and loss of appetite in the placebo control group. However, the extent of these improvements was not different between the two study groups for most of the study parameters, whereas belching, feeling of acid regurgitation, heartburn, and the total score for the Hong Kong dyspepsia index were significantly more responsive to famotidine than placebo. No significant effectiveness of famotidine therapy was found regarding quality of life. CONCLUSION AND RECOMMENDATIONS: This study showed a significant improvement in the total dyspepsia scores of FD, with a marked effect on belching, heartburn, and the feeling of acid regurgitation. These findings suggest that famotidine may be administered in certain FD patients who have significantly more symptoms of belching, heartburn, and acid regurgitation.

Predictive factors for ultrasonographic grading of nonalcoholic Fatty liver disease.

BACKGROUND: There are several studies in the literature investigating factors which can induce non-alcoholic fatty liver disease (NAFLD) in different populations. However, the existing literature lacks powerful studies addressing the factors which may predict the severity of NAFLD. OBJECTIVES: In the current study, we aimed to evaluate factors independently associated with liver echogenicity in an Iranian NAFLD patient population. PATIENTS AND METHODS: A total of 393 patients attending as outpatients at the Hepatology Clinic of Baqiyatallah University of Medical Sciences were entered into this analysis. Univariate and multivariable linear regression models were performed to evaluate the effects of the study variables on the NAFLD grade, defined by ultrasound hepatic echogenicity. RESULTS: Univariate linear analyses revealed a significant relationship between; the ultrasonographic grading of NAFLD and body weight (P < 0.001), abdominal girth (P = 0.007), pelvic girth (P = 0.032), fasting blood glucose (FBS) (P = 0.005), serum insulin (P = 0.035), hemoglobin A1c (HbA1c) (P = 0.012), triglycerides (P = 0.049), aspartate aminotransferase (AST) (P = 0.015), alanin aminotransferase (ALT) (P = 0.026), and homeostasis model assessment (HOMA) (P = 0.002). Multivariable linear regression models left only; HbA1C (P = 0.011, ß = 0.133), body weight (P = 0.001; ß = 0.176) and serum triglyceride (P = 0.034; ß = 0.112) as factors independently associated with liver echogenicity. CONCLUSIONS: Diabetic patients can reduce liver damage of NAFLD with control of their HbA1C through the lower ranges. Hypertriglyceridemia and body weight are the other implicated factors, which worsen hepatic echogenicity in the NAFLD patient population. We recommend future prospective studies and clinical trials to confirm our findings.

Elevated alanine aminotransferase activity is not associated with dyslipidemias, but related to insulin resistance and higher disease grades in non-diabetic non-alcoholic fatty liver disease.

OBJECTIVE: To explore demographic and metabolic factors associated with increased alanine aminotransferase (ALT) activity in non-diabetic non-alcoholic fatty liver disease (NAFLD) patients. METHODS: Overall 372 patients who consecutively attended to Gastroenterology Clinic of Baqiyatallah University of Medical Sciences, Tehran, Iran awere diagnosed as NAFLD entered into analysis. Exclusion criteria were having diabetes mellitus and fasting blood glucose over 126 mg/dL, active hepatitis B virus infection, having hepatitis C virus positive serology, and to be under corticosteroid therapy. ALT levels were considered pathologically high when it was over 30 IU/L for men and over 19 IU/L for women. RESULTS: Bivariate analyses using t test and chi-square test showed that patients with pathologically augmented ALT levels had significantly higher NAFLD grades in their ultrasonographic evaluations (P=0.003). Moreover, these patients represented significantly higher homeostatic model assessment levels (P=0.003), levels of serum insulin (P=0.002), fasting blood glucose (P<0.001), and uric acid (P=0.02). The prevalence of insulin resistance was also higher in patients with increased serum ALT concentrations. Multifactorial logistic regression models showed that ultrasonographic grading of NAFLD (P=0.027) and insulin resistance (P=0.013) were the only variables significantly associated with abnormal ALT levels. CONCLUSIONS: This study shows that the associations of increased ALT serum levels in NAFLD patients are different from what are supposed before. By excluding diabetic patients from our population, we find that increased ALT levels are not associated with dyslipidemias but are independently associated with insulin resistance and NAFLD grading on ultrasonographic evaluations. Further studies are needed to confirm our results.

Effect of cesarean section on the risk of perinatal transmission of hepatitis C virus from HCV-RNA+/HIV- mothers: a meta-analysis.

BACKGROUND: Hepatitis C virus (HCV) vertical transmission is considered the main route of HCV infection in children. Some authors have stated that cesarean section (C/S) can reduce perinatal HCV transmission. However, the study findings are heterogeneous and high-quality studies are lacking. AIMS: To evaluate the effect of mode of delivery on the risk of perinatal mother-to-infant transmission of HCV. METHODS: Only the peer-reviewed published studies that compared perinatal transmission rate of HCV in elective or emergency cesarean section with vaginal delivery in HCV-RNA+/HIV- mothers were included. We applied the random effect model of DerSimonian and Laird method with heterogeneity and sensitivity analyses. RESULTS: We identified 8 studies that involved 641 unique mother-infant pairs which fulfilled our inclusion criteria. Aggregation of study results did not show a significant decrease in HCV vertical transmission among study (mothers who underwent C/S) versus control (mothers who gave birth vaginally) patients [pooled odds ratio, 1.1 (95% CI 0.45-2.67)]. The P value was 0.35 for our test of heterogeneity. CONCLUSIONS: Our meta-analysis suggests that C/S does not decrease perinatal HCV transmission from HCV-RNA+/HIV- mothers to infants.