JOURNAL OF CLINICAL EXCELLENCE
Year:2013 | Volume:1 | Issue:1|Papers Count:8

Hepatitis B virus (HBV) infection is a major global health problem and is a factor for progressive liver diseases such as chronic hepatitis, cirrhosis and epatocellular carcinoma.HBV is an envelope, double stranded DNA virus with a genome of approximately 3200 base pairs. It has been classified into eight major genotypes (A-H) and multiple subtypes, and HBV genotypes have distinct geographical distribution of the world. WHO estimation of HBV prevalence, suggests that there are nearly two billion people worldwide who have been infected with this virus and more than 350 million of people live with chronic infection (up to 5% of the world population), of these; near one million people die annually from complications of chronic hepatitis B, which is the 10th leading cause of death worldwide.Throughout the world, carrier variability rate for hepatitis B infection is estimated to be 0.1% to 20%, with regions classified as having low (<2%), intermediate (2-7%) and high (>8%) endemic. In Iran, it is estimated that near 30% of population have been exposed to HBV and the endemicity is intermediate, with a carrier rate 1.3%-3.8% in the different provinces of this country. In Iran, the HBV vaccination program has been started in 1993 and after that, Iran can be considered as one of the countries with low HBV infection endemicity. The most genotype circulating in some provinces of Iran were genotype D in different clinical forms of HBV infections. The distribution of HBV genotypes may guide us in determining disease burden.It is important to have information about the epidemiology of HBV as response to therapy and vaccination to control HBV infection. Therefore, its successful treatment has major value in quality of life of patients infected by HBV. This study designed a systematic review of chronic HBV infection to determine the successful treatment and following HBV positive patients.

Hepatitis C infection is a major worldwide health issue. According to world health organization (WHO) it has 3% prevalence, and approximately 170 million people are infected by this virus.Hemodialysis patients are prone to different infections; including hepatitis C. Immune system impairment due to uremia, transmission of infection agents during the course of blood transfusion in anemic patients, shared hemodialysis equipment and insufficient instrument disinfection increase the risk of transmission of hepatitis Candsimilar infections. Evaluation of presence of hepatitis C by qualitative, quantitative methods, determination of its genotype, liver biopsy and histological evaluation are laboratory and clinical approaches to detect and determine the type and progress of the disease. As there is no certain available vaccine for hepatitis C infection, protection of hemodialysis patients against this infection has a critical impact on morbidity and mortality rate in patients. Hepatitis C screening of patients who enter a hemodialysis facility for the first time and re-examining among hemodialysis patients at least twice a year are very important. On the other hand, practicing hygiene guidelines in hospitals and proper disinfection of hemodialysis ward and its equipment are of particular importance in transmission and prevention of hepatitis C.

Radiotherapy is widely used for cancer treatment. In radiotherapy, free radicals and other reactive oxygen species are produced when they are passed through cells. These free radicals can interact with critical macromolecules such as DNA which is led to cell toxicity and death.Radio protective agents and antioxidant supplements can scavenge free radicals and protect cells against toxicity induced by these toxic substances. Although free radicals produced by radiotherapy are necessary for cancer treatment, they are toxic for normal cells. It is a paradoxical effect for antioxidant as a protective agent in normal cells or tumor cells. It is the main problem of antioxidant co-administration in patients during radiotherapy.After reviewing clinical trials and systematic reviews about efficacy of antioxidants to reduce side effects induced by radiotherapy in patients, it was found that antioxidant supplements improved average survival rate and reduced side effects induced by radiotherapy.Further clinical trials for more evidence for selection of antioxidant, dosage and duration of administration are needed.

Neonatal Hydronephrosis is a common abnormality diagnosed antenatally observed in 1% of neonates. Although most cases of prenatal hydronephrosis are due to renal outlet obstruction, vesicoureteral reflux (VUR) is a common cause occurring in 10 to 15 percent of them.Early detection of these abnormalities in neonates and infants is critical due to inducing higher risk of renal damage in very young children. Ultrasonography is the most popular imaging study performed in these neonates. Dynamic renal scan is helpful to determine presence of obstruction and severity of renal function insult. There is a great controversial issue in performing VCUG in neonates with antenatal hydronephrosis. Most authors recommend VCUG for all of them.According to etiologies there are different ways of therapies: surgery for sever degree of obstruction, antibiotic prophylaxis for VUR and observational therapy for others. The most important factors for determining patients’ outcome are severity of renal involvement and correct diagnosis in appropriate time of postnatal life.

Urticaria is a common skin disorder; the estimate prevalence is 0.3 to 11.3 percent and it affects up to 20% of the general population during their lifetime. Acute urticaria less than 6 weeks is more common. Chronic urticaria with or without angioedema, which is defined as wheals with at least 2 times in a week appearance for more than 6 weeks with prevalence of 0.1 percent. The size of lesion is from millimeters to centimeters.Angioedma is associated in 30 to 50 percent of urticaria. Duration of urticarial is variable from some weeks to some years. Any age can be involved but it is common in middle aged females. There is not any known etiology in most patients. At present, autoimmune factors cause 40-50 percent of it.It does not cause mortality except in anaphylaxis. It is a benign disease but it causes significant impairment in patients’ quality of life (personal activities, social and spiritual). Exact pathophysiology and etiology in most of chronic urticarial is not known; however, different factors such as IgG1 or IgG3 subclasses are participated in these diseases.

Circumcision is the commonest surgical procedure carried out in boys. It was initially done for religious and cultural reasons and only in recent century the procedure was medically done. Many papers have shown circumcision epidemiologically reduces UTIs (Urinary Tract Infection); however, some authors consider these data are not sufficient to recommend routine neonatal circumcision. Others have corroborated the association between foreskin presence and an increased incidence of UTIs. Here, we evaluate the preventive effect of neonatal circumcision on urinary tract infection and review the controversial.

Cholesterol reduction by statins improves the survival of patients with the atherosclerotic cardiovascular diseases, though serum cholesterol level is normal or borderline.In some studies, statins have been administered to the heart failure patients irrespective of their atherosclerosis state or LDL-levels. Statins may have favorable effects on the oxidative stress and the cardiac remodeling process. Due to the contradictory results of the studies, this review will briefly discuss the role of oxidative stress and inflammation in the heart failure, and then the effects of statins on the inflammatory mediators involved in the heart failure and the clinical trials assigned to the role of statins in the management of heart failure. Finally, considering the methodology of clinical trials, recommendations regarding the use of statins in heart failure patients will be presented.

Wilms tumor is the most common renal tumor of childhood that in 1, 27. Of cases is along with congenital anomalies such as anidria, genitourinary abnormalities and mental retardation. A 3.5 years old child was treated with the diagnosis of wilms tumor. He also had bilateral anidria, hypospadiasis and mental retardation. There were no other congenital abnormalities. The patient was taken under operation and chemotherapy was started for him.Now the patient is in the second phase of chemotherapy and the treatment has been successful until now.