GOVARESH Journal
Year:2013 | Volume:18 | Issue:1 (82)|Papers Count:7

Background: The mechanism behind the apparent lack of effective antiviral immune response in patients with chronic hepatitis C virus (HCV) infection is poorly understood. Although multiple levels of abnormalities have been identified in innate and adaptive immunity, it is postulated that production of specific cytokines such as IL-10 may contribute to the induction and maintenance of HCV persistence. Production of IL-10 by CD4+, CD25+, IL-10+ regulatory T cells with regulatory capacity (Tregs) appears to be one of the viral mechanisms that alter the antiviral immune response. As the first report, that attempts to mimic physiological forces that can occur during HCV infection, in this study we evaluate the ability of HCV-core antigens in increasing the frequency of CD4+, CD25+, IL-10+ regulatory T cells.Materials and Methods: We analyzed peripheral blood mononuclear cells (PBMCs) from chronic HCV-infected patients (n=19) and normal controls (n=6) to determine the effect of the HCV-core antigen in the frequency of HCV-specific IL-10 production.PBMCs of different groups were isolated, cultured and stimulated with core antigen. Then, an in-house triple-stain flow cytometric method was used to investigate the frequency of CD4+, CD25+, IL-10 producing cells.Results: Following incubation of PBMCs with HCV-core antigen, a population of CD4+, CD25+, IL-10+ cells (regulatory T cells) increased. However we observed no increase in Tregs in the negative controls.Conclusion: The study supports the view that specific CD4+, CD25+, IL-10+T cells may be implicated in host immune tolerance during an HCV infection. It is likely that HCV vaccine candidates avoid epitopes that lead to strong IL-10 production.

Background: Muscle cramps are painful manifestations that occur in many cirrhotic patients. This study aims to evaluate the risk factors for developing muscle cramps.Materials and Methods: This cross-sectional study evaluated 24 cirrhotic patients (18 male, 6 female) during 15 months. Patients underwent careful examinations administered by the same person to determine the underlying cause of disease, presence of ascites, jaundice and encephalopathy as possible causes for muscle cramps. A specific questionnaire that contained demographic information, frequency, location, duration and time of muscle cramps was completed for each patient.Results: Patients' mean ages were 45.1 years for females and 48.3 years for males. The frequency of muscles cramps was 37.5% (6 males, 3 females). The most frequent time for the occurrence of cramps was at night and when patients were at rest (88%). The calf muscle (77%) was the most involved muscle group that experienced cramping. Patients with muscle cramps had lower serum albumin level (p<0.01) and higher PT (p<0.05) compared to those who did not experience cramps.Conclusion: Lower serum albumin level as well as increased PT was associated with muscle cramps in cirrhotic patients. However further studies are mandatory to confirm the findings of this study.

Background: Hepatocellular carcinoma (HCC) is a primary liver cancer that frequently causes mortalities. Transarterial chemoembolization (TACE) is a new palliative treatment for advanced stages of HCC. In this study, we have assessed the results of TACE on a group of Iranian patients with advanced HCC treated at Imam Khomeini General Hospital.Materials and Methods: This was a case series, cohort study conducted on 36 patients with HCC who met the study criteria. Patients underwent two sessions of TACE at a 4-6 week interval. All patients underwent triphasic computerized scans (CT scan) before treatment and at six weeks after the second session.Results: After at least a one year follow up period, 20 (55.6%) patients died and 16 (41.7%) survived. Survival at 6 months was 58% and at 12 months, it was 33.3%. Post-TACE tumor necrosis (>50%) was significantly associated with 6 (p=0.029) and 12 (p=0.00) month survival. There was a significant association between 6 and 12 month survival and Okuda stage (p -V=0.001 and 0.003), ascites (p -V=0.058 and 0.012) and branch portal vein thrombosis (p -V=0.036 and 0.024). There was no association of WHO criteria to 6 (p -V=0.139) and 12 (p -V=0.139) month survival.Conclusion: Tumor necrosis less than 50%, presence of ascites and thrombosis of the portal branches are associated with lower survival. Suitable selection and taking into consideration post-TACE tumor necrosis is suggested to enhance survival.

Background: Upper endoscopy, as an important diagnostic and occasional therapeutic tool is invasive. Sedation of patients during the endoscopy procedure with minimal side effects could raise patient tolerability, allowing for ease and increased effectiveness of this procedure.Materials and Methods: In this study, 105 patients who were candidates for the upper endoscopy procedure were randomly divided into two groups: (A) midazolam (n=53) and (B) placebo (n=52). Group A patients received 5 mg of midazolam dissolved in 5 cc distilled water and group B received 5 cc of distilled water, via an intra-nasal drip. After 40 to 45 minutes, the upper endoscopy was performed. During the endoscopy, patients were monitored and the endoscopy time, gag reflex stimulation, heart rate, arterial oxygen saturation (SPO2), amnesia and patient justification were recorded and compared.Results: The average age in group A was 39.3 years; for group B, it was 39.9 years. There were no statistically significant results for average endoscopy time (p=0.23), gag reflex stimulation (p=0.27), heart rate (p=0.09), SPO2 (p=0.49), amnesia (p=0.12), and patient justification (p=0.1) between both groups.Conclusion: According to the results of this study, it seems that intra-nasal midazolam is not effective for patient sedation. This field needs additional evaluation.

Background: Gastrointestinal disorders are common complaints for which endoscopy is one of the most important diagnostic procedures. Anxiety is an unpleasant, ambiguous feeling of apprehension and fear of an unknown origin that occurs during anxious and previously stressful situations or during an injury. Lack of sufficient information and fear of pain can cause anxiety prior to an endoscopy, reducing the trend of patients and increasing the endoscopy time. This study aims to evaluate the effectiveness of various teaching methods (oral, written, oral-written) on patient anxiety prior to an endoscopy.Materials and Methods: This was a case-control study that enrolled 100 patients, 18-80 years of age, who had at least reading and writing literacy. Patients who referred to a specialized clinic at Tabriz University of Medical Sciences for their first endoscopy between December to March 2011 were selected. We randomly divided patients into four groups (oral, written, oral written teaching, and control) after their first anxiety assessment with the Beck questionnaire. The information was given to patients by the investigator using the training packages. The next day, 30 minutes prior to the endoscopy, patients completed another Beck Anxiety questionnaire and the effectiveness of the different methods was evaluated.Results: Mean anxiety scores decreased in all three teaching groups after intervention, which was statistically significant compared with the control group (p<0.001).The difference in anxiety scores between the teaching groups (written, oral, oral-written) was not statistically significant (p<0.32).Conclusion: The provision of adequate information to patients about the endoscopy procedure, independent of the teaching method, can reduce patient anxiety.

Iran is an endemic region for hydatid disease. Primary pancreatic hydatosis is a rare event; severe acute pancreatitis related to pancreatic hydatid cyst is extremely rare.We present the case of a patient with severe acute pancreatitis and hydatosis of the pancreas without liver or lung involvement. All etiologies for acute pancreatitis were excluded. The patient underwent a distal pancreatectomy which led to the diagnosis of pancreatic hydatosis.Since hydatid disease is endemic in some regions, it should be considered as one of the underlying etiologies for inflammation or infection of the pancreas (acute pancreatitis).