GOVARESH Journal
Year:2005 | Volume:10 | Issue:2|Papers Count:8

Background Data concerning the information on the prevalence and association of the Helicobacter pylori cytotoxinassociated gene A (CagA) with disease is still controversial. The aim of this study was to isolate and identify H. pylori by culture methode from biopsy specimens and its relationship with associated diseases by molecular techniques (PCR). Materials and Methods Gastric biopsy specimens obtained from 220 patients (aged 18 to 68 years) were evaluated for presence of H. pylori using PCR assay on isolates for CagA gene. Results From 220 patients that included in this study, 120 patients, 51 from PUD (38 duodenal ulcer and 13 gastric ulcer) and 69 from NUD patients (35 gastritis, 18 reflux disease without and 16 with esophagitis) yielded positive for H. pylori culture. Frequency of CagA gene in H. pylori isolated from patients with peptic ulcer diseases (PUD) and non-ulcer dyspepsia (NUD) was 82.3% and 59.4%, respectively. Conclusions Our data confirmed that CagA gene in H. pylori is a virulence factor with high frequency in PUD. Therefore, we suggest that detection of H. pylori gene expression may contribute in improving the diagnosis and understanding the pathogenesis of H. pylori infections. 

Background Patients with bleeding disorders are frequently infected with hepatitis C virus (HCV). There are few reports on the effect of standard interferon in these patients and no published report on pegylated interferon. The aim of this study was to compare pegylated interferon alpha-2a and standard interferon alpha with ribavirin in patients with bleeding disorders and chronic HCV infection. Materials and Methods Consecutive patients referring to a specialized clinic in Tehran were included in the study. The first 37 patients received pegylated interferon (PEGASYS, Hoffmann-La Roche Inc., Basel, Switzerland), 180 μg weekly and the next 38 patients received standard interferon, 3 million units 3 times a week. Both groups also received ribavirin 800 mg daily. Patients were treated for 48 weeks and were followed for 24 weeks. Liver biopsy was not performed due to the potential risks involved in patients with bleeding disorders. Results 34 patients in each group completed the study. The intention-to-treat sustained viral response was 34% and 62% in the standard interferon and pegylated interferon group, respectively (p=0.02). Conclusions Pegylated interferon alpha-2a and ribavirin is almost twice as effective as standard interferon and ribavirin in treating HCV infection in patients with bleeding disorders and is an acceptable treatment option even when histologic data is not available.

Background There are only a very small number of reports which discuss subtype, sex distribution, clinical features and laboratory characteristics of autoimmune hepatitis in children. The aim of this study was both to define the clinical features, biochemical and histological findings and also to determine the age and sex related distribution of autoimmune hepatitis (AIH). Materials and Methods Data of 30 children presenting with AIH (20 girls and 10 boys) have been analyzed for their clinical, serological, and histological profile. The most common presenting signs or symptoms were jaundice (60%), abdominal mass (23.4%) and constitutional symptoms (weakness, anorexia and paleness) (6.7%). Results About 10% of patients had an acute hepatitis like clinical presentation. Twenty two children (73.3%) (15 girls, 7 boys, 2.1:1) had AIH type 1 and 4 patients (13.3%) type 2 due to specific autoantibodies. Four children could not be classified. In liver biopsy, 100% of patients had interface hepatitis and fibrosis with or without cirrhosis were found in 60%. Conclusions In our cohort the prevalence of AIH was 2:1 in girls. Type 1 was the most frequent diagnosis (73.3%) and was more prevalent in older children. Patients with type 2 were younger. The clinical presentation of AIH in children was unspecific and each type could only be differentiated by the determination of the specific autoantibodies.

Background: Non-cardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health care resources. Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP. Thus the typical symptoms of reflux like Heartburn and regurgitation, when present as predominant symptoms are quite specific for diagnosing GERD patients but in patients with NCCP the clinical diagnos of reflux is difficult and need to utilize invasive methods or omeprazol (PPI) test for its detection. The aim of the study  was to evaluate the role of clinical presentation in diagnosing GERD in NCCP patients. Materials and Methods: NCCP patients underwent upper endoscoy, Bernstein test and short course of omeprazol test. the patients were divided in two groups based on the GER or non-GER related chest pain. In the end, clinical presentation of the patients was compared in two groups. GERD was considered positive as evidences of mucosal injury on upper endoscopy and or Bernstein and PPI tests had been positive together. Results: From 78 NCCP patients (41 male; mean age 50.4 ± 2.3), the chest pain in 35 patients (44.8 %) were related to GERD. Two groups were the same based on sex and age. The chest pain; severity, site, radiation and relation to food, exercise, and sleep were the same in two groups, except two symptoms; the pain that was relived by anti-acid (p<0.031) and presence of classical reflux symptoms (p<0.009) were seen in GERD patients. It was interest that in the history of the patients, heart burn (p<0.036) and regurgitation (p<0.002) were seen in patients with GERD-related chest pain. Conclusions: Clinical examination is important in diagnosing GERD in NCCP. Although the chest pain is the same in reflux and non refluxrelated NCCP, but the symptoms of heartburn or regurgitation in present or recent past history of patients are diagnostic for GERD-related chest Pain.

Background: Bone marrow transplantation is a good therapeutic modality for beta thalassemia. Liver complications is one of the major causes of morbidity and mortality following BMT. Determination of the factors of liver injury leads to earlier diagnosis after BMT and improves prognosis. Materials and Methods: We studied 113 major Beta thalassemic patients who have been transplanted from 1990- 2000 in bone marrow transplantation center of Shariati Hospital. 62 were male and 51 were female. 27 patients were class one, 56 were class two and 30 were class three. The median age of each classes were 6.5, 6.3 and 8.7 year. Conditioning regime consisted of busulfan (3.5-4mg/Kg) and cyclophophamide (40-50 mg/kg). For GVHD prophylaxis we gave cyclosporine ± metothrexate. Grade of liver fibrosis defined by biopsy in all patients before BMT. All patients and their donors tested for HBsAg, HBsAb, HCVAb, CMVAb with RIA method. We assessed causes of liver dysfunction before and after transplantation and effect of high ferritin level on liver function. Results: Hepatic dysfunction in first year after transplantation were seen in 86 (76%) patients. Causes of liver dysfunction were consisted of 53.1% GVHD, 15.93% cyclosporine hepatotoxicity, 5.3% conditioning regime hepatotoxicity and 1.77% VOD. In all three classes hepatic GVHD, cyclosporine toxicity, death and normal liver function post BMT had significant relation with hepatic dysfunction before BMT (p=0.001). In patients with ferritin level more than 1000, there were significant hepatotoxicity with conditioning regime (p=0.001). 17 (15.04%) of patients have been died. Conclusions: In this study we determined incidence and causes of hepatic dysfunction before and after BMT in major beta thalassemic patients. According to our study the incidence of hepatic dysfunction was 76.1% and hepatic GVHD and drug hepotoxicity were the most common causes of hepatic dysfunction in all three classes. Serum ferritin level had not significant relation to GVHD, cyclosporine hepatotoxicity and VOD. Govaresh/ Vol. 10, No. 2, Summer 2005; 74-79

Background: Hepatitis C (HCV) is increasing worldwide including Iran. HCV is more prevalent among intravenous drug abusers (IDU), especially if imprisoned, mostly due to needle sharing. We determined the rate of HCV seropositivity among IDU prisoners and compared it with those of non prisoners. Materials and Methods: A cross-sectional survey was done on consenting IDU inhabiting two prisons and attending three rehabilitation centers in Tehran, Iran. A questionnaire was completed for each subject and 5mL blood drawn. The samples were kept at 2-8°C until the sera were separated and stored at -70°C. HCV Ab (ELISA 1, third generation, DIA. PRO, Italy) with a sensitivity and specificity of 98% was checked by a single technician. Chi-square, Fisher's exact test and multivariable analysis were used where appropriate. Results: Four-hundred and sixty seven subjects [346 (74.1%) prisoners; 425 (91%) male] were enrolled. Overall 66% tested positive for HCV Ab [287 male (67.5%), 21 female (50%), p<0.02]. HCV seropositivity was higher among prisoners (78.3% vs. 30.6%, p<0.001) and older IDU (76.9% vs. 62.9%, p=0.002). Multivariable analysis showed association between HCV seropositivity and imprisonment (OR= 9.32, 95%CI: 5.60- 15.51), sharing syringes (OR=2.00, 95%CI: 1.27-3.17), duration of intravenous drug use annually (OR=1.16, 95%CI: 1.08-1.24) and male sex (OR=4.18, 95%CI: 2.02- 8.67). Conclusions: HCV is rather common among IDU prisoners. Imprisonment is an independent risk factor.The infected IDU going back to the community may be an important source of HCV.Taking effective strategies (high risk group education, provision of sterile syringes, identification and treatment of infected IDU) to reduce the risk of this public health problem is needed urgently.

Background: In northeastern Iran there is an area of high incidence of esophageal cancer which is populated by residents of Turkmen ancestry. Several environmental risk factors for esophageal cancer have been proposed, but the roles of familial and genetic factors have not been studied extensively in the Turkmen population. Materials and Methods: We evaluated the importance of familial risk factors for esophageal cancer by performing a case-control study of 167 cases of esophageal squamous cell carcinoma and 200 controls of Turkmen ethnicity. Detailed family pedigrees of the cases and controls were constructed, which documented all cancers in first- and seconddegree relatives. The actuarial risk of cancer was then estimated in 2097 first-degree relatives of cases and 2783 first-degree relatives of the controls. A hazard ratio was constructed, based on a comparison of the two cumulative incidence curves. Results: The risk to age 75 of esophageal cancer in the first-degree relatives of Turkmen patients with esophageal cancer was 34%, versus 14% for the first-degree relatives of the controls (hazard ratio = 2.3; p = 3 x 10-8). 9.6% of the cases reported that their parents were related, versus 2.5% of the controls (odds ratio = 4.1; p -value = 0.006). Conclusions: Familial factors are important in the etiology of esophageal cancer among the Turkmen residents of Iran. The hazard ratio of 2.3 for cancer among first-degree relatives is consistent with an important contribution of heritable factors. It will be of interest to perform marker studies to establish which genes are responsible. 

Celiac disease can be accompanied with multiorgan involvement in addition to gastro-intestinal involvement. A 16-year-old young man - known case of celiac disease - was admitted because of exacerbation of gastrointestinal complaints. During further investigations, hypothyroidism and membranous glomerulonephritis were discovered. The patient was improved with a gluten-free diet and specific treatment of hypothyroidism and glomerulonephritis.