Govaresh
Volume:9 Issue: 4, 2005

Hepatitis B is the most common cause of chronic hepatitis and liver cirrhosis in Iran. Most studies about HBV have been done among hospitalized patients and blood donors and scantly among normal population. The aim of this study was to determine prevalence, risk factors and intrafamilial spreading of HBV in general population of Gonad. A total of 1035 inhabitants of three villages and city of Gonbad who were recruited in "Golestan cohort study on esophageal cancer" underwent this study. HBsAg was checked twice in six-month intervals. All family members who lived with a HBsAg positive subject in a home and were older than 2 years underwent HBsAg and HBcAb checking. Forty four out of the 1035 (4.25%) were found to be HBsAg positive twice. Seventy (6%) and 20(7%) out of the 279 family members were positive for HBsAg and HBcAb respectively. All HBsAg positive family members were older than 12 years. There was no significant difference for definite risk factors of HBV (through blood and sexual) between HBsAg positive and HBsAg negative subjects. Prevalence of HBsAg positive in Gonbad is much more than average rate of Iran. Intrafamilial spread is in medium range and defined risk factors for HBV did not have any role in our population. It seems neonatal HBV vaccination program is efficient enough to protect young children against HBV.

Irritable bowel syndrome (IBS) is the most common disorder diagnosed by gastroenterologists seen in about 40-50% of patients seeking care from a specialist. IBS has been treated with selective serotonin reuptake inhibitors, but there is not enough evidence from controlled trials for their effectiveness. The aim of the study was to compare the effects of fluoxetine and placebo in the treatment of pain and constipationpredominant IBS in a double-blind randomized controlled trial. Forty four cases meeting Rome II criteria for IBS with predominance of pain and constipation were included in this study. Organic causes were ruled out by detailed history, physical examination, laboratory tests, and colonoscopy. Participants were then randomly assigned to receive either fluoxetine or placebo for 12 weeks. Subjects were followed using a simple symptom score system during treatment and four weeks after termination of treatment. Fluoxetine was significantly more effective than placebo in decreasing abdominal discomfort, relieving feeling and sense of bloating, increasing frequency of bowel movements and decreasing consistency of stool. The total symptom score decreased from 10.7 to 2.8 in the fluoxetine group vs. 10.5 to 6.7 in controls (p‹0.001). Fluoxetine is an effective and well-tolerated short-term treatment for pain and constipation-predominant IBS.

Among most of the hepatic diseases, elevation of alanine amino transferase (ALT) level is the hallmark of hepatocyte necrosis. But, no study has been performed in this field in Iran. This study is designed to compare the grade, stage, and Histological Activity Index (HAI score) of liver pathology between patients with normal serum ALT and elevated serum ALT. It has been conducted on 32 patients with normal serum ALT and 84 patients with elevated ALT level, at our clinic. The median grade and stage among patients with normal serum ALT level were 4 and 1, and among patients with elevated serum ALT they were 6.5 and 2, respectively. Stages more than 2 were detected in 5 (15.6%) and 36 (42.9%) of normal ALT and elevated ALT groups respectively (p= 0.006). Although liver lesions are milder among most of the patients with normal serum ALT, liver biopsy is considered to be useful in chronic hepatitis C regardless of serum ALT level.

With respect to the importance of hepatitis A in patients with chronic liver disease, current study was conducted with the aim of determining the prevalence of previous hepatitis A infection in hepatitis B virus carriers with different stages of liver disease. This was a cross sectional study. 283 HBsAg positive subjects (including 118 inactive carriers, 144 patients with chronic active hepatitis and 21 cirrhotic subjects)Â were selected from Tehran Hepatitis Center within 3 months period in 2004. All subjects were assessed for Anti HAV Ab, demographic data, risk factors of blood borne disease, place of birth, place of living, history of jaundice, history of hepatitis patients, ALT, AST, Platelet, Stage, Grade and Score. From all subjects, 224 patients (79.2%) were affected with HAV. 89 inactive carriers (75.4%), 115 patients with chronic active hepatitis (79.9%) and 20 cirrhotic patients (95.2%) were Anti HAV Ab positive. 47 patients under 30 year (65.3%), 123 those between 30 and 49 years (80.4%) and 54 over 50 years old subjects (93.1%) were positive for HAV infection (p=0.000). Our results indicated that 80% of patients with hepatitis B have previous infection with hepatitis A and 20% of them are susceptible to it. The frequency of infection rises with increasing age. Because of increased fatality of this infection in higher ages, vaccination against hepatitis A in this population is recommended.

Following the application of simple serological tests for the diagnosis of coeliac disease (CD) in the 1980s, it gradually became clear that the prevalence of CD in different countries in the Middle East, North Africa and India is almost the same as that in Western countries. The prevalence of CD in at-risk populations in these regions is reported to range between 3 and 20% and the prevalence in people with type 1 diabetes is approximately 3-5%. Clinical manifestations of CD vary markedly with age, the duration and the extent of disease. Clinical studies showed that presentation with nonspecific symptoms or no symptoms is as common in the Middle East as it is in Europe. Wheat has been the major staple food in these regions for many centuries and it is possible that the continuous and high level of exposure to wheat proteins has induced some degree of immune tolerance, leading to milder symptoms, which are misdiagnosed as irritable bowel syndrome or unexplained gastrointestinal disorders. A high index of suspicion for CD should be maintained in all developing countries for patients who present with chronic diarrhoea or iron deficiency anaemia. The best method for diagnosing CD in patients with diarrhoea is the panel of coeliac serological tests followed by small-bowel biopsy. In the absence of supplies for a gluten-free diet in Middle Eastern countries, maintaining this diet represents a real challenge to both patients and clinicians.

Congenital generalized lipodystrophy (CGL) is a rare and progressive disorder (1 in 12 milion). Common clinical manifestations are lipoatrophy, acromegaloid feature, acanthosis nigricans, Hyperlipidemia, diabetes mellitus or abnormal glucose tolerance test. Rarely fatty liver and cirrhosis is seen. The highest number reported in literature is 8 cases from Brazil and 6 cases from Scandinavia, respectively. The oldest case was a 19-year-old girl. Our case is a 13-year-old male with all above manifestations, also he had liver cirrhosis. Another case of CGL had been reported by first author of this article, 13 years ago in Iranian Medical Journal.

Hepatitis B is one of the most important etiologic factors of acute and chronic hepatitis, cirrhosis of the liver and hepatocellular carcinoma. The best preventive method is vaccination. The Aim of the study was to evaluate the immunization rate against hepatitis B in medical health personnel. This study was conducted on 331 health care workers employed in public, semiprivate, and private hospitals that had received the complete dosage of vaccination with an average duration of 0-3 years since the last dose, and had not previously received any booster or HBV - Immunoglobulin. The Shariati (public), Imam Khomeini (public), Baqiyatallah (semi-private) and Day (private) hospitals were the sites of our research. Regarding the age and occupational status, persons were randomly selected and data relating to demographic aspects and serum anti-HBS titer were recorded in all individuals and then were evaluated. Results show that out of the 331 cases, 47 (14.2%) were non-responder (Anti-HBs titer ‹10 IU/L), 160 (54.4%) had low  response (10|£|Anti-HBs titer |£|100 IU/L), and 104 persons (31.4%) were found to have good response (Anti-HBs titer ›100 IU/liter). There was no significant relationship between the antibody titer and other variables including age, gender, smoking, body mass index (BMI) and duration since last dose of vaccine. We suggest the assessment of Anti-HBs titer after complete vaccination in high-risk groups to find non- and low-responders in order to revaccinate them.

Ingestion of ciprofloxacin can be associated with esophagitis and esophageal ulcer. We report a 46-yearold man with odynophagia and dysphagia following ciprofloxacin ingestion, with a glance on diagnosis and treatment. Also, we propose recommendations for prevention of drug-induced esophagitis, according to shape, size, formulation and their etiologic role on esophagitis.