Govaresh
Volume:18 Issue: 4, 2014

Hepatitis B virus (HBV) infection is the main cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC). Several factors such as serum HBV DNA level, genotype and specific viral mutations have been clarified to determine disease progression of chronic hepatitis B. Among these, mutations can also occur in chronic HBV patients with antiviral treatment such as lamivudine therapy. A better understanding of the host and viral mechanisms that influence the course of HBV infection and drug resistance to effective therapeutic approaches will improve the organization of patients with chronic HBV infection to attain viral eradication. This study aims to review the molecular biology of HBV, as well as the natural and induced genetic variations in response to anti-viral therapy in humans. The effect of host genetic factors in the outcome of HBV infection and new strategies for antiviral therapy are addressed.

Sexual dysfunction is common in chronic diseases such as irritable bowel syndrome (IBS). Sexual function is an important aspect of quality of life. The present study seeks to determine the relationship between sexual function and quality of life in patients with IBS. Materials and Methods L:In this cross-sectional study, 47 female patients with IBS who referred to the one of gastroenterologist clinics in Tehran and gastroenterologist clinic at Imam Khomeini Hospital, selected via the available sampling method. Patients completed the Irritable Bowel Syndrome Quality Of Life questionnaire (IBS-QOL) and Female Sexual Function Index (FSFI). Data were analyzed by Pearson correlation models. According to the IBS-QOL, patient's mean score for quality of life(121.9) was poor. The FSFI mean score was indicative of sexual dysfunction. We observed a significant correlation between sexual function and quality of life in patients with IBS (p<0.05). There was a significant correlation between dyspareunia and quality of life in patients with IBS (p<0.05). This study showed the presence of a relationship between sexual function and quality of life in patients with IBS. Therefore appropriate strategies for education and counseling should be adopted, as well as referral to a psychologist or psychiatrist for sexual health promotion to improve the quality of life in patients with IBS.

Due to the increasing outbreak of irritable bowel syndrome (IBS) and its relation to hospital costs and disruptions to quality of life, this study is an attempt to investigate patient quality of life and its relationship with IBS according to the results of the WHQOL-BREF Questionnaire. This descriptive-analytic, cross-sectional study enrolled 250 patients and 250 healthy participants who referred to the Gastroenterology Clinic of Sina Hospital, affiliated with Tehran University of Medical Sciences during 2012. The diagnosis of IBS was determined by a gastrointestinal expert based on ROME-III Criteria. Then, the study was explained to participants prior to administration of this questionnaire. The level of life quality in patients with IBS was less than the control group. There was no significant difference between groups in terms of age, gender, education level, marital status, and place of residency. There was no significant difference in the above factors among patients in the subgroups of IBS. Regression analysis between quality of life and independent variables showed a correlation between quality of life to severity of IBS symptoms and disease duration. The results of the study indicated that quality of life correlated with severity of symptoms and disease duration. The quality of life in IBS patients can be enhanced by efficiently controlling symptoms.

Recent studies have shown a critical role for HLA-DQ2 and HLA-DQ8 in the pathogenesis of celiac disease. No study has been performed on the prevalence of these two HLA types in Iranian celiac patients. We enrolled 24 celiac patients and 37 first-degree relatives in whom the diagnosis of celiac was excluded by serologic tests. HLA typing for HLA-DQ2 (DQB1*02), HLA-DQ8 (DQB1*03), HLA-DQ B1*05 and HLA-DQ B1*06 was performed using polymerase chain (PCR) reaction. Twenty two (91.7%) celiac patients and twenty seven (73%) controls were positive for the HLA-DQ2 and/or HLA-DQ8 heterodimers. There was no significant difference between the two groups (p=0.068). However, celiac patients were statistically more positive for homozygote HLA-DQ2, whereas non-celiac participants were more positive for homozygote HLA-DQ8 (p<0.05). other hand, the higher prevalence of homozygote HLA-DQ2 in celiac patients shows its stronger role in diseas pathogenesis. Further studies on larger populations are needed in Iran.

Celiac disease (CD) is an immune-mediated inflammation of the small intestine caused by sensitivity to dietary gluten and related proteins in genetically sensitive individuals. Recurrent aphthous stomatitis (RAS) is an inflammatory condition characterized by painful recurrent, single or multiple ulcerations of the oral mucosa. The association between CD and RAS has been evaluated in several studies. The purpose of this study was to determine the prevalence of CD in patients with RAS. This was a prospective cross-sectional study that enrolled 181 patients with recurrent oral ulcers (at least three attacks per year). Patients'' peripheral blood samples were studied in terms of anti-tissue transglutaminase (anti-tTG) antibodies (IgA), anti-endomysial antibody (IgA) and serum IgA levels. Each patient that had a positive celiac serology underwent a duodenal biopsy. Information from all patients was entered into checklists. After completion of the checklists, the obtained data were analyzed by SPSS v19 statistical software. Of the 181 enrolled patients with recurrent aphthous, 43 (23.75%) were male and 138 (76.25%) were female. Average age of these patients was 28.45 ± 12.27 years. The average age of disease onset was 23.39 ± 9.46 years. Serologic survey results showed that only 2 patients were positive for these antibodies - both were women whose average age was 29 years. The average age of their disease onset was 22.5 years and biopsy results confirmed the presence of lymphocytic enteritis with crypt hyperplasia (Marsh II). According to the results of this study, although there is a low prevalence of CD in patients with RAS, screening RAS patients for key serological markers of CD has clinical value.

Hemodialysis patients have a low immune response to the hepatitis B (HB) vaccine. The method of administration plays an important role in immune response establishment. This case control study compares the efficacy of intradermal (ID) and intramuscular (IM) injection methods for the HB vaccine. This study was undertaken in hemodialysis centers. We recruited 50 patients after excluding those with histories of previous HB vaccination, immunosuppressive therapy, and who were positive for HBsAb, HBsAg, and HCV antibody. Patients were randomly assigned to receive HB vaccine by either the ID or IM injection methods. The timeline for vaccine administration was 0, 1, 2 and 6 months for both groups. The ID group received 2 µg of EngerixB in both the right and left anterolateral forearms, for a total dose of 4 µg; the IM group received 20 µg in two sites in the deltoid muscle, for a total dose of 40 µg. We measured HBsAb titers at the third and seventh months following the first doses of HB vaccine. In the third month after the first HB vaccination,40.4% of the patients reached HBsAb levels of at least 10 mIU/ml in the ID group versus 60.9% in the IM group. At the seventh month following the first HB vaccination, 68% of patients reached HBsAb levels of at least 10 mIU/ml in the ID group versus 68% in the IM group. However the mean HBsAb titer in the ID group was 459±323.8 versus 294.6±277.5 mIU/ml in the IM group. There was no significant relation between seroconversion rates for both injection methods. However the mean titers of HBsAb for both the third and seventh months after the first HB vaccination in the ID group were more than the IM group. The cost for the low dose HB vaccine in the ID group is less than the high dose vaccine for the IM group. Thus, it is beneficial to use the ID low dose HB vaccine for underdeveloped countries.

Rhabdomyolysis is a serious clinical condition resulting from release of toxic intracellular materials into the systemic circulation. Multiple factors have been demonstrated to be responsible for this syndrome. However، currently medications and alcohol are considered to be the primary causative agents. To the best of our knowledge there are few reported cases of rhabdomyolysis following prescription of peginterferon alfa-2b in patients with chronic hepatitis. Here، we have reported the case of a 46-year-old male with hepatitis C virus (HCV) infection who suffered an acute onset of generalized myalgia and weakness، with elevated serum creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) levels six months after administration of peginterferon alfa-2b. Considering the clinical picture and laboratory findings، we diagnosed the patient with rhabdomyolysis. Peginterferon alfa-2b and ribavirin were discontinued and intensive intravenous hydration commenced. Within ten days the patient improved significantly after which he was discharged in an appropriate physical condition.

Multiple sclerosis (MS) is an autoimmune inflammatory process that affects the central nervous system (CNS). Celiac disease (CD) is a systemic autoimmune disorder of gluten intolerance. Based on the presumed association of MS with multiple autoimmune processes، the coincidence of MS with gluten sensitivity has been investigated with controversial results. Here، we report a known case of MS with mild gastrointestinal symptoms and spontaneous abortions. Thorough paraclinical evaluations revealed iron deficiency anemia and high titers of tissue transglutaminase antibody (tTG). A small bowel biopsy demonstrated changes compatible with CD، MARSH type 3c. Based on the serologic results and biopsy findings، a diagnosis of CD was established and the patient was instructed to consume a gluten-free diet. Gastrointestinal symptoms abated and her serum levels of tTG normalized، along with improvement in the patient’s iron profile during follow ups. The combined presence of MS and CD is a rare situation for which previous studies have failed to clarify the existence of any correlation between MS and CD. Thus، further investigation of CD in MS patients with gastroenterological complaints is recommended.