فهرست مطالب

Hepatitis Monthly
Volume:11 Issue: 7, Jul 2011

  • تاریخ انتشار: 1390/06/20
  • تعداد عناوین: 14
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  • Ghanaati H., Firouznia K., Jalali Ah, Shakiba M Page 507
    Interventional radiologists are physicians who specialize in minimally invasive targeted therapies, offering the most in-depth knowledge of the less invasive therapies that are available and diagnostic and clinical experience across all specialties. Interventional radiologists offer treatments for hepatobiliary diseases without significant side effects or damage to the adjacent normal tissue. We briefly introduce some of the interventional procedures in gastroenterology.
  • Ali Dabbagh, Samira Rajaei Page 511
    The fluorinated hydrocarbons that are used for anesthesia are derived from ether. Although they have many benefits, there are several side effects of these drugs, including untoward hepatic effects. Whether the use of halothane gas can be revitalized is unknown. Introducing nanocarriers inside the halothane molecule can increase its benefits as an anesthetic in the lungs and cardiovascular system and prevent exposure to the liver. The findings of new fields, such as cancer therapy, and anesthetic agents, such as propofol, can improve the quality of the drug using nanomedicine.
  • Peter Higgs, Rachel Sacks-Davis, Judy Gold, Margaret Hellard Page 513
    Background
    Alcohol consumption, current injecting drug use, and pre-existing mental illness have been identified as 3 of the main reasons for excluding patients from treatment for hepatitis C.
    Objectives
    We reviewed the literature to obtain an evidence base for these common exclusion criteria.
    Materials And Methods
    We reviewed original research and meta-analyses investigating the effects of alcohol consumption, current injecting drug use, and pre-existing mental illness.
    Results
    We identified 66 study reports relevant to the review, but found only limited evidence to support withholding of treatment on the basis of the 3 previously mentioned exclusion criteria.
    Conclusions
    Currently, there is a lack of evidence for many of the barriers faced by patients in availing treatment for hepatitis C. Adherence to treatment routine was found to be a better predictor of sustained virological response than injecting drug or alcohol consumption during treatment period or the presence of a pre-existing mental disorder. Although several challenges remain, we need to ensure that treatment decisions are based on the best available evidence and the treatment is performed appropriately on a case-by-case basis.
  • Qian-Feng Xia, Yang-An Wen, Ping Liu, Pu Li, Jin-Bo Liu, Xi Qin, Shi-Yun Qian, Zhi-Guang Tu Page 519
    Background
    The duplex mutation primers offer many advantages over other multi-labeled probes for real-time detection of amplification products.
    Objectives
    To develop and validate a novel real-time PCR for quantification of HCV RNA based on the duplex mutation primers technology.
    Materials And Methods
    The duplex mutation primers were selected in the highly conservative 5' non-coding region (5'NCR) of the HCV RNA. The assay was validated with the Viral Quality Control panel, which also includes Chinese HCV RNA standards.
    Results
    The detection limit was 57 IU/mL, and a good linear correlation in the range of 102-108 IU/mL was revealed (r2 = 0.999) with the novel method. This assay has a dynamic range of at least 8 log10 without the need for specimen dilution, good clinical intra- and inter-run precision, and excellent correlation with a commercially available assay(r2 = 0.95).
    Conclusions
    The high sensitivity, wide linear range, and good reproducibility, combined with low cost, make this novel quantitative HCV real-time PCR assay particularly well suited for application to clinical and epidemiological studies.
  • Schiavini M., Angeli E., Mainini A., Uberti-Foppa C., Zerbi P., Sagnelli C., Cargnel A., Vago G., Duca Pg, Giorgi R., Rizzardini G., Gubertini G Page 525
    Background
    Chronic hepatitis C is more aggressive during HIV infection. Available data about risk factors of liver fibrosis in HIV/HCV co-infected patients derive from studies based on a single liver biopsy.
    Objectives
    To evaluate the risk factors of liver fibrosis progression (LFP) and to investigate the role of antiretroviral therapy (ARV) in HIV/HCV patients who underwent paired liver biopsy.Patients and
    Methods
    We retrospectively studied 58 patients followed at two Infectious Diseases Departments in Northern Italy during the period 1988-2005. All specimens were double-blinded and centrally examined by two pathologists. LFP was defined when an increase of at least one stage occurred in the second biopsy, according to the Ishak-Knodell classification.
    Results
    In a univariate analysis, serum levels of alanine aminotransferase (ALT) > 150 IU/L at the first biopsy (P = 0.02), and a > 20% decrease in CD4+ cell count between the two biopsies (P = 0.007), were significantly associated with LFP. In multivariate analysis, a > 20% decrease in CD4+ cell count remained independently associated to LFP (Odds Ratio, 3.99; 95% confidence interval, 1.25-12.76; P < 0.02). Analysis of life survival curves confirmed the correlation between CD4+ cell count and LFP.
    Conclusions
    Our findings highlight that in HIV/HCV coinfected patients, an effective antiretroviral therapy that assures a good immune-virological profile contributes to reducing the risk of LFP.
  • Ioan Sporea, Radu Badea, Roxana Sirli, Monica Lupsor, Alina Popescu, Mirela Danila, Mircea Focsa, Alexandra Deleanu Page 532
    Background
    In chronic liver diseases, a correct estimation of the severity of liver fibrosis is important for recommendations regarding the treatment. Nowadays, evaluation of fibrosis is done by noninvasive methods such as biochemical scores and transient elastography instead of liver biopsy. The lack of sensitivity to detect fibrosis, because of its heterogeneity is a drawback of liver biopsy (LB).
    Objectives
    To compare transient elastography (TE) and acoustic radiation force impulse (ARFI) for the evaluation of liver stiffness (LS), against percutaneous LB.Patients and
    Methods
    Our study comprised of 223 subjects; 52 without fibrosis (38 volunteers and 14 patients with F0 on LB), 36 with F1, 40 with F2, 26 with F3 and 69 with liver cirrhosis (46 with LB and 23 with signs of cirrhosis). For each patient we performed in the same session 10 TE and 5 ARFI measurements. The median values were calculated.
    Results
    A strong linear correlation (Spearman rho = 0.870) was found between TE and fibrosis (P < 0.0001); there was also a weaker correlation between ARFI and fibrosis (Spearman rho = 0.646; P < 0.0001). TE measurements were also correlated with ARFI measurements (Spearman rho = 0.733, P < 0.0001). The best test for predicting significant fibrosis (F ≥ 2) was TE with a cut-off value of 7.1 kPa (AUROC 0.953). For ARFI, the cut-off value was 1.27 m/s-area under ROC curve (AUROC): 0.890, sensitivity (Se) of 88.7%, specificity (Sp) of 67.5%, positive predictive value (PPV) of 64.5%, and negative predictive value (NPV) of 90% (P = 0.0044). For predicting cirrhosis (F = 4), the optimum cut-off values were 14.4 kPa for TE (AUROC: 0.985, Se: 95.6%, Sp: 94.7%, PPV: 89.2%, NPV: 98%) and 1.7 m/s for ARFI (AUROC: 0.931, Se: 93%, Sp: 86.7%, PPV: 73.6%, NPV: 96.9%) (P = 0.0102).
    Conclusions
    LS evaluation by means of ARFI is not superior to TE for the assessment of liver fibrosis. ARFI is an accurate test for the diagnosis of cirrhosis.
  • Bartosz Bilski Page 539
    Background
    In medical terms, occupational diseases are defined as health disorders specifically associated with the working environment of people and their occupational activity. From the medical and legal perspectives, the vast majority of European countries consider particular diseases to be of occupational origin if they are mentioned in the current list of occupational diseases and caused by exposure to factors in the working environment that are harmful to health.
    Objectives
    The aim of this study was to analyze the occurrence of cases of viral hepatitis certified as an occupational disease in Poland during 1979-2009. This article presents the medical, economic, and legal aspects of the epidemiology of hepatitis as an occupational disease in Poland.
    Materials And Methods
    Publically available statistical data on certified occupational diseases in Poland and data contained in individual "occupational disease diagnosis cards" (based on data used in Poland statistical form), regarding certified cases of hepatitis among health care professionals, which were collected by the Department of Occupational Hygiene of the Polish Public Health Service, were analyzed in this study.
    Results
    In Poland, the highest number of cases of hepatitis certified as an occupational disease was observed in 1987. A gradual reduction in the number of cases of hepatitis as an occupational disease has been noted since then. Currently, hepatitis C as an occupational disease is certified more frequently than hepatitis B. In Poland, the number of women with hepatitis certified as an occupational disease is higher than that of men. However, among health care professionals, particularly nurses, this difference is insignificant because women outnumber the men. The existence of such a situation is due to the significant quantitative predominance of women over men among medical personnel, especially among nurses.
    Conclusions
    Immunization of health care professionals against the hepatitis B virus (HBV), introduced in Poland in 1988, was an important factor involved in reducing the number of cases of occupational viral hepatitis. Socioeconomic and financial factors affected the epidemiological data on cases of hepatitis certified as an occupational disease in Poland. An additional problem associated with the diagnosis of occupational diseases is the lack of obligatory testing for anti-hepatitis C virus (HCV) and anti-hepatitis B surface antigen (HBsAg) antibodies and examinations to ensure the efficacy of HBV vaccination among medical staff before and during employment.
  • Wan-Dong Hong, Yi-Feng Ji, Dang Wang, Tan-Zhou Chen, Qi-Huai Zhu Page 544
    Background
    Prediction of esophageal varices in cirrhotic patients by noninvasive methods is still unsatisfactory.
    Objectives
    To evaluate the accuracy of an artificial neural network (ANN) in predicting varices in patients with HBV related cirrhosis.Patients and
    Methods
    An ANN was constructed with data taken from 197 patients with HBV related cirrhosis. The candidates for input nodes of the ANN were assessed by univariate analysis and sensitivity analysis. Five-fold cross validation was performed to avoid over-fitting.
    Results
    14 variables were reduced by univariate and sensitivity analysis, and an ANN was developed with three variables (platelet count, spleen width and portal vein diameter). With a cutoff value of 0.5. The ANN model has a sensitivity of 96.5%, specificity of 60.4%, positive predictive value of 86.9%, negative predictive value of 86.5% and a diagnostic accuracy of 86.8% for the prediction of varices.
    Conclusions
    An ANN may be useful for predicting presence of esophageal varices in patients with HBV related cirrhosis.
  • Simona Bota, Roxana Sirli, Ioan Sporea, Mircea Focsa, Alina Popescu, Mirela Danila, Mihnea Strain, Madalina Sendroiu, Alexandra Deleanu, Isabel Dan Page 548
    Background
    Liver biopsy (LB) is still considered to be the gold standard for assessment of liver fibrosis.
    Objectives
    To evaluate the effectiveness of various non-invasive methods for predicting liver fibrosis, including transient elastography (TE), APRI score, Lok score, Forns score, FIB-4 score, Fibrosis Index, King score, and Bonacini score, in comparison with the effectiveness of LB and to create a new scoring system for fibrosis prediction.Patients and
    Methods
    This study included 212 patients with chronic HCV hepatitis. LB, TE, and various biological tests were performed during a single hospital visit. Using established formulae, data from these tests were used to create scores for assessment of liver fibrosis.
    Results
    The results of all the tests showed significant correlation with histological fibrosis. TE results (r = 0.62), King score (r = 0.57), and APRI score (r = 0.56) showed the closest correlation with severity of fibrosis. The following formula was derived from our data by multiple regression: Predicted liver fibrosis score (PLF score) = 0.956 + 0.084 × TE - 0.004 × King score + 0.124 × Forns score + 0.202 × APRI score. A direct correlation (r = 0.68) was found between the PLF score and liver fibrosis. The cut-off values of the PLF score for various stages of fibrosis were: F ≥ 1, 1.77 (Area under ROC curve (AUROC) = 0.76); F ≥ 2, 2.18 (AUROC = 0.78); F ≥ 3, 2.47 (AUROC = 0.86); and F = 4, 2.98 (AUROC = 0.97).
    Conclusions
    We found that our newly developed PLF score, which is derived from the scores of multiple tests, is more strongly correlated with fibrosis than each component score used individually. The PLF score is more effective than TE for predicting severe fibrosis, but they have similar effectiveness in predicting liver cirrhosis.
  • Selinger Cp, Leong Rw, Yilmaz Y., Yonal O., Kurt R Page 556
  • Mendez-Navarro J., Avelar-Escobar G., Gallardo-Cabrera Ve, Malaguarnera M., Vacante M., Giordano M., Malaguarnera M., Galvano F., Volti Gl Page 562