Antiviral therapy in neonatal cholestatic cytomegalovirus hepatitis

BACKGROUND: Neonatal hepatitis refers to a heterogeneous group of disorders, caused by many factors including cytomegalovirus infection, revealing similar morphologic changes in the liver of an infant less than 3 months of age. Approximately 40% of cholestasis in infants is due to neonatal hepatitis. It may cause latent or acute cholestatic or chronic hepatitis, including cirrhosis in immunocompetant infant. METHODS: Twelve infants diagnosed with neonatal cytomegalovirus hepatitis in the last one year were included in the study. Group 1 consisted of seven babies treated with ganciclovir for 21 days. Group 2 included five cases who did not receive antiviral treatment. Physical examination, biochemical, serologic and virologic tests were done for both groups at the time of diagnosis and in the third month. RESULTS: Initial levels of total bilirubin, aminotransferases, gamma glutamyl transpeptidase, and alkaline phosphatase revealed a significant decrease after the treatment in Group 1 (p < 0.05) when compared with Group 2. This study revealed that ganciclovir treatment is a safe and effective in cases with cholestatic hepatitis. Similarly, all the patients in the treatment group had evidence of improvement serologically and virologically, while the comparison group did not reveal any significant change(p < 0.01). CONCLUSION: The clinical spectrum of perinatal infection varies from an asymptomatic infection or a mild disease to a severe systemic involvement, including central nervous system. The treatment in the early period of infection improved serologic markers and cholestatic parameters significantly. Further studies will lead us to clarify the efficacy of ganciclovir treatment in the early period of cytomegalovirus hepatitis, and the preventive role of anti-viral therapy on progressive liver disease due to cholestasis and hepatitis in neonatal cytomegalovirus infection

The Helicobacter pylori duodenal ulcer promoting gene, dupA in China

<p>Abstract</p> <p>Background</p> <p>The prevalence of <it>H. pylori </it>is as high as 60–70% in Chinese population. Although duodenal ulcer and gastric cancer are both caused by <it>H. pylori</it>, they are at opposite ends of the spectrum and as such are considered mutually exclusive. Duodenal ulcer promoting (<it>dupA</it>) gene was reported to be associated with duodenal ulcer development. The aim of this study was to determine the prevalence of <it>dupA </it>gene of <it>Helicobacter pylori </it>in patients with various gastroduodenal diseases and to explore the association between the gene and other virulence factors.</p> <p>Methods</p> <p><it>H. pylori </it>were isolated from gastric biopsies of patients with chronic gastritis, duodenal ulcer (DU), gastric ulcer (GU), or non-cardia gastric carcinoma. The <it>dupA</it>, <it>cagA</it>, <it>vacA</it>, <it>iceA </it>and <it>babA2 </it>genotypes were determined by polymerase chain reaction. Histological features of gastric mucosal biopsy specimens were graded based on the scoring system proposed by the updated Sydney system. IL-1β polymorphism was investigated using restriction fragment length polymorphism.</p> <p>Results</p> <p>Isolates from 360 patients including 133 with chronic gastritis, 101 with DU, 47 with GU, and 79 with non-cardia gastric carcinoma were examined. The <it>dupA </it>gene was detected in 35.3% (127/360) and the prevalence DU patients was significantly greater than that in gastric cancer or GU patients (45.5% vs. 24.1% and 23.4%, <it>P </it>< 0.05). Patients infected with <it>dupA</it>-positive strains had higher scores for chronic inflammation compared to those with <it>dupA</it>-negative strains (2.36 vs. 2.24, p = 0.058). The presence of <it>dupA </it>was not associated with the <it>cagA</it>, <it>vacA, iceA </it>and <it>babA 2 </it>genotypes or with IL-1β polymorphisms.</p> <p>Conclusion</p> <p>In China the prevalence of <it>dupA </it>gene was highest in DU and inversely related to GU and gastric cancer.</p

Clinical and histological features of nonalcoholic steatohepatitis in Iranian patients

BACKGROUND: Although several studies have been performed on risk factors and natural course of NASH, it seems that NASH tends to be more than a disease confined to strict boundaries. The objective of this study was to assess the clinical and paraclinical features and risk factors for non-alcoholic steatohepatitis (NASH) patients in an Iranian population METHODS: Patients with histologically confirmed NASH who had elevated liver aminotransaminases, negative serologic markers of viral or autoimmune hepatitis and no findings in favor of metabolic liver disease were enrolled. A careful history was taken regarding alcohol intake. RESULTS: 53 patients consisting of 32 male and 21 female entered the study. The mean age was 37.8 ± 11.3 years. Twenty-six patients (55.3%) were overweight, 15 (31.9%) obese, 40 (75.5%) dyslipidemic, and three patients (5.7%) were diabetic. Liver biopsy showed mild steatosis in 35.7%, moderate steatosis in 53.6%, and severe forms in 10.7%. In 80.2% of patients, portal inflammation was present, and 9.4% had cirrhosis. The amount of increase in liver enzymes bore no relationship with fibrosis, portal inflammation, and degree of steatosis. CONCLUSIONS: The patients in our study showed a male predominancy and were somewhat younger than other studies

Bile reflux index after therapeutic biliary procedures

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