Validation of Hepascore as a Predictor of Liver Fibrosis in Patients with Chronic Hepatitis C Infection

Introduction. Liver biopsy is an invasive determinator for hepatic fibrosis. Serum biomarkers can probably be used as an alternative to liver biopsy in assessment of the degree of fibrosis in patients with chronic Hepatitis C. Method. Eighty patients with chronic Hepatitis C were included in the study using simple nonrandom sampeling metod. After fulfillment of liver biopsy, the patients were categorized according to the METAVIR Scoring system. The Hepascore algorithm is computed based on age, sex, and the serum levels of total bilirubin, δ-glutamyl transferase, α2-Macroglobulin, and hyaluronic acid. The spearman and ROC tests were used. Results. According to the liver biopsy results, 12, 25, 20, 7 and 16 patients had F0, F1, F2, F3, and F4, respectively. With regard to the 0.34 cut-off point Hepascore had 67%, 56%, 64%, and 56% sensitivity, specificity, respectively, positive prediction value (PPV), and negative prediction value (NPV), respectively, for diagnosis of significant fibrosis. For a Hepascore cut-off point 0.61, sensitivity, specificity, respectively, PPV and NPB 82%, 86%, 70%, and 92% in diagnosis of severe fibrosis. For a Hepascore cut-off point 0.84, sensitivity, specificity, PPV and NPB were respectively 100%, 97%, 89%, and 100% for diagnosis of cirrhosis. Conclusion. Hepascore has a high value in diagnosis of the level of fibrosis, particularly cirrhosis. Therefore, it can be used for primary screening of patients to determine the need for liver biopsy

Detection of Legionella pneumophila in the bronchoalveolar lavage samples by real time PCR in patients with ventilator-associated pneumonia in ICU

زمینه و هدف: لژیونلا پنوموفیلا به خاطر توانایی آن در ایجاد پنومونی ناشی از ونتیلاسیون مکانیکی مورد توجه مراکز درمانی است. هدف از این مطالعه ردیابی گونه های لژیونلا پنوموفیلا در نمونه های بدست آمده از برونکوآلوئولار لاواژ با روشReal Time PCR در بیماران بستری در بخش مراقبت های ویژه ی بیمارستان الزهرا(س) اصفهان می باشد. روش بررسی: در یک مطالعه توصیفی تحلیلی سی و نه نمونه برونکوآلوئولار لاواژ در بیماران مبتلا به پنومونی همراه با ونتیلاتور بستری در بخش مراقبت های ویژه (ICU) بیمارستان الزهرای اصفهان در سال 1390 گرفته و تا زمان آزمایش در 20- درجه سانتیگراد نگهداری شد. DNA به روش فنل کلروفرم استخراج و آزمایش Real Time PCR در 45 چرخه شامل oC95 برای 4 ثانیه و oC58 برای 30 ثانیه انجام شد. در حالی که پروب به روش Taq Man عمل می کرد. یافته ها: نتیجه برای حضور باکتری لژیونلا پنوموفیلا در همه نمونه ها منفی شد. حداقل سن افراد در مطالعه 20 و حداکثر 86 سال بوده است. مدت زمان بستری افراد مورد مطالعه در ICU حداقل 2 روز و حداکثر 65 روز است. مدت زمان ونتیلاسیون افراد مورد مطالعه حداقل 2 روز و حداکثر 65 روز بود. نتیجه گیری: این مطالعه عدم حضور لژیونلا پنوموفیلا در بیماران دچار پنومونی وابسته به ونتیلاتور در ICU بیمارستان الزهرای اصفهان رادریک مقطع زمانی نشان می دهد؛ لذا بر اساس مطالعه فوق، شناخت الگوی میکروبیولوژیک لژیونلا پنوموفیلا در سایر مراکز درمانی نیز امری منطقی به نظر می رسد

Cytochrome P450 2C19 Polymorphism in Iranian Patients with Coronary Artery Disease

<p><strong>BACKGROUND:</strong> The polymorphisms of cytochrome P450 2C19 (CYP2C19) gene are major prognostic factors for the response to clopidogrel therapy in patients with coronary artery diseases (CAD). The CYP2C19*2 is the most important allele responsible for resistance to clopidogrel therapy. This study examined CYP2C19 gene polymorphism (CYP2C19*1 and *2) in Iranian patients.</p> <p>&nbsp;</p> <p><strong>METHODS:</strong> This cross-sectional study was performed on 43 Iranian patients with CAD who underwent percutaneous coronary intervention (PCI) and received drug-eluted stents (DES). CYP2C19 polymorphisms were assessed using real time PCR and frequency of CYP2C19*1 and CYP2C19*2 were determined, and then homo- or heterozygous state of genes was detected by Melt Curve Analysis method.</p> <p>&nbsp;</p> <p><strong>RESULTS:</strong> Forty three patients (mean age = 58.8 &plusmn; 10.0 years, 79.1% male) participated in this study. CYP2C19*1/CYP2C19*1 genotype was observed in 31 (72.1%) of participates, CYP2C19*1/CYP2C19*2 genotype in 10 (23.3%), and CYP2C19*2/CYP2C19*2 genotype in 2 patients (4.7%). The frequency of CYP2C19*2 allele in the sample was 27.9%.</p> <p>&nbsp;</p> <p><strong>CONCLUSION:</strong> This study demonstrated a high prevalence of CYP2C19*2 gene polymorphism in Iranian patients. Further studies with larger samples or longitudinal are required to determine the effects of this polymorphism on the prognosis of CAD patients in our population.</p> <p>&nbsp;</p> <p><strong>Keywords:</strong> CYP2C19, Polymorphism, Clopidogrel, Coronary Artery Disease, Iran.</p> <p>&nbsp;</p

Fecal calprotectin is a useful marker to diagnose ulcerative colitis from irritable bowel syndrome

Background: This study was aimed to evaluate the predictive value of fecal calprotectin in patients with ulcerative colitis from patients with irritable bowel syndrome (IBS). Materials and Methods: Between May and October 2013, 88 adult patients, between the age 18 and 65 years with a history of chronic diarrhea of unknown origin were assessed. Standard colonoscopies were performed in all patients to assess ulcerative colitis. Before colonoscopies, they were asked to supply a stool specimen. Fecal calprotectin value was measured using a commercial enzyme-linked immunosorbent assay kit. Results: The mean of age, gender combination, and body mass index were not significantly different between patients with ulcerative colitis or IBS. The duration of disease in ulcerative colitis patients was significantly higher than IBS patients (P < 0.0001). The level of calprotectin in ulcerative colitis patients was significantly higher than IBS patients (265.9 vs 115.8, respectively, P = 0.001). Also, cutoff value >164 μg/g with sensitivity and specify of 57 (CI: 41%-71.6%), and 75 (CI: 59.7%-56.8%), respectively, was the best for discrimination between patients with ulcerative colitis and those with IBS. Conclusion: Our results show that fecal calprotectin as a noninvasive method, which can be used to identify patients with ulcerative colitis from IBS patients has low sensitivity and specificity

Prevalence of occult hepatitis B virus infection in hemodialysis patients in Isfahan, Iran

Background: The absence of a detectable hepatitis B surface antigen (HBsAg) with or without hepatitis B core antibody (anti-HBc) or hepatitis B surface antibody (anti-HBs) in the presence of hepatitis B virus-DNA (HBV-DNA) is defined as occult HBV infection. This study was aimed to evaluate the prevalence of occult HBV infection in patients receiving hemodialysis (HD) in Isfahan, Iran. Materials and Methods: This cross sectional study was done on 400 patients without acute or chronic HBV infection with end-stage renal disease undergoing regular HD. Blood samples were collected prior to the HD session, and serological markers of viral hepatitis B included HBsAg, anti-HBs and anti-HBc were measured using standard third generation commercially avail-able enzyme immunoassays kit, then samples of positive anti-HBc and negative anti-HBs were tested for HBV DNA using quantitative real-time polymerase chain reaction techniques. Data were analyzed by SPSS using t-test and Chi-square test. Results: The mean age of patients was 51.6 ± 11.2 years. Anti-HBc positive was observed in 32 (8%) of 400 studied patients with negative HBsAg. Of 32 patients with anti-HBc positive, 15 were males and 17 were females with mean age of 49.7 ± 12.6 years. Among 32 patients with anti-HBc positive, 10 patients were negative for anti-HBs. All of 10 patients were negative for HBV DNA. The prevalence of occult HBV infection was 0%. Conclusions: The prevalence of occult HBV infection in HBsAg negative patients undergoing HD was 0% and look to be among the lowest worldwide. So, occult HBV infection is not a significant health problem in HD patients in this region

Correlation between Vitamin D3 level and extrahepatic manifestation in chronic hepatitis type-C virus patients

Background: Chronic hepatitis type-C virus (HCV) infection is one of the most common worldwide viral disorders, which leads to various clinical complications as well as extrahepatic manifestations. Furthermore, Vitamin D3 has also been reported to have relationship with the mentioned complications. The aim is to evaluate the correlation between Vitamin D3 level and extrahepatic manifestation in chronic HCV patients. Materials and Methods: This cross-sectional study has been carried out on 90 patients with chronic hepatitis C. The level of Vitamin D3 was assessed in plasma of 90 patients with chronic HCV. Genotyping was done and clinical and sign and symptoms of recruited patients were gathered. Extrahepatic manifestations were evaluated and the correlation of blood, hepatic, and immunological factors and the level of Vitamin D3 were assessed. Results: Most of our patients were male (92% vs. 8%). Twenty-nine percent had the insufficient amount of Vitamin D3 (21–30 ng/ml), and the remains had the Vitamin D3 level between 13–20 ng/ml. Furthermore, our assessment demonstrated that deficiency of Vitamin D3 was associated with the extrahepatic manifestations such as purpura (odds radio [OR] [95% confidence interval (CI) 95%] = 8.80 [1.74–44.47], P = 0.004), vasculitis (OR [95% CI] = 11.70 [3.01–45.41], P < 0.001), arthralgia (OR [95% CI] = 20.26 [4.21–97.47], P < 0.001), myalgia (OR [95% CI] = 4.00 [1.01–17.27], P = 0.048), and glomerulonephritis (P = 0.021). Conclusion: According to our results, the extrahepatic manifestation in the patients with sufficient levels of Vitamin D3 would be less possible. In fact, it could be stated that deficiency in the Vitamin D3 can have a significant relationship with these manifestations