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

High frequency of SEN virus infection in thalassemic patients and healthy blood donors in Iran

<p>Abstract</p> <p>Background</p> <p>SEN virus is a blood-borne, circular ssDNA virus and possessing nine genotypes (A to I). Among nine genotypes, SENV-D and SENV-H genotypes have the strong link with patients with unknown (none-A to E) hepatitis infections. Infection with blood-borne viruses is the second important cause of death in thalassemic patients. The aim of this study was to determine the frequency of SENV-D and SENV-H genotypes viremia by performing nested-PCR in 120 and 100 sera from healthy blood donors and thalassemic patients in Guilan Province, North of Iran respectively. Also, to explicate a possible role of SEN virus in liver disease and established changes in blood factors, the serum aminotransferases (ALT and AST) and some of the blood factors were measured.</p> <p>Results</p> <p>Frequency of SENV-D, SENV (SENV-H or SENV-D) and co-infection (both SENV-D and SENV-H) viremia was significantly higher among thalassemic patients than healthy individuals. Frequency of SENV-H viremia was significantly higher than SENV-D among healthy individuals. In comparison to SENV-D negative patients, the mean of mean corpuscular hemoglobin was significantly higher in SENV-D positive and co-infection cases (<it>P </it>< 0.05). The means of AST and ALT were significantly higher in thalassemic patients than healthy blood donors, but there were not any significant differences in the means of the liver levels between SENV-positive and -negative individuals in healthy blood donors and thalassemic patients. High nucleotide homology observed among PCR amplicon's sequences in healthy blood donors and thalassemic patients.</p> <p>Conclusions</p> <p>The high rate of co-infection shows that different genotypes of SENV have no negative effects on each other. The high frequency of SENV infection among thalassemic patients suggests blood transfusion as main route of transmission. High frequency of SENV infection in healthy individuals indicates that other routes rather than blood transfusion also are important. Frequency of 90.8% of SENV infection among healthy blood donors as well as high nucleotide homology of sequenced amplicons between two groups can probably suggest that healthy blood donors infected by SENV act partly as a source of SENV transmission to the thalassemic patients. In conclusion, SENV-D isolate in Guilan Province may be having a pathogenic agent for thalassemic patients.</p

Fat necrosis Secondary to Pancreatitis Mimicking Transverse Colon Cancer: A Case Report

Fat necrosis secondary to pancreatitis can be either mild and self limited or create severe organ damage,but may rarely lead to abdominal opancreatic pseudotumor.We report a case of fat necrosis secondary to pancreatitis which clinically simulates transverse colon cancer

Open Drainage and Detention Basin Combined System Optimization

Introduction: Since flooding causes death and economic damages, then it is important and is one of the most complex and destructive natural disaster that endangers human lives and properties compared to any other natural disasters. This natural disaster almost hit most of countries and each country depending on its policy deals with it differently. Uneven intensity and temporal distribution of rainfall in various parts of Iran (which has arid and semiarid climate) causes flash floods and leads to too much economic damages. Detention basins can be used as one of the measures of flood control and it detains, delays and postpones the flood flow. It controls floods and affects the flood directly and rapidly by temporarily storing of water. If the land topography allows the possibility of making detention basin with an appropriate volume and quarries are near to the projects for construction of detention dam, it can be used, because of its faster effect comparing to the other watershed management measures. The open drains can be used alone or in combination with detention basin instead of detention basin solitarily. Since in the combined system of open and detention basin the dam height is increasing in contrast with increasing the open drainage capacity, optimization of the system is essential. Hence, the investigation of the sensitivity of optimized combined system (open drainage and detention basin) to the effective factors is also useful in appropriately design of the combined system. Materials and Methods: This research aims to develop optimization model for a combined system of open drainage and detention basins in a mountainous area and analyze the sensitivity of optimized dimensions to the hydrological factors. To select the dam sites for detention basins, watershed map with scale of 1: 25000 is used. In AutoCAD environment, the location of the dam sites are assessed to find the proper site which contains enough storage volume of the detention basin and the narrower valley. After the initial selection of dam sites, based on the reservoir volume to construction volume ratio of each dam site, best sites were selected to have the higher ratio. The layout of the main drainage scheme that is responsible for collecting and transferring overland flows of farmlands and reservoir outflows was designed. In order to simulate the hydrological processes in upstream watershed and flood analysis, HEC-HMS model which is an extended version of HEC-1 was used as hydrologic model. The optimal combination of open drainages and detention basins was also developed. Watershed in terms of detention basin dams, topography and drainage were divided into 19 smaller sub-basins. The downstream agricultural basin due to the slope and drainage area was divided into 27 sub-basins. Regarding available information of the watershed, SCS method was used to calculate losses and to convert rainfall to runoff hydrograph. In this section Muskingum flood routing method was used considering its accuracy. In the present optimization model, the total cost of the combined system of dams and open drains used as the objective function. It is function bottom outlet diameter which is minimized by using optimization model. Other factors of the simulation model such as dam height and drainage dimensions were defined as function of the diameter of the bottom outlet of dams. After determining the optimal dimensions of the combined system of open drainage and detention basins, a sensitivity analysis was performed on hydrological factors. Results and Discussion: After optimization of the dimensions of open drainage and detention basin integrated-system, sensitivity analysis was carried out on the dimensions of system for variation of flood simulation parameters such as rainfall, curve number and lag time. The error of estimated rainfall effected far less than the curve number (CN) on the optimum dimensions and cost. 10% variation of the rainfall depth caused respectively, 7%, 8% and 10% error in optimum dam height, drainage optimal depth and total cost. Lag time was identified less important effect in the determination of optimal dimensions. As its 10% changing produced 10% error in optimal dimensions costs. Conclusions: The research results showed that curve number is the most important factor in determining the optimal size and cost. As with 10% error in the estimation of curve number caused error rates of 21%, 25% and 24% of the optimal dam height, the optimal depth of the drain and minimized costs, respectively

Clinical and histological features of non-Alcoholic steatohepatitis in Iranian patients

Non-alcoholic steatohepatitis (NASH) is a disease of unknown origin characterized histologically by alcoholic-like liver injury in the absence in the absence of significant alcohol intake. This study was conducted to assess the clinical and pathological features of NASH patients in Iran. Patients with elevated liver transaminases, negative serologic markers of viral or autoimmune hepatitis and no findings in favor of metabolic liver disease were enrolled. A careful history was taken with special attention to alcohol intake and ultrasonography and liver biopsy were performed in those with no evidence of significant alcohol intake. A histology showing moderate to gross macrovesicular fatty change with inflammation (lobular or portal), with or without Mallory bodies, fibrosis, or cirrhosis, was considered diagnostic for NASH. Patients with mild steatosis were rechecked for the presence of hepatitis C virus (HCV) infection. Fifty-three patients who met the above criteria entered the study. Thirty-two patients (60.4%) were male and 21 (39.6%) were female with the mean age of 37.8±11.3 years. Twenty-six patients (55.3%) were diabetic. Mean AST to ALT ratio was 0.95±0.52; 65.3%of patients had a ratio below than 1, and 95.9% were below of 2. Ultrasonography was abnormal in 32 (76.2%) patients. 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 15.1% had some degrees of fibrosis. The amount of increase in liver enzymes bore no relationship with the presence of fibrosis, portal inflammation, and degree of steatosis (P&gt;0.05). The patients wee somewhat younger than other studies, and most of them were male which might be due to the low rate of alcohol consumption in our country. Most of the patients had body mass index (BMI) higher than normal. Our findings show that NASH must not be considered a disease confined to high-risk groups only, and its impact be larger than what is generally considered

A Multicenter Study To Evaluate The Safety And Efficacy Of Heber On (Interferon Alfa-2b) In Combination With Ribavirin For The Treatment Of Chronic Hepatitis C In Iran

Combination therapy with interferon and ribavirin is the most effective treatment for chronic hepatitis C today. The aim of this study was to evaluate the efficacy and safety of thrice-weekly Heberon (interferon alfa-2b) in combination with ribavirin as first -line treatment of chronic hepatitis C. Methods: A total of97 treatment-naive patients received Heberon three million units thrice-weekly subcutaneously in combination with ribavirin for 12 months. Serum HCV RNA levels were measured before and during therapy and 6 months after the end of therapy. End-of-treatment and sustained virological responses was defmed as an undetectable HCV-RNA level at the end of treatment, and 6 months after treatment was completed (end of follow-up), respectively. Results: In an intent-to-treat analysis, HCV-RNA was undetectable at the end of treatment in 49.5% of patients. At the end of follow-up, sustained virological response was 36.1 %. Combination treatment was generally well tolerated. Six patients stopped therapy because of side effects: severe cytopenia (n=4), depression (n=1), and hyperthyroidism (n= 1 ). Common side effects of therapy include: Flu-like syndrome (85.6%), generalized alopecia (41.2% ), injection site inflammation (37.1% ), mood changes (36% ), anorexia (34%) and weight loss (32% ). Conclusion: Heberon as an IFN product in combination with ribavirin for treat-ment of patients with chronic hepatitis Cis relatively safe, feasible, and potentially efficacious. It has comparable results in achieving end-of-treatment and sustained virological responses in chronic hepatitis C

Original Article Role of the Human Papillomavirus Infection in Esophageal Squamous Cell Carcinoma

ABSTRACT Background and Objective: Human papillomavirus (HPV) is one of the possible etiologic factor