Ghaemi, E.-O.

Kalavi, K.

Kazeminejhad, V.

Moradi, A.

Roshandel, G.

Semnani, S.

English

Golestan University of Medical Sciences Repository

Indian J Med Sci, Vol. 62, No. 5, May 2008adrenal cortical tumors: An immunohistochemicalstudy of 316 cases. Arch Pathol Lab Med2002;126:170-2. 14. van Slooten H, Schaberg A, Smeenk D, MoolenaarAJ. Morphologic characteristics of benignand malignant adrenocortical tumors. Cancer1985;55:766-73.15. Weiss LM, Medeiros LJ, Vickery AL. Pathologic features of prognostic signiﬁcance in adrenocorticalcarcinoma. Am J Surg Pathol 1989;13;202-6.Source of Support: NilConﬂict of Interest: None declared.203INDIAN JOURNAL OF MEDICAL SCIENCESAuthor Help: Online Submission of the ManuscriptsArticles can be submitted online from http://www.journalonweb.com. For online submission articles should be preparedin two files (first page file and article file). Images should be submitted separately.1)  First Page File: Prepare the title page, covering letter, acknowledgement, etc., using a word processor program. All information which can reveal your identity should be here. Use text/rtf/doc/pdf files. Do not zip the files.2) Article file: The main text of the article, beginning from Abstract till References (including tables) should be in this file. Do not include any information (such as acknowledgement, your names in page headers, etc.) in this file. Use text/rtf/doc/pdf files. Do not zip the files. Limit the file size to 400 kb. Do not incorporate images in the file. If file size is large, graphs can be submitted as images separately without incorporating them in the article file to reduce the size of the file.3) Images: Submit good quality colour images. Each image should be less than 400 kb in size. Size of the image can be reduced by decreasing the actual height and width of the images (keep up to about 4 inches) or by reducing the quality of image. All image formats (jpeg, tiff, gif, bmp, png, eps, etc.) are acceptable; jpeg is most suitable. The image quality should be good enough to judge the scientific value of the image.Always retain a good quality, high resolution image for print purpose. This high resolution image should be sent to the editorial office at the time of sending a revised article.4) Legends: Legends for the figures/images should be included at the end of the article file.                                    204 LETTERS TO EDITOR HEPATITIS B VIRUS GENOTYPES IN IRAN Sir, Hepatitis B virus (HBV) genotypes differ due to geographic parameters, and recently the clinical importance of HBV genotypes in their Pathogenesis has been discussed. HBV genotypes indicate their transmission route, geographical distribution, and the destination of immigrants infected with HBV.[1] We conducted the present study to evaluate the genotypic disparity of HBV in Golestan province of Iran, an area with high prevalence of HBV infection.[2] During a population-based cross-sectional study in Golestan province of Iran (2004-2005), 164 HBsAg-positive cases had been detected from a total sample size of 1850 participants. [2] In 126 of 164 cases (available serum samples), DNA extraction was carried out using standard phenol-chloroform method. Genotypic determination of the samples has been done by polymerase chain reaction (PCR) method using specific primers for HBV genotypes. PCR was performed in a total volume of 50 µL containing 5 μL of DNA extracted, 5 μL 10x  buffer PCR, [50 mM-KCl, 10 mM Tris-HCl pH 8.3, 1.5 mM MgCl2], 200 μM of each dNTP, 2 U Taq polymerase, and 25 pmol of each primer. After PCR, the ampli› ed products were electrophoresed on a 1% agar‘s gel, stained with ethidium bromide, and evaluated under UV light. One hundred twenty-six HBsAg-positive serum samples were assessed. The results of PCR by beta-globin primer, as well as other type-speci›c primers, in 9 samples were negative because the DNA of these samples was notextracted adequately. Therefore, these sampleswere excluded and PCR was continued forgenotype determination only in 117 cases. In 93 (79.5%) out of 117 samples, genotype Dwas detected, and the remaining 24 samples were not positive with any HBV type-speci›c primers. Results from this study have shown that theonly genotype of HBV detected in Golestanprovince was D type. In previous studiesfrom Iran, all HBV cases were detected as D genotype.[3,4] In another study, HBV genotypes A and D were the commonest in northern India. [5] Finally, Alexopoulou et al. suggested thatD type of HBV is common in Mediterraneancountries.[1] Our results were in line with theresults of all the above-mentioned studies. Previous studies showed that D type of HBV usually does not change liver enzymes (e.g., transaminases) considerably, and also thistype will not result in severe liver diseases.[5] Some researchers reported that lamivudine is more ef›cient in the treatment of patients with D type as compared to those with other types of HBV.[6] Therefore, it should be considered thatvaccination and educational programs canhelp us to control HBV infection ef› ciently.Also, health care workers should note thatlamivudine may be useful in the treatment ofa large number of HBV-infected patients inthis area. Indian J Med Sci, Vol. 62, No. 5, May 2008 Indian J Med Sci, Vol. 62, No. 5, May 2008hearing loss, and an impedance audiogramshowed absent stapedial reflex. CT scanshowed no fracture of the temporal bone and intact ossicles. The patient was prescribedhigh-dose steroids, along with vigorous facial nerve stimulation and massages. After 3 weeks of treatment, the facial nervestimulation tests were repeated and thereadings were compared to those taken prior totreatment. There was negligible improvement. The patient was offered an exploratorymastoidectomy to try to locate the lesion ofthe facial nerve and decompress or repairthe damaged part, which he turned down. He chose to be discharged against medical advice and discontinued all medications. Three months after the initial trauma, the patientclaimed to have suffered another episode oftrauma similar to the first episode but lesssevere and with no loss of consciousness. The patient did not seek any medical advice. Hehowever reported that his facial dis› gurement started improving and recovery was complete in6 to 7 days. There was, however, no reported improvement in lacrimation or taste.A repeat audiogram showed an increasedsensor ineural  component.  Impedanceaudiometry showed an absent stapedial reﬁ ex. We concluded that the motor component ofthe facial nerve had recovered but the otherfunctions remained depressed. Facial nerve paralysis can be a disfiguringdisorder with profound impact on the patient.[1]Patients suffering from this debilitating conditionare unable to express various emotional states.[2]It occurs in 5% of the cases of head injuries,[3] and25% of facial injuries recover spontaneously.[4]Strands of facial nerve interconnect withcranial nerves V, VIII, IX, X, XI, and XII andwith the cervical cutaneous nerves. This free intermingling of ›bers of the facial nerve with ›bers of other neural structures (particularlythe cranial nerve V) has been proposed asthe mechanism of spontaneous return of facial nerve function after peripheral injury to thenerve.[4]Early onset/complete palsy indicates disruption of continuity of the nerve. A delayed onset/partial paresis suggests secondary swellingor compression of nerve that is more likelyto recover spontaneously. Most patients ofperipheral traumatic facial nerve injury recover with time; and occasionally, treatment. Thecase we present is unique in the sense that a second similar episode of trauma resulted in recovery of facial nerve motor function which is inexplicable. It is possible that the repeattrauma to the facial nerve stimulated the nerve and speeded the recovery process or that the facial nerve recovered spontaneously and the second episode of trauma was coincident. In the literature, we have not come across any mention of repeat trauma leading to recovery of traumatic facial nerve palsy. This casehighlights the fact that the hope of recoveryin traumatic facial paralysis (delayed onset)should not be lost, and the patient shouldbe advised electro-physiotherapy for up to 6months after the initial episode.SANJAY ARORA, BS TULIDepartment of ENT, MMIMSR, Mullana (Ambala), IndiaCorrespondence: Dr. Sanjay Arora,D- 23, MMET Residential Complex, Mullana - 133 203, Ambala, India.E-mail: drsanjayarora@sify.com LETTERS TO EDITOR206                                                                    205 LETTERS TO EDITOR In conclusion, the most frequent type of HBV genotype in our study was D type, whichusually causes a mild liver disease. Henceproper vaccination, e ducational programs,and treatment with lamivudine are efficientstrategies in controlling HBV infection in ourarea. ABDOLVAHAB MORADI, VAHIDEH KAZEMINEJHAD1, GHOLAMREZA ROSHANDEL, KHODABERDI KALAVI, EZZAT-OLLAH GHAEMI2, SHAHRYAR SEMNANI Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Iran, 1Department of Pathology, 5 Azar Hospital, Golestan University of Medical Sciences, Iran, 2Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Iran Correspondence: Dr. Gholamreza Roshandel, Number 77, 2 nd Floor, Qabooseieh Passage, Gorgan, Golestan Province, Iran 49166-53588 E-mail: roshandel_md@yahoo.com REFERENCES 1.	 Alexopoulou A, Dourakis SP. Genetic heterogeneityof hepatitis viruses and its clinical signiﬁcance.Curr Drug Targets Inﬂamm Allerg 2005;4:47-55.2. 	  Gholamreza R, Shahryar S, Abbasali K,Hamidreza J, Abdolvahab M, Khodaberdi K, etal. Seroprevalence of hepatitis B virus and itsco-infection with hepatitis D virus and hepatitisC virus in Iranian adult population. Indian J MedSci 2007;61:263-8.3.	 Alavian SM, Keyvani H, Rezai M, Ashayeri N,Sadeghi HM. Preliminary report of hepatitisB virus genotype prevalence in Iran. World JGastroenterol 2006;12:5211-3.4.	 Amini-Bavil-Olyaee S, Sarrami-Forooshani R,Adeli A, Sabahi F, Abachi M, Azizi M, et al.Complete genomic sequence and phylogeneticrelatedness of hepatitis B virus isolates from Iran. J Med Virol 2005;76:318-26.5. 	 Kumar A, Kumar SI, Pandey R, Naik S, Aggarwal R. Hepatitis B virus genotype A is more often associated with severe liver disease in northern India than is genotype D. Indian J Gastroenterol 2005;24:19-22. 6.	 Thakur V, Sarin SK, Rehman S, Guptan RC,Kazim SN, Kumar S. Role of HBV genotypein predicting response to lamivudine therapyin patients with chronic hepatitis B. Indian JGastroenterol 2005;24:12-5.Indian J Med Sci, Vol. 62, No. 5, May 2008 

Hepatitis B virus genotypes in Iran

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