فهرست مطالب moayed alavian

Elastography as one of the most promising non-invasive methods in the diagnosis of liver diseases is attracting much attention. An interesting technique which is independent of imaging rate uses shear wave interference patterns induced by two external stimulation sources. In this article a 3D finite element model of liver tissue with superficial mechanical stimulation is presented through which, the possibility of using shear wave interference patterns to determine the type of liver fibrosis is investigated. In addition, the effect of various stimulation characteristics on the propagation of elastic waves and formation of shear wave interference patterns can be measured. Besides, ultrasound imaging and methods based on cross correlation are used to find target displacements caused by interference of shear waves. According to the results, the type of fibrosis was determined at all stages without error, and the mean elasticity estimation error of 4.98% was obtained for the finite element model.

Context: Hepatitis is a term used to describe any type of hepatitis inflammation. Screening for the virus antigen during pregnancy is mandatory in some parts of the world and is recommended in others. so that, most women are aware of and understand the disease if they have it when they are pregnant. Thus, the major concerns of these women are both the virus transmission to the fetus and the effects of hepatitis B on pregnancy outcome.
Evidence Acquisition: According to a specific protocol, we searched in the Pub med, Scopus, ISI web of science from 1990 to February 2015 to find the original articles, which investigated the hepatitis B effects in pregnant women with normal singleton pregnancy who were previously diagnosed with inactive CHB or were incidentally found to be HBsAg positive in routine antenatal blood test. We included any cohort, case control and cross sectional studies if they had a healthy control group and reported one or more considered maternal or prinatal outcomes in pregnant women. Meta-analysis was performed with Review manager 5.4 and Stata 11 software. We assessed the effect size that was pooled odds ratio (OR) and 95% confidence intervals (CIs) using the random effects model. We explored statistical heterogeneity using the chi-squared (Chi2), I2 and tau-squared (Tau2) statistical tests.
From a total of 156 identified studies, 56 studies were chosen for a detailed review, and 18 studies which met the inclusion and exclusion criteria were included in the meta analysis. Among the included studies, the outcomes were small for gestational age (SGA) large for gestational age (LGA), intra uterine growth restriction (IUGR), fetal distress, fifth minutes apgar score, first minute Apgar score, low birth weight (LBW) and Fetal Macrosomia.
In this study, hepatitis B had a cause effect on LGA and fetal Macrosomia. Among the other considered adverse pregnancy outcomes; it didn’t have any significant effect.

The prevalence of hepatitis C in Iran is 1% and 18% in general population and thalassemia patients respectively. The cost effectiveness analysis of adding Ribavirin to Peginterferon alfa-2a (PEG IFN alfa-2a) as a combination treatment strategy of chronic hepatitis C in thalassemia patients in comparison with monotherapy could help clinicians and policy makers to provide the best treatment for the patients.. In this study we aimed to assess whether adding Ribavirin to PEG IFN alfa-2a is a cost effective strategy in different genotypes and different subgroups of 280 patients with chronic hepatitis C infection from the perspective of society in Iranian setting..Patients and A cost effectiveness analysis including all costs and outcomes of treatments for chronic hepatitis C infected thalassemia major patients was conducted. We constructed a decision tree of treatment course in which a hypothetical cohort of 100 patients received “PEG IFN alfa-2a” or “Peg IFN alfa-2a plus Ribavirin.” The cost analysis was based on cost data for 2008 and we used 9300 Iranian Rials (IR Rial) as exchange rate declared by the Iranian Central Bank on that time to calculating costs by US Dollar (USD). To evaluate whether a strategy is cost effective, one time and three times of GDP per capita were used as threshold based on recommendation of the World Health Organization.. The Incremental Cost Effectiveness Ratio (ICER) for combination therapy in genotype-1 and genotypes non-1 subgroups was 2,673 and 19,211 US dollars (USD) per one Sustain Virological Response (SVR), respectively. In low viral load and high viral load subgroups, the ICER was 5,233 and 14,976 USD per SVR, respectively. The calculated ICER for combination therapy in subgroup of patients with previously resistant to monotherapy was 13,006 USD per SVR. Combination therapy in previously resistant patients to combination therapy was a dominant strategy.. Adding low dose of Ribavirin to PEG IFN alfa-2a for treatment of chronic hepatitis C patients with genotype-1 was “highly cost effective” and in patients with low viral load and in previous monotherapy resistant patients was “cost effective.”.

Injecting drug users (IDUs) are a major and most important risk factor for rising hepatitis C virus (HCV) prevalence in Iran.. The objective of this study was to determine the effectiveness of methadone maintenance treatment (MMT) in prevention of HCV infection transmission among IDUs..Patients and A mathematical modeling has been used to estimate number of HCV infections averted. The input parameters used in the model were collected by self-reported method from 259 IDUs before registering and one year after MMT. Nonparametric statistical tests have been used to compare risky injecting and sexual behaviors among IDUs before and after participating in MMT program. Deterministic sensitivity analyses were done to show the effects of parameters’ uncertainty on outcome.. Of the 259 participants, 98.4% (255) were men, the mean age ± SD was 33.1 ± 7.58 years and HCV prevalence was 50%. The studied IDUs reported lower rate of risky injecting and sexual behavior after participation in MMT program. The cumulative incidence of HCV per 100 IDUs due to sharing injection and unsafe sexual contact with MMT program were 13.84 (95% CI: 6.17 -21.51), 0.0003 (0.0001 - 0.0005) and without it 36.48 (25.84 - 47.11) and 0.0004 (0.0002-0.0006) respectively.. The MMT program is an effective intervention to prevent HCV infection transmission, although it is essential to compare its effectiveness with other interventions before implementing it in nationwide..

Hepatitis C is prevalent among thalassemia patients in Iran. It is mainly transfusion mediated, in particular among patients treated before 1996 when blood screening was introduced.. The current study aimed to investigate why patients still seroconvert to anti-HCV in Iranian thalassemia centers.. Patients and During 2006-2007 sera were sampled from 217 anti-HCV positive thalassemia patients at nine thalassemia centers in Tehran and Amol city, where 34 (16%) patients had been infected after 1996. The HCV subtype could be determined by sequencing and phylogenetic analysis of partial NS5B and/or 5׳NCR-core region in 130 strains.. 1a (53%) was predominant followed by 3a (30%), 1b (15%), and one strain each of 2k, 3k and 4a. Phylogenetic analysis revealed 19 clades with up to five strains diverging with less than six nucleotides from each other within subtypes 1a and 3a. Strains in seven clades were from nine patients infected between 1999 and 2005 and similar to strains from eight patients infected before 1996, indicating ongoing transmission at the centers. Further epidemiological investigation revealed that 28 patients infected with strains within the same clade had frequently been transfused at the same shift sitting on the same bed. An additional eight patients with related strains had frequently been transfused simultaneously in the same room.. The results suggest nosocomial transmission at these thalassemia centers both before and after the introduction of blood screening. Further training of staff and strict adherence to preventive measures are thus essential to reduce the incidence of new HCV infections..

Hepatitis D virus (HDV) infection is characterized by rapidly progressive liver disease with adverse prognosis in most patients. Although interferon is the only approved anti-HDV therapy، evidence regarding the efficacy and safety of its various regimens is either old or scattered. We searched systematically Medline، EMBASE، Scopus، the Cochrane Central Register of Controlled Trials، and ISI. The studies that evaluated treatment of chronic HDV infection with standard or pegylated interferon for at least 48 weeks were identified. Our inclusion criteria were positive anti-HDV antibody for 6 months and positive HDV-PCR at the start of study. We performed a meta-analysis for proportions using the arcsine transformation in random effects model. Sustained virological response (SVR) rate (negative Polymerase chain reaction (PCR) 6 months after cessation of therapy) was the end point of interest. Data were abstracted from 14 studies containing 227 chronic HDV-infected patients who received standard or pegylated interferon alpha-2a or -2b. Twenty-one and 30 patients of 71 and 156 who received standard or peginterferon، respectively، beyond 48 weeks achieved SVR. Pooled SVR rates were 29% [95% confidence interval (CI) 19; 41] and 19% (95% CI 10; 29)، respectively. The rates of treatment withdrawal were similar. Our systematic review indicates that the literature lacks sufficient evidence to establish precise recommendations for treatment of HDV infection. Meta-analysis of these studies shows that standard dose of peginterferon is more effective than high dose of standard interferon as anti-HDV therapy.

The aim of study was to determine the preliminary result of treatment with pegasys in Iranian chronic hepatitis B patients (with genotype D) referred to Tehran Hepatitis center (THC). The genotype of HBV and ethnicity of the patients can affect the response rate to pegasys.Patients and During 2006-2008, 12 Patients with naïve chronic hepatitis B (genotype D) that referred to THC and candidate for treatment were consequently enrolled in this cross sectional study. All of the patients signed the written consent to enter the study. They were treated weekly with 180 microgram of pegylated interferon- alpha 2a (pegasys) subcutaneously. They were visited monthly during their treatment and follow up course in THC. The safety of treatment, the end of treatment response, the relapse rate and the sustained virologic response were measured in these patients. The end of treatment response rate was 83.3% in total. In patients who had end treatment response, the relapse rate was 50% (4/8) among HBeAg negative patients and 75% (3/4) among HBeAg positive patients. The sustained virologic response rate in this study was 41.6%. Our study showed that after treatment with pegasys, the genotype D chronic hepatitis B patients had an acceptable sustained virologic response rate (More than 30%). But the influence of HBV genotype on treatment response with pegasys needs to be reevaluated in these patients in future studies. In addition other patient-specific characteristics like genetic aspects should be taken into consideration.

The aim of this study was to identify and compare the pattern of acute viral hepatitis in two regions of Iran. The epidemiological pattern of acute hepatitis varies across the Globe depending on geographic region, health status, socioeconomic conditions and differences in exposure to etiological factors.Patients and A cross-sectional study was carried out among 357 cases of acute viral hepatitis referring to the hepatitis centers in Tehran (n = 109) and Zahedan (n = 248) during 2003-2004. All patients were tested against Anti-HAV IgM, HBsAg, HCV and HDV antibody by enzyme linked immunosorbent assay (ELISA). Specific viral cause of hepatitis and demographic characteristics of patients were compared between the two populations. Study participants in Zahedan were significantly younger than those in Tehran (11.4±9.63 years vs. 31.0±10.76; P< 0.05). The proportion of male participants in Tehran was considerably higher compared to Zahedan (86.2% vs. 52%; P< 0.05). In Tehran, HBV (62%) and HCV (15%) were the most frequent type of hepatitis, while in Zahedan, HAV (72%) and HBV (18%) were the most common type of hepatitis. The present study showed a discrepancy in morbidity pattern of acute hepatitis between the two regions of Iran. This variability may be due to differences in socioeconomic status and environmental risk factors for the acquisition of the different types of hepatitis. Therefore, regional information about viral hepatitis is needed in order to direct and evaluate prevention and control activities.

To investigate if hepatic iron content influences the response to therapy in patients with chronic hepatitis C or B. It seems that the presence of elevated body iron stores and, in particular, elevated hepatic iron levels, is one of the strongest predictors of resistance to interferon treatment for chronic hepatitis C or B.Patients and Two hundred and one patients with chronic hepatitis C or B who were referred to Tehran Hepatitis Center were enrolled in this study. Histological quantification of hepatic iron was carried out by scoring iron separately within hepatocytes, sinusoidal cells, and portal triads. To estimate a cut off point for iron deposit as a predictor of response to treatment, Odd´s ratio with 95% confidence interval was calculated for each level of iron deposit. Iron scores were divided into two levels of high and low at several cut-off points, but the most significant differences were found when score 2 was considered as the cut-off point. Odd''s ratios were not significant in any of the hepatic zones. The lowest P-values were related to zone II sinusoidal cells and the total of sinusoidal cells and portal iron score (P= 0.08) in which the Odd''s ratios were 6 (95% CI, 0.77 to 46.6) and 3.9 (95% CI, 0.88 to 17.4) respectively. In our society, liver iron content cannot be considered as an important risk factor of resistance to treatment in chronic hepatitis patients because of the very small prevalence. So, hepatic iron measurement and scoring do not seem cost-effective and valuable for all patients with chronic hepatitis in our population.

Hepatitis C is an emerging disease in the world and Iran. In this review the situation in Iran will be more clarified and the strategies for better control will be discussed.

Hepatitis C virus (HCV) infection is frequent among kidney transplant recipients, and it is currently the major cause of chronic liver disease following kidney transplantation. The presence of HCV infection has been found to negatively affect the morbidity and mortality rates in patients on dialysis, as well; it seems that kidney transplantation is a reasonable treatment option after a careful pretransplant evaluation. Nevertheless, there are several questions about the indications of kidney transplantation, pretransplant evaluation, transplantation from HCV-infected donors, patient and graft survival rates, and kidney diseases associated with hepatitis C virus after kidney transplantation. This review deals with the most current information on pretransplant and posttransplant evaluations, complications, treatment, and prognosis of HCV-infected kidney transplant recipients.