فهرست مطالب

  • Volume:20 Issue: 3, 2020
  • تاریخ انتشار: 1399/01/17
  • تعداد عناوین: 6
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  • SeyyedMohammad Miri, Fatemeh Roozbeh, Ali Omranirad, SeyedMoayed Alavia* Page 1

    Context: Within only 30 days after the first announcement of infection with “SARS-CoV-2” in Wuhan, it spread to more than 20 countries and become a pandemic by WHO as a “high alarming level of infection” with 136,343 involved cases all over the world.

    Methods

    To uncover more about the probable gastrointestinal transmission and its clinical manifestations, we reviewed all research publications with keywords including: “COVID-19”, “SARS-CoV-2”, “Coronavirus”, “outbreak”, “ARAS-CoV” in Medline, Scopus, Google Scholar as well as all news in social media about “novel COVID-19 pandemic”. Out of 40 recent publications, 10 articles were studied by 2 authors.

    Results

    Although the SARS-CoV-2 tends to infect respiratory epithelial cells through the respiratory tracts, recent investigations detected the virus in the stool specimen, raising the question of the fecal-oral transmission route. Different studies showed that almost all gastrointestinal signs and symptoms were seen in elderly patients (more than 65 years old). including anorexia (40%), nonspecific abdominal pains (8%), diarrhea (10%) and nausea and Vomiting in about 8% of patients. Anorexia and generalized abdominal pain suffer many treated cases even 10 - 20 days after negative blood tests (like CRP, lymphopenia) and negative PCR of respiratory samples. The main reason for this prolonged anorexia and abdominal pain may be due to the long persistence of COVID-19 in the gastrointestinal tracts after primary treatment.

    Conclusions

    Comparing to SARS, patients with COVID-19 showed less diarrhea, nausea, vomiting and/or abdominal discomfort before respiratory symptoms. Feces as a potential contagious source of Viral RNA can last even after viral clearance in the respiratory tract. We strongly recommend all cured patients of COVID-19 to disinfect and clean their toilets until 17 - 20 days after negative blood tests and solving their respiratory disorders. Gastrointestinal manifestations have seen in all men while no women referred with GI signs.

    Keywords: Gastrointestinal, Outbreak, COVID-19, Corona, SARS-CoV-2
  • Payam Izadpanahi, Mahyar Mohammadifard, Tahmine Tavakoli, Najmeh Abbasi*, SeyedAlireza Javadinia Page 2
    Background

     Chemotherapy is one of the fundamental treatments for cancer patients, which has significantly improved the survival rate. Alongside its benefits, many side effects are imposed on the patient following chemotherapy. Ones is hepatotoxicity that initially develops as fatty liver and hepatic steatosis, but may progress to liver failure if the risk factors persist.

    Objectives

     We aimed to determine the prevalence of fatty liver in breast and gastrointestinal cancer patients during and after chemotherapy and its risk factors.

    Methods

     This cross-sectional study was performed on 140 patients undergoing chemotherapy for either breast or gastrointestinal cancer who referred to the Oncology Clinic of Birjand University of Medical Sciences in 2016 - 2017. Demographic data regarding the disease and chemotherapy regimens were extracted from the patients’ medical records. Before and after chemotherapy, the patients were evaluated by sonography for fatty liver. Data were imported into SPSS version 19 software and analyzed by chi-square (or Fisher test) and McNemar at the 5% significance level.

    Results

     A total of 152 patients were enrolled in the study, of whom 85 had breast cancer and 67 had gastrointestinal cancer. Most patients were in the age group of 45 - 54 years (48 cases, 31.6%). The mean Body Mass Index (BMI) was 23.17 ± 4.52. The frequency of fatty liver before and after chemotherapy increased from 2% to 46.7% in all patients (P = 0.0001). The frequency of fatty liver after chemotherapy was significantly higher in females than in males (52.4% and 34.7%, respectively, P = 0.04). There was no significant relationship between chemotherapy-induced fatty liver and age (P = 0.9), BMI (P = 0.17), history of diabetes mellitus (P = 0.2), and the presence of metabolic syndrome (P = 0.4). The highest frequency of fatty liver was observed in patients treated with AC-T, FOLFOX, and ECF with 53.5%, 42.9%, and 29.2%, respectively (P = 0.09).

    Conclusions

     The results showed that chemotherapy was associated with a significantly increased risk of fatty liver, which was more in women than in men. However, the occurrence of the fatty liver following chemotherapy could be expected in all scenarios, regardless of diabetes, metabolic syndrome, BMI, and the age of the patients.

    Keywords: Breast Cancer, Chemotherapy, Hepatotoxicity, Gastrointestinal Cancer, Fatty Liver
  • Hadir Okasha *, Manal Baddour, Mohamed Elsawy, Nadia Sadek, Mahmoud Eltoweissy, Amany Gouda, Omar Abdelkhalek, Marwa Meheissen Page 3
    Background

     Blood safety is an important health issue, especially in Egypt with a high prevalence of HCV infection and recent massive efforts for control.

    Objectives

     The study was conducted to evaluate the feasibility of the nucleic acid amplification technique (NAT) in Egyptian blood banks.

    Methods

     A total of 12,036 plasma sample donations collected from two Egyptian blood banks were screened by NAT using a chessboard pooling scheme. The donations were divided into two groups: Group 1 included 10,020 seronegative, while Group 2 included 2,016 blindly tested donations.

    Results

     Out of the total donations, seven tests were positive by NAT. The serology results of those seven seronegative donations were confirmed. They were also retested individually by NAT. The pool format 6x12 was the most reliable for screening. The cost of NAT was reduced to one-quarter and the positive sample in the pool was easily pointed by using the chessboard format.

    Conclusions

     The study demonstrated the importance of introducing NAT for HCV screening in Egyptian blood banks by adopting a pooling scheme to reduce cost.

    Keywords: Hepatitis C, HCV, Pooling, Blood Banks, Nucleic Acid Testing
  • Dangui Zhang, Xubin Zhang, Lu Xu, D. Lorne Tyrrell, Michael Houghton, William Ba Thein* Page 4
    Background

     Hepatitis C virus (HCV) infection is prevalent worldwide, especially among drug users. The epidemiology of HCV is rarely reported among drug users in developing countries, including China.

    Objectives

     We aimed to describe the seroepidemiology of HCV infection in drug users at a Detoxification Center in Southeast China.

    Methods

     With approval from the Shantou Center for Disease Control, the archived data of drug users (n = 5,228) at the largest monitored-detoxification center in Shantou during 2011 - 2017 were analyzed for demographics, risk behaviors, and HCV serology.

    Results

     Among HCV-tested drug users, 36.9% (1930/5228) were people who inject drugs (PWID). The mean annual HCV seroprevalence rate over the seven-year study period was 36.3% for all drug users, including 67.3% and 16.6% for PWID and non-PWID, respectively, with the highest prevalence (78.1%) in 2017 and the lowest prevalence (58.6%) in 2015 for PWID. Independent risk factors of HCV infection identified by multiple logistic regression analysis were engaging in unprotected sex (OR = 1.553, 95% CI = 1.078 - 2.236), injecting drugs (10.28, 8.98 - 11.763), and sharing needles/syringes (2.24, 1.129 - 4.445) for all drug users and sharing needles/syringes (2.062, 1.438 - 2.957) for PWID.

    Conclusions

     This study reports the seroepidemiology of drug users in the monitored Detoxification Center in Southeast China. A relatively high HCV positivity rate, especially among PWID, their high-risk behaviors and low education, and lack of institutional interventions of HCV monitoring and transmission call for government-sponsored educational programs to raise drug users’ awareness of the risk of HCV infection and other co-infections and monitoring of the infectious status and treatment of HCV-infected drug users.

    Keywords: Risk Factors, Hepatitis C, Epidemiology, Drug Users, Health Risk Behaviors
  • Jianchun Lu, Tianmin Xu, Chunhua Chen, Shuqin Zheng, Lin Lin, Yuan Xue* Page 5
    Introduction

     Severe infection is a major risk factor for mortality in patients with liver failure. Multidrug-resistant Klebsiella pneumoniae may lead to fatal infection, especially in patients with severe hepatitis.

    Case Presentation

     We describe a 70-year-old Chinese patient with acute-on-chronic liver failure (ACLF) and multidrug-resistant KPC-producing K. peumoniae V113 isolate infection. The serum total bilirubin (TBIL) level was 308.7 µmol/L at the time of admission, and the international normalized ratio (INR) was 2.56. The serum level of TBIL ascended to 526 µmol/L on the 14th day after admission, and then gradually declined. The INR was maintained above 1.5 for 2 months. Creatinine level significantly increased (from 92.5 to 241 µmol/L) in the first month after admission, while estimated glomerular filtration rate declined to 16.9 mL/min 1.73m2. Diammonium glycyrrhizinate, plasma, as well as albumin were given intravenously. At the time of admission, she had sepsis with symptoms, including fever and shivering, and K. pneumoniae was identified by blood culture test. Biapenem combined with moxifloxacin was shown to be effective, while that could not eliminate the bacteria. Fever and shivering re-occurred, and repeated drug susceptibility tests confirmed the same multidrug-resistant K. pneumoniae isolate without extended-spectrum β-lactamases. Combination treatment of meropenem and ertapenem resulted in a positive clinical outcome without deterioration of liver function. Furthermore, single-molecule real-time (SMRT) sequencing identified 3 genes (blaPKC, blaTXM, and catA2) on the plasmid and 3 genes (blaSHV2, catB3, and arnA) on the chromosome. Moreover, 10 multidrug resistance efflux pump genes and 2 fosmidomycin efflux pump genes were found on the chromosome.

    Conclusions

     Meropenem combined with ertapenem might be used for treating patients with ACLF and multi-drug resistant K. pneumoniae V113 isolate infection.

    Keywords: Klebsiella pneumoniae, Carbapenemase, Meropenem, Ertapenem, Acute-on-Chronic Liver Failure
  • Zhiyong Shi, Mingxia Zhang, Wenhui Yang, Jun Xu * Page 6
    Introduction

     Human epididymis protein 4 (HE4) is a secretory protein encoded by the whey-acidic four-disulfide core domain protein 2 (WFDC2) gene. Clinically, HE4 is an important serological biomarker used to detect and monitor epithelial ovarian cancer. Although elevated in a high percentage of patients with ovarian and endometrial cancer, high serum HE4 levels may also be detected in patients with other various non-gynecologic malignant disorders such as lung adenocarcinoma and breast cancer. However, the association between high HE4 and hepatic neuroendocrine neoplasms (HNENs) remains unknown.

    Case Presentation

     Herein, two patients with HNENs and elevated serum HE4 are presented. Both cases were old women who underwent pelvic examination and ultrasonography and the results were normal. Immunohistochemistry assays demonstrated high HE4 expression in neuroendocrine carcinoma, whereas no HE4 expression was observed in hepatocellular carcinoma and clear cell renal cell carcinoma liver metastases.

    Conclusions

     This preliminary observation suggested HE4 concentrations may be elevated in neuroendocrine neoplasm patients with no ovarian cancer. Thus, HE4 results should be interpreted cautiously in female patients with HNENs. In addition, this preliminary observation suggested the need to perform further studies to assess the implications of our results in terms of the potential role of HE4 as a serum biomarker in the diagnosis and prognosis of HNEN patients.
     

    Keywords: WFDC2, Human Epididymis Protein 4, Neuroendocrine Neoplasms