review of psychosocial issues in patients with chronic hepatitis B

Psychosocial issues and health-related quality of life [HRQOL] are important components of care in patients diagnosed with chronic hepatitis B [CHBV]. In this review, we searched Medline, ISI Web of Knowledge, Google Scholar and the American Association for the Study of Liver Diseases [AASLD] website [until January 2012] using relevant terms and we categorized the retrieved content into three areas: HRQOL, mental health, and psychosocial issues such as stigma and coping. Increasing severity of CHBV leads to a decline in HRQOL. Cirrhosis worsens HRQOL, whereas treatment and psycho-education improves it. Frequency of mood disorders seems to be increased in patients with CHBV, although not all studies have shown this trend. Some factors such as alcohol consumption and low social support negatively impact patients' mental health. Those with CHBV generally have better HRQOL and mental health than their hepatitis C [HCV] counterparts. Patients with psychiatric disorders, particularly those with prolonged institutionalization, have a generally higher risk of acquiring CHBV infection compared to the general population. Robust studies regarding the stigma in patients with CHBV are lacking, although some studies have suggested a higher degree of perceived stigma in these patients. HRQOL and mental health are significantly affected in CHBV patients, particularly in those with more severe forms of the disease. There are few studies that addressed the effects of intervention in CHBV patients with psychosocial problems. Other subjects necessitating additional research include stigma, coping mechanisms, and other less common, yet important psychosomatic disorders

Intra-abdominal desmoplastic small round cell tumor in a 45-year-old man: a case report

Intra-abdominal desmoplastic small round cell tumor is a rare entity with a few reports worldwide. This tumor commonly occurs in children and adolescent and occurrence in adult age group is very rare. Here, we describe an adult male with symptoms of intestinal obstruction due to abdominal mass, located in splenic flexure. After resection, the diagnosis of intra-abdominal desmoplastic small round cell tumor was established by pathologic and immunohistochemical studies. We emphasize that albeit being rare, this tumor should be mentioned as one of the differential diagnoses of widespread intra-abdominal lesions in any age group. A brief review of epidemiology, clinical manifestations as well as pathological and molecular features is also included in the paper.

Validity, reliability and factor structure of hepatitis B quality of life questionnaire version 1.0: findings in a large sample of 320 patients

Background: Quality of life is of significant importance in chronic hepatitis B [CHBV]. We aimed to assess the psychometric properties of the Hepatitis B Quality of Life Questionnaire v1.0 [HBQOL] in a large sample of 320 Iranian patients with CHBV

Methods: After adapting the Iranian version through forward-backward translation and expert panel discussion, we administered HBQOL together with Short-Form 36 [SF-36], Medical Outcome Study Social Support Questionnaire [MOS-SS], Hospital Anxiety and Depression Scale [HADS], and the Iowa Fatigue Scale [IFS] to 320 non-cirrhotic Iranian patients. We used principal component analysis with Varimax rotation to determine the factor structure. To evaluate the psychometric properties of HBQOL, test-retest and internal consistency reliabilities, divergent and convergent validity with other instruments, and discriminatory power were calculated

Results: Thirty-one questions loaded on to six factors [Anticipation anxiety, Stigma, Psychological well-being, Vitality, Transmissibility and Vulnerability] which explained 63.6% of total variance. Test-retest reliability was 0.66. Cronbach's alpha was 0.94 for the overall scale and between 0.7 and 0.9 for subscales, with the exception of the Vulnerability subscale. HBQOL and its subscales showed acceptable convergent and divergent validity with other instruments. Furthermore, Vulnerability subscale of HBQOL discriminated between patients with chronic active and chronic inactive hepatitis

Conclusion: The Iranian version of HBQOL is reliable, valid, and sensitive to the clinical conditions of the patients. This instrument has acceptable factor structure to measure several aspects of quality of life in patients with chronic HBV

Surveillance for hepatocellular carcinoma after autologous stem cell transplantation in Cirrhosis

During the resent years there has been interest in using bone marrow stem cells to treat liver cirrhosis. However, there is a potential concern for malignant transformation after stem cell therapy. The aim of this study was to evaluate the development of hepatocellular carcinoma [HCC] after autologous bone marrow stem cell transplantation for liver cirrhosis. All the patients who underwent autologous stem cell transplantation for liver cirrhosis between 2005 and 2011 at our center were enrolled. Cellular infusion was made through peripheral vein, portal vein, or hepatic artery.The patients were invited to undergo screening for hepatocellular carcinoma. The screening was made with ultrasonography and alpha-feto protein [AFP] measurement. Thirty two patients [18 males] were included in the study. Mean age of patients was 45.7 years. Fifteen patients [47%] received mesenchymal stem cell [MSC], 9 [28%] received bone marrow mononuclear cells, 5 [16%] were given CD 133-positive bone marrow cells, and 3 [9%] patients received CD 34-positive bone marrow cells. Mean duration of follow up was 20.5months. Mean serum level of AFP was 2.8 ng/ml at baseline and 3.4ng/ml at the end of follow up [p= 0.3]. One patient was found to have hepatocellular carcinoma three months after infusion of bone marrow mononuclear cells. The incidence rate for HCC was 1.8 cases per 100 person-years in this study. Autologous bone marrow stem cell infusion does not appear to increase the risk of hepatocellular carcinoma. The incidence rate of HCC in this study is comparable or even less than the reported rates of HCC in cohort studies of cirrhotic patients

Eosinophilic gastroenteritis: a case series from Iran

Eosinophilic gastroenteritis [EG] is a rare inflammatory disorder of the gastrointestinal [GI] tract. There have been several case series of patients with EG from the western world and East Asia. However, there has not been a report of patients with EG from the Middle East region. The aim of this study is to describe clinical characteristics and treatment response in a series of EG patients from Iran. We retrospectively reviewed charts with a diagnosis of EG from 1997 to 2010 at Shariati Hospital and the private clinics of the authors. Clinical characteristics of the patients were evaluated, and the treatment response and relapse rate were assessed. Twenty-two patients [9 male] with EG were identified. Mean age of the patients was 45.1 +/- 15.5 [range: 27-75] years. Median duration between symptom onset and diagnosis was 12 [range 1- 48] months. Twenty [90%] patients had mucosal involvement, one [5%] had muscular involvement and one [5%] had subserosal involvement. Patients were followed for a median duration of 36.5 [range 4- 123] months. Two [90%] patients had mucosal involvement, one [5%] had muscular involvement and one [5%] had subserosal involvement. Patients were followed for a median duration of 36.5 [range 4-123] months. Two patients had spontaneous remission with supportive care. The remaining 20 patients responded well to oral corticosteroid treatments. The relapse rate was 33%. Episodes of relapse were successfully controlled with a repeat course of corticosteroids. Two patients with several relapses required maintenance treatment with azathioprine. The clinical characteristics and treatment responses of EG patients from Iran are similar to reports from other parts of the world. Patients need to undergo close follow up after treatment to detect early signs of relapse