QT intervals in patients receiving a renal transplant.

OBJECTIVES: Cardiovascular disease is the most-common cause of mortality in patients with end-stage renal disease and renal transplant. Prolongation of QTc(max) and QTc dispersion are risk factors of cardiac arrhythmias and mortality. This study compares the changes of QT parameters before hemodialysis, after hemodialysis, and after renal transplant. MATERIALS AND METHODS: Patient candidates for renal transplant were selected. Mean serum electrolyte and 12-lead electrocardiogram were recorded (1) immediately, (2) before and, (3) after the last dialysis session before renal transplant, (4) and 2 weeks after a kidney transplant in 34 patients with normal graft function (plasma Cr ≤ 176.8 µmol/L). Each QT interval was corrected for the patient's heart rate using Bazett's formula. The QT parameters (QTd, QTcd, QTc(max)) were compared between prehemodialysis, posthemodialysis, and 2 weeks after renal transplant using a paired t test and a general liner model repeated measure. The correlation between QT parameter changes and serum electrolyte and acidbase alternation was analyzed. RESULTS: The corrected maximal QT interval (QTc(max)) decreased significantly after successful renal transplant compared to prehemodialysis (P = .002) and posthemodialysis (P = .003) with a paired t test and a General Liner Model Repeated Measure (P < .001) between the 3 groups. Also, the mean of QTc(max) decreased significantly after renal transplant (P = .001) compared to what it was before hemodialysis and after hemodialysis. There was a significant correlation (r= -0.37) between reduction of QTc(max) and serum Ca level (P = .01) in postrenal transplant period. CONCLUSIONS: Renal transplant with normal graft function decrease QTc(max) compared to prehemodialysis and posthemodialysis that may correlate with normalization of electrolytes from the uremic state of the normal kidney function.

Occult hepatitis B infection in a hemodialysis population in Guilan province, northern Iran.

Hemodialysis (HD) patients are vulnerable to transfusion-transmitted infections such as hepatitis B virus (HBV). HBV infection with undetectable hepatitis B surface antigens (HBsAg) is described as occult HBV and can lead to serious complications. The aim of this study was to evaluate the prevalence of occult HBV and concomitant factors in HD patients. Using a cross-sectional design, clinical and epidemiological data were obtained from May to September 2009 in 11 different HD units in Guilan province in northern Iran. After serological testing for HBV surface antigens in 514 HD patients using a third-generation enzyme-linked immunosorbent assay kit (Diapro, Milano, Italy), HBsAg-negative patients were tested for HBV DNA using a Qiagen PCR kit (Artus Qiagen GmbH, Hilden, Germany). After omission of seven HBsAg-positive patients, 507 patients were included in the study, 280 (55.2%) of whom were male and 227 (44.8%) were female. Patients ranged in age from 16 to 66 years (mean 53.2 years). No HBV DNA was detected in HBsAg-negative patients. Some 59 patients (11.6%) were anti-hepatitis C virus positive and 32 (6.3%) were hepatitis C virus positive according to polymerase chain reaction. The study results indicate that occult HBV infection is not a significant health problem in HD patients in Guilan province.

Hepatitis C and hepatitis B seroprevalence and associated risk factors in hemodialysis patients in Guilan province, north of Iran: HCV and HBV seroprevalence in hemodialysis patients.

BACKGROUND: Hepatitis C virus (HCV) and hepatitis B virus (HBV) infection are especially problematic in patients with end-stage renal disease who are undergoing hemodialysis (HD). OBJECTIVES: To determine the prevalence of HCV and HBV infection in HD population in Guilan, north of Iran. PATIENTS AND METHODS: In a cross-sectional study, from May to September 2009, in 11 different hemodialysis units in Guilan province, North of Iran, clinical data such as age, gender, duration of dialysis, HBsAg and anti-HCV antibody of 514 HD patients were recorded. Patients with positive antibodies against HCV were tested for HCV RNA. RESULTS: From 514 patients, 286 (55.64%) were male. 61 (11.9%) patients were anti-HCV-positive and 31 (50.8%) were HCV PCR-positive. There was significant relationship between HCV Ab-positivity with gender and HD duration (p < 0.05). There was significant difference between the mean HD duration in anti-HCV-positive and anti-HCV-negative patients (p < 0.05). Also, significant relationship was found between HCV RNA-positivity with gender and HD duration (p < 0.05). Seven (1.4%) patients were positive for HBsAg. Two (0.38 %) were found positive for both HBsAg and anti-HCV antibody. CONCLUSIONS: There is low a prevalence of HCV and HBV in HD patients in our region. The rate can be decreased by HBV vaccination of end-stage renal disease patients before setting chronic HD, antiviral treatment and isolation of infected individuals.

Effect of hepatic iron concentration and viral factors in chronic hepatitis C-infected patients with thalassemia major, treated with interferon and ribavirin.

BACKGROUND: Beta thalassemia major patients are vulnerable to transfusion-transmitted infection, especially hepatitis C virus (HCV), and iron overload. These comorbidities lead to cirrhosis and hepatocellular carcinoma in these patients. In order to prevent these complications, treatment of HCV infection and regular iron chelating seems to be necessary. The aim of this study was to evaluate the effect of hepatic iron concentration (HIC) and viral factors on the sustained virological response (SVR) in chronic HCV-infected patients, with beta thalassemia major being treated with interferon and ribavirin. MATERIALS AND METHODS: We enrolled 30 patients with thalassemia major and chronic HCV who were referred to the Hematology Clinic of Guilan University of Medical Sciences, between December 2002 and April 2006. HIC was measured by atomic absorption spectroscopy before treatment. The viral factors (viral load, genotype) and HIC were compared between those who achieved a SVR and nonresponders. RESULTS: Mean age of the 30 thalassemic patients, was 22.56 ± 4.28 years (14-30 years). Most patients were male (56.7%). Genotype 1a was seen in 24 (80%) cases. SVR was achieved in 15 patients (50%). There were no significant correlations between HIC (P = 1.00), viral load (P = 0.414), HCV genotype (P = 0.068), and SVR. No difference was observed in viral load (P = 0.669) and HIC (P = 0.654) between responders and nonresponders. CONCLUSION: HIC, HCV viral load, and HCV genotype were not correlated with virological response, and it seems that there is no need to postpone antiviral treatment for more vigorous iron chelating therapy.

Relationship between serum HBV DNA level and liver histology in HBV carriers with normal ALT in Guilan province, Iran.

BACKGROUND: Chronic hepatitis B virus (HBV) infection remains a major health problem. The aim of this study was to determine the serum HBV DNA levels in HBeAg-negative HBV patients and look for a relationship between serum HBV DNA level and liver histology. MATERIAL/METHODS: In a cross-sectional study, 70 patients with positive serum hepatitis B surface antigen (HBsAg) and normal ALT for at least 6 months were enrolled. Quantification of HBV DNA was performed by real-time PCR. Liver biopsy specimens were performed for grading and staging of chronic hepatitis. RESULTS: Fifty-four patients (34 males, 20 females) were included. Mean + or - SD serum HBV DNA level was 282,280.46 + or - 1,474,295 copies/ml, fibrosis (0-6) 2.37 + or - 1.263, necroinflammation (0-18) 0.33 + or - 0.476, and BMI 26.65 + or - 4.9. The mean serum HBV DNA level had significant differences between grade <4 and grade > or = 4 cases (P<0.05). The relationship between serum HBV DNA level and liver grade was confirmed by the Kendall test (P<0.05). No significant relationship between serum HBV DNA level and liver histological stage, gender, age, BMI, or HBeAg was observed in these patients (P>0.05). CONCLUSIONS: It is advantageous to measure serum HBV DNA level quantitatively in patients who are inactive carries of hepatitis B. If they have HBV DNA levels > or = 104 copies/ml, it will be necessary to perform a liver biopsy and apply therapy accordingly.

Recurrence of Helicobacter pylori infection 1 year after successful eradication: a prospective study in Northern Iran.

BACKGROUND: The aim was to investigate the H. pylori recurrence rate one year after successful eradication in dyspeptic patients in Guilan province, northern Iran. MATERIAL/METHODS: Patients with chronic dyspepsia were enrolled in our gastroenterology clinic. Gastric biopsies were obtained by endoscopy and H. pylori infection was diagnosed using the Rapid Urease Test (RUT). Patients with H. pylori infection were prescribed clarithromycine-based quadruple therapy for 10 days. The (13)C urea breath test ((13)C-UBT) was used to assess H. pylori status 10 weeks after completing H. pylori therapy. Patients who H. pylori-negative had a second (13)C-UBT after 1 year to establish the recurrence rate. RESULTS: Of 269 dyspeptic patients with RUT positivity for H. pylori in endoscopy who were treated with the quadruple regimen for 10 days, 240 had negative (13)C-UBT 10 weeks after the end of therapy, with an eradication rate of 89.2% (95%CI: 82.2-97.2%) by per-protocol analysis. Of this group, 153 patients (63.8%) were female. The (13)C-UBT at 1 year was positive in 12 (5.0%) of the 240 patients. A mean age of >35 year, being female, living in an urban area, and a household size of more than 5 person were more frequent in the (13)C-UBT-positive patients at 1 year, but they were not statistically significant. In this study there was also no significant relationship between, job, educational status, and the source of domestic water with recurrence of H. pylori infection. CONCLUSIONS: According to these data, the H. pylori recurrence rate in our region is 5% after successful eradication.

Anti CagA antibody among patients with non-cardia gastric cancer in comparison with non-ulcer dyspepsia in an area with high incidence of gastric cancer.

OBJECTIVE: To evaluate the correlation between anti CagA antibody (Ab) and presence of gastric cancer. METHODS: In a descriptive cross-sectional study during October 2003 to October 2005, in the Gastrointestinal Subspeciality Center in Razi Hospital, Rasht, Iran, we assessed anti-Helicobacter Ab immunoglobulin G (IgG) and anti CagA Ab IgG by the enzyme-linked immunosorbent assay (ELISA) method in 52 patients with gastric adenocarcinoma and 57 patients with nonulceric dyspepsia (NUD). RESULTS: Among 52 patients with gastric cancer, anti-Helicobacter pylori Ab was negative in 13 (25%) and positive in 39 persons (75%). Among 57 patients with NUD, anti-Helicobacter pylori Ab was negative in 5 (8.5%) and positive in 52 patients (91.2%) (p=0.043). This significant difference did not remain after logistic regression for adjustment of confounders (p=0.068). The CagA Ab was positive in 22 (42.3%) patients with cancer and 32 (56.1%) of the NUD group. There was no difference in this regard before (p=0.212) and after (p=0.131) logistic regression analysis. CONCLUSION: Anti CagA Ab does not have a significant value as an independent predictive factor in gastric adenocarcinoma.

Relationship between elevated liver enzyme with iron overload and viral hepatitis in thalassemia major patients in Northern Iran.

OBJECTIVE: To determine the relationship between elevated liver enzymes with iron overload and viral hepatitis in thalassemic patients. METHODS: This descriptive cross-sectional study was carried out in the thalassemic ward of Tonekabon Hospital, Mazandaran, Northern Iran from 20 April to 20 September of 2006. Patients were studied with respect to age, liver enzymes, anti-hepatitis C virus (anti-HCV) antibody, and hepatitis B surface antigen (HBsAg), transferrin saturation (TSAT), and blood transfusion index (multiplication of frequency and units of transfusion). Alanine aminotransferase (ALT) > or =40 U/L was considered elevated. RESULTS: Sixty-five patients were evaluated (median age 19.51+/-8.9 years, range 4-54). Eleven patients were anti-HCV positive (16.9%). The mean serum ferritin was significantly higher in patients with ALT > or =40 (2553.08 ug/L versus 1783.7750 microg/L) (p=0.012). The mean ALT was significantly higher in patients with TSAT > or = 60% (41.26 U/L versus 28.82 U/L) (p=0.021). The relationship between ALT > or =40 and anti-HCV positivity was statistically significant. The mean ALT was 60.91 U/L in anti-HCV positive patients and 39.29 U/L in the negative group (p=0.001). The mean serum iron and transfusion index were significantly higher in anti-HCV positive versus negative patients (234.0 versus 195.4815; p=0.02), (1693.6 versus 1036.29, p=0.014). CONCLUSION: Close association between elevated ALT with iron overload, transfusion index, age, and anti-HCV positivity in thalassemic patients of Tonekabon is recommended to re-evaluate transfusion and Desferal doses and therapies other than blood transfusion.