Background:Hepatitis delta virus (HDV) is dependent on the hepatitis B virus for transmission and propagation. Based on isolated HDV sequences from different parts of the world, at least three major different genotypes with different geographic distributions are suggested. Studies have shown that genotype 1 is the predominant genotype of HDV in different parts of Iran; however, the genotype distribution of this virus has not been identified in Mashhad, northeast Iran.Objectives:This current study determines the frequency of HDV major genotypes in Mashhad, Iran.Patients and Methods:Twenty-five participants were enrolled in this study. All samples were positive for HBsAg (determined by Enzyme-linked immunosorbent assay (ELISA)) and anti-HDV. RNA extraction and cDNA synthesis was performed. Then, PCR was performed and HDV genotypes were determined by restriction fragment length polymorphism (RFLP).Results:Of 25 patients, 12 (48%) were positive for HDV RNA. Genotype analysis of HDV RNA revealed that the prevalence of HDV genotypes I and II was 83.3% (n = 10) and 16.7% (n = 2), respectively.Conclusions:This study showed that the most prevalent genotype of HDV in Mashhad was genotype I. It was of interest that in contrast to other provinces of Iran, HDV genotype 2 was observed in Mashhad. Similar studies with larger sample sizes could provide valuable information regarding the molecular epidemiology and geographical distribution. It may also help control and prevent the spread of hepatitis D virus infections. In addition, the genotyping of HDV may predict the severity of the disease.
About 6 percent (2%-7%) of the world’s population is chronically infected by the hepatitis B virus (HBV). The role of fibroscan for fibrosis assessment in HBV patients has not been widely studied. The present study was designed for the assessment of hepatic fibrosis by fibroscan in HBV positive patients. This is a cross-sectional study with two groups of case and control. According to the physical examination, lab data, abdominal ultrasound, and hepatitis viral load, the case group was categorized into three subgroups: inactive carrier, chronic hepatitis, and cirrhosis. The Control group was selected from a healthy population of 145 HBV patients, and 370 healthy persons entered the study. The case group included 35 inactive carriers, 63 chronic hepatitis B, and 47 cirrhotic patients, and their mean amount of fibrosis (measured by fibroscan) was 6.169 kpa, 7.758 kpa, and 24.0255 kpa, respectively. Also, the mean amount of fibrosis was 5.5510 (SD=2.43) in the control group. There was a statistically significant difference between cirrhotic patients and other groups (P<0.001). Also, a strong association between viral load and fibrosis degree was observed in chronic hepatitis B patients (P<0.001, R2=0.7811). Fibroscan is a novel instrument for the estimation of the liver fibrotic stage in HBV cirrhotic patients.
Introduction. Celiac disease (CD) is a chronic and common cause of dyspepsia with a rising prevalence worldwide. This study is aimed at investigating the prevalence of CD in dyspeptic patients based on serology and biopsy, determining the associated factors, and assessing the necessity of regular duodenal biopsies from normal mucosa in diagnosis of CD among dyspeptic patients. Methods. This cross-sectional study was performed on 530 adult dyspeptic patients who underwent gastroduodenoscopy in Imam Reza hospital, Mashhad, during 2016-2018. Demographic characteristics, clinical data, and laboratory analyses were extracted from hospital records. CD was diagnosed based on intestinal biopsy and serum antitissue transglutaminase (anti-TTG) levels. Mucosal lesions were classified according to the modified Marsh classification. Data were analyzed in SPSS with P < 0.05 being considered significant. Results. Overall, 163 males (30.8%) and 367 females (69.2%) with an average age of 46.38 ± 15.54 years were studied. High anti-TTG levels were seen in 36 (6.8%) patients, and duodenal pathologies were seen in 23 (4.5%) patients. Fifteen (2.8%) were diagnosed with CD based on both serology and biopsy. Bloating was the most common type of dyspepsia in CD patients (7, 46.7%), followed by epigastric pain (6, 40%), and postprandial fullness (2, 13.3%). Two CD patients (13.3%) reported a positive family history for CD. Logistic regression model showed that iron deficiency anemia (IDA), anti-TTG level, and Helicobacter pylori infection were predictors of histological changes of CD, whereas IDA was the only independent predictor of CD in dyspeptic patients ( OR = 17.65 , 95 % CI = 1.53 ‐ 202.52 , and P = 0.021 ). Conclusion. CD is prevalent in dyspeptic patients, but routine biopsy from normal-appearing duodenal mucosa is not recommended for all patients. Serological studies, complete history, and careful endoscopic evaluation may provide better cost-effective clinical solutions to improve the diagnostic yield of celiac disease in dyspeptic patients.
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