Nastaran Mahboobi

Epidemiology and risk factors of HCV infection among hemodialysis patients in countries of the Eastern Mediterranean Regional Office of WHO (EMRO): a quantitative review of literature

BackgroundHepatitis C virus infection (HCV) is the major co-morbidity of patients on chronic hemodialysis. There are many scattered and heterogeneous data about this infection in hemodialysis patients living in countries of the Eastern Mediterranean Region Office of WHO (EMRO) and its distribution is unknown in this region.AimsTo provide a more comprehensive tabulation of available data on the epidemiological characteristics and risk factors for HCV infection in hemodialysis patients in Iran and other EMRO countries.MethodsA systematic review was carried out based on the computerized literature databases. In all, 95% confidence intervals of infection rates were calculated using the approximate normal distribution model. Pooled odds ratios and 95% CIs were calculated by random effects models. The heterogeneity was assessed by either Q or χ2 statistics and quantified by I2.ResultsWe identified 62 studies that fulfilled our inclusion criteria involving 17,846 hemodialysis subjects. A total of 5,704 (32%) patients had positive serology for HCV infection. The prevalence ranged from 6–72% across countries. Pooled HCV seroprevalence was 17% (95% CI 13–20), 63% (95% CI 61–64), 48% (95% CI 45–51), 72% (95% CI 68–76), 23% (95% CI 21–24) in Iran, Saudi Arabia, Egypt, Morocco and Tunisia respectively. Hemodialysis duration OR = 7.63 (95% CI 4.64–12.53), transfusion OR = 2.06 (95% CI 1.47–2.89) and previous transplantation failure OR = 2.66 (95% CI 1.46–4.86) were major risk factors of HCV infection. Age, sex and dialysis session/week were not associated with infection rate.ConclusionNearly 32% (95% CI 31–33) of hemodialysis patients in the EMRO countries are infected with HCV. Despite evolution of new strategies to confine HCV transmission among hemodialysis patients, nosocomial transmission is still the major route of HCV infection in these patients in this region.

Halothane: how should it be used in a developing country?

The anaesthetic agent halothane is still widely used in developing countries including the Islamic Republic of Iran because of its low price. Because of halothane-induced hepatitis, a rare complication, it has been replaced by other inhalation anaesthetics in Western countries; it has been suggested by some Iranian professionals that the Islamic Republic of Iran should do the same. We evaluated various dimensions of this replacement through a literature review to assess the incidence of halothane-induced hepatitis and costs of anaesthetics in the country. We also conducted a questionnaire survey of 30 anaesthesiology/gastroenterology experts about their views on the subject. The results indicate that the incidence of halothane hepatitis in the Islamic Republic of Iran is very low and could mostly be avoided by strict adherence to guidelines. Complete withdrawal of halothane in the Islamic Republic of Iran might not be appropriate at present. Comprehensive cost-effectiveness studies are needed before a decision is made on complete replacement of halothane with other anaesthetics.

Oral conditions associated with hepatitis C virus infection.

Hepatitis C virus (HCV) infection in more than 170 million chronically infected patients with no developed preventive vaccine is a globally important issue. In addition to expected hepatic manifestations, a number of extrahepatic manifestations, such as mixed cryoglobulinemia, glomerulonephritis, polyarteritis nodosa, rashes, renal disease, neuropathy, and lymphoma, have been reported following HCV infection, which are believed to be influenced by the virus or the host immune response. HCV combination therapy with pegylated interferon and ribavirin might be associated with side effects as well. The association of HCV with special oral conditions has also been reported recurrently; the mechanism of most of which remains unclear. This article reviews the association of HCV infection with some of the oral conditions such as oral health, Sjogrens syndrome, lichen planus and oral cancer.

Optimal Duration of Treatment for HCV Genotype 1 Infection in Slow Responders: A Meta-Analysis

Background A head-to-head comparison of the 72-week and 48-week anti-HCV therapies in slow responders with genotype 1 infection has been performed in several randomized clinical trials (RCTs). Objectives This review aimed at summarizing and pooling the results of these studies. Materials and Methods RCTs that had evaluated the 72-week vs. 48-week anti-HCV therapy (peginterferon and ribavirin) in slow responders with HCV genotype 1 infection were systematically identified. A meta-analysis was performed using the random effects model. Heterogeneity in results was assessed on the basis of the Q statistics, and publication bias was evaluated by using Harbord’s modified test. The end point was set as a sustained virological response (SVR). Results Data of 1206 subjects were retrieved from 7 studies. A total of 631 patients had received extended therapy. Slow virological responders who received the 72-week therapy had a significantly higher probability of achieving SVR than their counterpartswho received the 48-week therapy [RR = 1.44 (95% CI, 1.20–1.73)]. With regard to publication biases, the heterogeneity in funnel plots was not significant (P = 0.19, I2 = 30%, PHarbord = 0.1). Conclusion Our meta-analysis showed that the 72-week therapy with peginterferon and ibavirin is significantly superior to the standard 48-week therapy in slow responders th HCV genotype 1 infection.