Medical Journal of The Islamic Republic of Iran (MJIRI)

 ABSTRACT

 One of the best reliable markers of hepatitis B virus infection is antibodies to the core antigen (Anti-HBc). A first-time blood donor with HBsAg positivity was identified as an HBV carrier that was anti-HBc negative. The patient was followed for 24 months in order to investigate the evolution of his HBV serological profiles and HBVDNA (PCR). In the follow-up for 24 months, HBsAg, HBeAg and HBV-DNA (PCR) were positive but all the time anti-HBc remained negative. HBV DNA viral load was 3.4×106 copies per mL. In the immunohistochemical study on the needle liver biopsy, the hepatocytes were positive for HBcAg and HBsAg. For this immunological situation, the most probable hypothesis is an immunotolerance to HBV due to an in utero HBV infection. This situation does not impose a risk of HBV transmission by blood transfusion, because HBsAg positive donations are excluded and discarded by HBsAg screening tests.

 Abstract

 Background: Investigators were suspicious of tyrosine-methionine-aspartate-aspartate (YMDD) mutations occurred only in patients who were treated by lamivudine. However, YMDD mutations of hepatitis B virus gene (HBV DNA) in patients with chronic hepatitis B (CHB) untreated with antiviral medicines was reported in some studies. The aim of this study was to evaluate YMDD mutations in Iranian Patients with chronic hepatitis B (CHB) untreated with antiviral medicines.

 Methods: In a cross sectional study, 151 adult patients with positive Hepatitis B surface antigen (HBsAg) (78 asymptomatic hepatitis B virus carriers, 73 active chronic hepatitis B patients or cirrhosis patients) were evaluated for YMDD mutants. The patients who were treated with interferon and Lamivudine or Adfovier in one year prior to the study were excluded. YMDD mutations of HBV DNA were detected by PCR-RFLP (PCR Restriction Fragment Length Polymorphism) in a single laboratory.

 Results: The mean (±SD) age of patients was 37±4 years. Eighty one (54%) cases were male and 70 (46%) were female. Eight cases (5.3%) out of 151 had YMDD mutations. The type of mutation in all of these patients was YSDD. There was no significant relationship between YMDD mutation and viral load and HDV Ab (p>0.05).

 Conclusions: The mutant strains of the YMDD motif of HBV polymerase can be found in some patients without lamivudine treatment. However, in view of rather clinically insignificant YMDD mutation frequency, routine testing for YMDD mutations prior to antiviral therapy is not recommended in these patients.

Background: Infectious diseases are major public health problems, among which blood-borne ones are the most important infections. Patients who undergo orthopedic surgery are at higher risk of transmitting infectious diseases from and to others, due to repeated blood examinations and injection, drains secretion and receiving blood products. Accordingly, in this study we determined prevalence of Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) and human immunodeficiency Virus (HIV) infections in patients who underwent surgery in a general training hospital.

Methods: In this cross-sectional study the prevalence of HBV, HCV, and HIV infections was determined among 320 patients under orthopedic trauma surgeries in a general training hospital in Tehran, Iran from 2009 to 2011. Associations of these rates with age, gender, marital status, residence location, substance abuse history, hospital admission history, previous surgery, blood transfusion, dentistry procedures, and previous medical history were also assessed.

Results: A total of 320 patients (290 male, 30 female) were studied. Ten patients (3.2%) had at least one of these three infections. Totally 10 patients (3.2%), 2 subjects (0.6%), and 8 patients (2.5%) had HCV, HIV, and HBV infections, respectively. None of the evaluated variables had significant relationship with HCV, HBV, and HIV infections (p> 0.05).

Conclusion: According to the obtained results, routine use of diagnostic tests for infectious disease such as HIV and viral hepatitis is recommended and should be considered before orthopedic operations.