Plasma Zinc Level in Hepatitis C Patients With or Without Beta Thalassemia Major; Is There Any Difference?

Background

Zinc deficiency has been reported frequently in hepatitis C patients in the literature. Furthermore, a decrease in zinc level has been shown in beta thalassemia major as well. Iranians consume a large amount of phytate in their regimens which can bind with zinc and decrease its gastrointestinal absorption.

Objectives

This study was designed to determine plasma zinc level in an Iranian sample with the diagnosis of hepatitis C with or without concomitant beta thalassemia major.

Patients and Methods

Between April 2011 and April 2012, plasma zinc level was determined via atomic absorption method, in 130 hepatitis C patients with or without beta thalassemia major in a known referral center of hepatic diseases in Tehran, Iran.

Results

Mean ± standard deviation (SD) of plasma zinc levels was determined as 0.78 ± 0.22 mg/L. Also zinc level was 0.76 ± 0.19 mg/L and 0.80 ± 0.24 mg/L in thalassemic and non thalassemic patients, respectively. T-test analysis showed that there is no significant difference between these two groups regarding plasma zinc level (P = 0.235).

Conclusions

It is concluded that zinc level of studied patients is less than which is reported in normal Iranian population. Moreover, there is not a significant difference in plasma zinc levels between thalassemic and non thalassemic patients and it seems to be a common problem in both ones. Addition of zinc supplement may be recommended in both groups in order to optimize the nutritional support and probably improve the treatment response.     

Estimation of Glomerular Filtration Rate: What Are the Pitfalls?

Because of the high prevalence of chronic kidney disease, estimation of the glomerular filtration rate (GFR) is necessary to diagnose, stage, and follow the progression of renal impairment, and to adjust the dosage of medications with predominantly renal excretion. The main pitfall of using 24-h urinary creatinine clearance is the inaccuracy of urine collection. Multiple formulas based on serum creatinine have been proposed for the estimation of renal function in daily clinical practice and in large-scale studies. The two most widely used formulas are Cockcroft-Gault (CG) for the estimation of creatinine clearance and MDRD (Modification of Diet in Renal Disease) for the estimation of GFR. However, the performance of these formulas is satisfactory only in individuals with a GFR level less than 60 mL/min/1.73 m², and the presence of determinants of serum creatinine that are not dependent on GFR, such as gender, age, body weight, or chronic illness, should also be considered. Because of the need for an accurate and reproducible measurement of serum creatinine, uniform creatinine assay calibration is now available. The utility in daily practice of new markers of GFR, such as cystatin C, remains to be demonstrated.     

Estimation of Glomerular Filtration Rate in Older Patients with Chronic Renal Insufficiency: Is the Modification of Diet in Renal Disease Formula an Improvement?

OBJECTIVES: To evaluate a new formula for glomerular filtration rate (GFR), derived from the Modification of Diet in Renal Disease (MDRD) study in older people. DESIGN: An observational study of the performance of the MDRD formula compared with other formulae and creatinine clearance (ClCr) as measures of the GFR. SETTING: Volunteers were recruited via outpatient clinics. PARTICIPANTS: Fifty-two patients (27 men, 25 women: mean age 80, range 69-92) with a variety of medical diagnoses. Mean GFR was 53.3 mL/min/1.73 m2 (range 15.9-100.2). Exclusion criteria included renal replacement therapy/renal transplantation and cognitive impairment. MEASUREMENTS: 51Chromium ethylenediaminetetraacetic acid (51Cr EDTA) was used as the reference method against which the formulaic estimates of GFR were compared using bias plot and regression analyses. RESULTS: The MDRD and Cockcroft and Gault formulae (both coefficient of determination (R2) = 0.84) gave the best fit with GFR, followed by the Jelliffe formula (R2 = 0.81), ClCr (R2 = 0.73) and the Baracskay formula (R2 = 0.56). ClCr (-1.2%) demonstrated minimal bias compared with the MDRD (8.0%) and Cockcroft and Gault (-10.4%) formulae. However, imprecision compared with 51Cr EDTA was lowest for the Cockcroft and Gault formula, with 50% of estimates lying between -9.5 and -0.5 mL/min/1.73 m2 of measured 51Cr EDTA clearance. This compares with -6.7 and 10.1 mL/min/1.73 m2 for ClCr and 0.0 and 12.7 mL/min/1.73 m2 for the MDRD formula. CONCLUSION: Calculated estimates of GFR are an improvement over ClCr estimation. On balance, the MDRD formula does not improve the estimate of GFR compared with the Cockcroft and Gault formula in older Caucasian patients with chronic renal insufficiency.     

Are There Still Difficult-to-Treat Patients with Chronic Hepatitis C in the Era of Direct-Acting Antivirals?

Difficult-to-treat populations with chronic hepatitis C (CHC), in the era of interferon treatment, included patients with liver cirrhosis, kidney impairment, treatment-experienced individuals, and those coinfected with the human immunodeficiency virus. The current study aimed to determine whether, in the era of direct-acting antivirals (DAA), there are still patients that are difficult-to-treat. The study included all consecutive patients chronically infected with hepatitis C virus (HCV) who started interferon-free therapy between July 2015 and December 2020 in the Department of Infectious Diseases in Kielce. The analyzed real-world population consisted of 963 patients, and most of them were infected with genotype 1 (87.6%) with the predominance of subtype 1b and were treatment-naïve (78.8%). Liver cirrhosis was determined in 207 individuals (21.5%), of whom 82.6% were compensated. The overall sustained virologic response, after exclusion of non-virologic failures, was achieved in 98.4%. The univariable analysis demonstrated the significantly lower response rates in males, patients with liver cirrhosis, decompensation of hepatic function at baseline, documented esophageal varices, concomitant diabetes, body mass index ≥25, and previous ineffective antiviral treatment. Despite an overall very high effectiveness, some unfavorable factors, including male gender, genotype 3 infection, liver cirrhosis, and treatment experience, significantly reduce the chances for a virologic response were identified.     

AST/ALT Ratio ≥1 Is Not Diagnostic of Cirrhosis in Patients with Chronic Hepatitis C

Medical guidelines forinterferon-_2a or-_2b(IFN-) treatment of chronic hepatitis C virus(HCV) infection depend upon baseline liver histology. Abetter long-term response to IFN- therapy correlates with less inflammation and absenceof cirrhosis. It has been suggested that the presence ofcirrhosis in patients with chronic hepatitis C virusinfection may be predicted based on an AST/ALT ratio 1. This study was designed todetermine if the presence of cirrhosis can be predictedin patients with chronic HCV infection by such a ratio.Seventyseven patients, including 23 cirrhotics, withchronic HCV infection were studied. Serum ALT, AST, andHCV-RNA levels and hepatic activity index (HAI),reflecting histologic inflammation in all liverbiopsies, were assessed. AST/ALT ratios and mean ALT,AST, and HCV-RNA were determined for both cirrhoticand noncirrhotic patients. HAI was correlated with ALT,AST, and HCV-RNA levels, the latter determined byquantitative RT-PCR. The likelihood ratio (LR) and positive predictive value of an AST/ALT ratio1 for cirrhosis was 7.3 and only 77% , respectively.In cirrhotics vs noncirrhotics, there were nosignificant differences between mean serum ALT (149± 28 vs 176 ± 17 units/liter), AST (139± 28 vs 102 ± 8 units/liter), or HCV-RNAlevels (589,160 ± 147,053 vs 543,915 ±75,497 copies/ml), respectively. There was asignificant, but clinically weak, correlation between serum ALT and HAI (r =0.234), and none between HAI and either serum AST orHCV-RNA levels. Our results support the need for a liverbiopsy prior to treatment of chronic HCV infection, since the AST/ALT ratio fails to predictaccurately the presence of cirrhosis.     

Correlation of Iron Overload and Glomerular Filtration Rate Estimated by Cystatin C in Patients with β-Thalassemia Major

Historically, renal involvement has not been a commonly recognized complication in patients with β-thalassemia major (β-TM). Herein, we studied the impact of iron overload on glomerular filtration rate (GFR) estimated by cystatin C based GFR (Cyst C eGFR). We enrolled 149 patients with β-TM in a cross sectional study in a single center in Oman. We investigated the correlation between measurement of serum ferritin and Cyst C eGFR. We used univariable linear regression to study the impact of serum ferritin on Cyst C eGFR and backwards stepwise regression to adjust for potential confounders. We included 78 males and 71 females with a mean age of 17.3?±?9 years (range 2.5–38.5). Seventeen patients had diabetes mellitus. Patients were taking deferiprone (DFP) and deferoxamine (DFO) (26 patients), DFP (58 patients), deferasirox (DFX) (62 patients) and one patient was taking only DFO. There was a very weak negative linear relationship between serum ferritin and Cyst C eGFR (correlation coefficient ?0.25). In the univariable analyses, serum ferritin (p?=?0.004), diabetes status (p?p?p?=?0.033), chelation with DFX (p?=?0.05) and diabetes status (p?相似文献   

Is There a Difference Between CAGE Interviews and Written CAGE Questionnaires?

Background: The CAGE questionnaire is a frequently studied and used instrument for screening of alcohol problems. It was developed and tested as a written questionnaire, but, clinically, it is often used as an oral interview. No comparisons have been made between the results of a written and an oral CAGE. This study attempted to (1) compare the results of a written CAGE questionnaire and a CAGE interview, and (2) compare the efficiency of using a simple open‐ended question about drinking habits before asking the CAGE and asking the CAGE without an introduction. Methods: All patients who attended a general internal medicine, cardiology, or hepatology clinic were classified according to the week of the consultation, as follows: group I (week 1), patients completed a written CAGE and were subsequently interviewed during a normal consultation by a physician, who also asked the CAGE questions; group II (week 2), a physician first interviewed the patients, including the CAGE, and subsequently patients completed a written CAGE; and group III (week 3), patients completed a CAGE interview after an open‐ended introduction (“What do you drink during the day?”). Kappa values were used to compare the answers of the written and oral CAGE interviews (groups II and I). Nonparametric ANOVA was used to compare the results of group III and the oral interview of group II. Results: Mean age was comparable between the groups, gender ratio was comparable between groups I and III, but there were fewer males in group II. Comparison of all written CAGEs with the oral CAGEs in the same patients resulted in an accuracy of 0.91 and a kappa value of 0.75 (95% CI, 0.66–0.84). No significant difference could be found between the results of the oral CAGE with or without an open‐ended introduction (p= 0.46). Conclusions: We found no difference between the oral and the written versions of the CAGE. This is important because most research results originate from written questionnaires. Our results do not support the finding that a different approach to the CAGE questions results in an increasing number of patients in which alcohol problems were detected.     

Relationship of MTHFR Gene 677C→T Polymorphism,Homocysteine, and Estimated Glomerular Filtration Rate Levels With the Risk of New-Onset Diabetes

East Asian patients with diabetes have a higher risk for renal complications and strokes than Europeans. We aimed to evaluate the effect of methylenetetrahydrofolate reductase (MTHFR) gene 677C→T polymorphism, which was associated with a higher stroke risk and was common in the Chinese population, as well as homocysteine and estimated glomerular filtration rate (eGFR) levels on the risk of new-onset diabetes (NOD).A total of 2422 subjects without diabetes were followed-up for 7 years. NOD was defined as fasting plasma glucose ≥7.0 mmol/L or self-reported physician diagnosis of diabetes.Compared with subjects with MTHFR 677CC genotype, those with TT genotype had a higher risk of NOD in females (odds ratio 2.78, 95% confidence interval 1.39–5.56) but not in males (0.80, 0.40–1.61, P for interaction = 0.008). Furthermore, MTHFR 677C→T polymorphism was more strongly associated with the risk of NOD among females with higher body mass index (BMI, ≥23 vs <23 kg/m², P for interaction = 0.009) or lower high-density lipoprotein-cholesterol (HDL-C, <1.3 vs ≥1.3 mmol/L, P for interaction = 0.015) levels. Hyperhomocysteinemia (≥16 vs <10 μmol/L) was not significantly associated with NOD in males (0.88, 0.42–1.85) or females (1.52, 0.65–3.57). However, mildly decreased eGFR (<90 vs 90–120 mL/min/1.73 m²) was associated with NOD mainly in males (1.96, 1.01–3.78; females, 0.74, 0.32–1.72, P for interaction = 0.134).Females with MTHFR 677TT genotype had a significantly higher risk of NOD, particularly those with higher BMI or low HDL-C levels. The higher risk of NOD associated with mildly decreased eGFR also warrants more investigation. Our results provide insights into the ethnic differences of diabetic complications between East Asian patients and Europeans.     

Magnetic Resonance Imaging of Patients With Chronic Lateral Epicondylitis: Is There a Relationship Between Magnetic Resonance Imaging Abnormalities of the Common Extensor Tendon and the Patient's Clinical Symptom?

The aim of the study is to determine the inter-reliability and intra-observer reliability of magnetic resonance imaging (MRI) for lateral epicondylitis and investigate whether there is a potential relationship between MRI abnormalities of the common extensor tendon (CET) and its clinical symptom.The study group comprised 96 consecutive patients (46 men and 50 women) with a clinical diagnosis of chronic lateral epicondylitis, which were examined on 3.0 T MR. An MRI scoring system was used to grade the degree of tendinopahty. Three independent musculoskeletal radiologists, who were blinded to the patients’ clinical information, scored images separately. Clinical symptoms were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE).Of all the patients, total 96 elbows had MRI-assessed tendinopathy, including 38 (39.6%) with grade 1, 31 (32.3%) with grade 2, and 27 (28.1%) with grade 3. Inter-observer reliability and intra-observer agreement for MRI interpretation of the grades of tendinopathy was good, and a positive correlation between the grades of tendinopathy and PRTEE was determined.MRI is a reliable tool in determining radiological severity of chronical lateral epicondylitis. The severity of MR signal changes positively correlate with the patient''s clinical symptom.     

Hepatitis C Virus and Statins: Is There a Role?

Hepatitis C treatment-response rates range from 50%–80% depending on genotype, viral load, fibrosis stage, interleukin 28B (IL28B) polymorphism, and metabolic abnormalities. Lipid metabolism could influence sustained-virological response (SVR), and raised levels of low-density lipoprotein cholesterol were found in sustained responders. The capacity of 3-hydroxy-3-methylglutaryl coenzyme A(HMG-CoA) reductase inhibitors to impede hepatitis C virus (HCV) replicon replication in vitro in a dose-dependent fashion raised hope that this class of medications could serve as an adjunct to standard interferon-based therapy. In cell culture models of HCV infection, antiviral activity of statins was greater for fluvastatin. The mechanisms by which statins interfere with HCV replication are not completely understood yet. Adding statins to peginterferon plus ribavirin may improve (SVR) in HCV patients, but this method requires further prospective evaluation. However, current data suggest that lipid metabolism may be linked to IL28B polymorphisms, and patients bearing favorable genotype CC (rs12979860) showed higher cholesterol levels and higher (SVR) rates, emerging as a confounding factor in the interaction of statins and SVR. The use of statins raises many questions, and additional trials are needed before we can use statins as adjuvant therapy for HCV.     

Is There a Need for Cluster Hepatitis B and C Epidemiological Studies in the Region?: Yes

Some arguments for community based prevalence and risk factor studies for hepatitis C and B in Latin America and The Caribbean (LAC) are offered. Background definitions about study designs are provided. Epidemiologic observations within a framework of risk factor pathways of chronic viral hepatitis C and B, suggest that LAC may be in an intermediate position regarding risk factor mix. Most of the evidence available is limited. Answers require more cross-sectional studies to understand current epidemiology and risk factors of both conditions.     

Low Creatinine Potentially Overestimates Glomerular Filtration Rate in Older Fracture Patients: A Plea for an Extensive Use of Cystatin C?

AimMuscle mass is frequently reduced in older patients experiencing injurious falls and may further reduce during hospitalization for bone fracture. In these patients, renal function may be overestimated, because it is usually calculated using serum creatinine, which is strictly related to muscle mass. We evaluated if creatinine levels change during hospitalization in older patients with fracture. We also assessed the role of cystatin C as a more appropriate marker of renal function, comparing estimated glomerular filtration rate (eGFR) according to different formulas based on creatinine and/or cystatin C levels.MethodsPatients aged 65+ years, consecutively hospitalized for fracture, were enrolled in a prospective cohort study. Creatinine and cystatin C levels were measured at baseline and in the post-operative period; eGFR was calculated using six equations based on creatinine and/or cystatin C.Results425 patients were enrolled (mean age 84 years, mean creatinine 0.97 mg/dL, mean cystatin C 1.53 mg/L). Creatinine levels significantly decreased after surgery (p<0.001), while cystatin C remained stable. According to creatinine-based formulas, eGFR was < 60 mL/min/1.73 m² in 29–30% at baseline and only in 17% participants in the post-operative period. Conversely, according to equations including cystatin C, eGFR was < 60 mL/min/1.73 m² in half to three-quarters of the sample at all assessments.ConclusionsIn older fractured patients, creatinine levels decline during hospital stay and may possibly overestimate renal function, whereas cystatin C remains stable. Whether cystatin C is a more reliable marker of renal function in this specific population should be further investigated.     

Association Between Catalase Gene Polymorphisms and Risk of Chronic Hepatitis B,Hepatitis B Virus-Related Liver Cirrhosis and Hepatocellular Carcinoma in Guangxi Population: A Case–Control Study

Reactive oxygen species (ROS) play critical roles in hepatocarcinogenesis. The catalase (CAT) enzyme is involved in the repair of ROS. Therefore, we investigate the association between CAT gene polymorphisms and the risk of hepatocellular carcinoma (HCC).A total of 715 subjects were divided into 4 groups: 111 chronic hepatitis B (CHB) patients, 90 hepatitis B virus (HBV)-related liver cirrhosis (LC) patients, 266 HBV-HCC patients, and 248 healthy controls. The polymerase chain reaction-restriction fragment length polymorphism strategy was used to detect CAT gene rs1001179, rs769217, and rs7943316 polymorphisms.Binary logistic regression analyses adjusting for sex, age, ethnicity, smoking and alcohol consumption, and body mass index suggested that subjects carrying the rs769217 T allele were at marginally increased risk of CHB, LC, and HCC, with adjusted odds ratios (ORs) of 1.51 (95% confidence interval [CI] = 1.04–2.20, P = 0.029), 1.48 (95% CI = 1.03–2.14, P = 0.035), and 1.51 (95% CI = 1.14–1.98, P = 0.004), respectively. Similarly, those individuals carrying the rs769217 TT genotype had a moderately increased risk of CHB, LC, and HCC, with adjusted ORs of 2.11 (95% CI = 1.05–4.22, P = 0.035), 2.00 (95% CI, 1.01–3.95, P = 0.047), and 1.93 (95% CI = 1.14–3.28, P = 0.015), respectively. Moreover, subjects carrying the rs769217 CT genotype and at least 1 copy of the T allele (dominant model) were 1.78 times and 1.83 times more likely to develop HCC, respectively (OR = 1.78, 95% CI = 1.16–2.73, P = 0.009 and OR = 1.83, 95% CI = 1.23–2.71, P = 0.003). This association between CAT rs769217 T alleles and HCC risk is significantly strengthened among men, nonsmokers, nondrinkers, and among individuals <50 years of age. Furthermore, we found 1 high-risk haplotype GTA for CHB (OR = 1.45, 95% CI = 1.05–2.01) and 1 protective haplotype GCA for HCC risk (OR = 0.67, 95% CI = 0.52–0.87). We did not found any significant difference in CAT rs1001179 and rs7943316 polymorphisms between controls and cases.Our findings suggest that the CAT rs769217 T allele is associated with increased risk of CHB, HBV-LC, and HBV-HCC in Guangxi population.