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Background: Hepatitis B is a problematic condition which can affect both patients and health systems. The fetus health effect, transmissibility of infection, disease screening during pregnancy and confronting the disease during pregnancy as a new diagnosis case have made this disease close to the reproductive health domain. A health need assessment is a first step in designing an equality health service, the aim of this study was the development and validation of the health need questionnaire of hepatitis B affected women in the reproductive health domain. Methods: Based on the specific design, this study had two phases. At the first step to develop the instrument, we conducted some qualitative interviews with hepatitis B affected women and reproductive health care providers. After analyzing, we developed a health need questionnaire, the psychometric characteristics of which were determined in the second phase. Results: After analyzing the data, we received 88 codes and 186 items. The research team removed 9 items during the face and content validity based on the cut off point of Impact Score, content validity ratio (CVR) and the content validity index(CVI). To elucidate, the questionnaire with 79 items developed in the psychometric evaluation phase. Internal consistency of the total scale was good with Cronbach alpha coefficient 0.87, and Spearman correlation coefficient of 0.84 that indicated good stability. In the construct validity by exploratory factor analysis, the Kaiser-Meyer-Olkin (KMO) index was higher than 0.90 and also the Bartlett test of sphericity was significant (P < 0.001). Concerning the cumulative percentage of the variance, the 4 factors determined 54.99% of the total variance. Conclusions: This study lead to development and validation of a questionnaire to evaluate the health needs of hepatitis B affected women in the reproductive health domain.

Context: Hepatitis C virus (HCV) has been the main cause of post transfusion hepatitis. Long-term hepatitis can ultimately result in cirrhosis and hepatocellular carcinoma. Viral hepatitis, especially HCV infection, is a major health concern in the Middle East. The current study carried out a systematic search concerning HCV seroprevalence among blood donors in Middle Eastern countries. Evidence Acquisition: Articles were identified through searching databases including PubMed, Scopus, and Web of Science. We reviewed systematically all studies reporting HCV seroprevalence among blood donors in Middle Eastern countries. Results: A total of 5662 relevant records were identified by the electronic search, of which a total of 47 studies were identified as eligible papers that were meta-analyzed for the pooled seroprevalence of HCV among blood donors. Overall, HCV seroprevalence among blood donors in Middle Eastern countries was estimated 0.88% (95%CI = 0.79% - 0.97%). The highest pooled HCV seroprevalence rate was related to Egypt (5.76% [95%CI = 3.30% - 8.22%]), Libya (1.56% [95%CI = 0.99% - 2.13%]), and Yemen (1.09% [95%CI = 0.69% - 1.50%]) while the lowest pooled seroprevalence rate was in Iran and Israel with the rates of 0.14% (95%CI = 0.12% - 0.17%) and 0.16% (95%CI = 0.06% - 0.25%), respectively. Results of annual HCV seroprevalence suggest that there is a decrease in seroprevalence rate of HCV over time among blood donors in Egypt, Iran, Oman, Lebanon, Libya, and Saudi Arabia. Conclusions: Our results showed that the trend of HCV seroprevalence over time among Middle Eastern blood donors was decreasing. It suggests that recent safety measures implemented in Middle Eastern countries have been effective.

Breakdowns of the 7-year war in Syria, especially in the health care infrastructures, such as water networks, and in the basic health requirements, such as public hospitals, emergency equipment from one side and emigration of the skilled resources from the country from the other side, has led to a disaster not only for the residents and neighboring countries but also for all other countries, which accept asylum seekers. Deficiency of national immunization programs and safe water has increased the risk of new epidemics of enterally transmitted virus infections like Hepatitis A virus (HAV) infection. Ringing alarms of a public health emergency must concern all authorized policy makers around the world. Vaccination against HAV, both for residents and asylum seekers, controlling the immune system of all other nations involved in Syria, fixing the water networks, and investing on infrastructures of the primary hygiene requirements would eliminate the risk of communicable infections in all the region.

Background: Sustained virologic response (SVR) to pegylated-interferon (PegIFN) and ribavirin (RBV) in hepatitis C virus (HCV)-infected patients could be predicted by detection of serum HCV RNA whereas detection of HCV RNA in other reservoirs such as peripheral blood mononuclear cells (PBMCs) for prediction of treatment response is still a mystery. Objectives: This study aimed at assessing the prediction of SVR by detection of HCV RNA in PBMCs or serum in patients during treatment. Methods: In a cohort study (2011 to 2014), 100 chronic HCV patients at Tehran Hepatitis Center were treated with PegIFN and RBV. Serum HCV RNA level was measured at baseline, 4, 12, and 24 weeks during treatment and at 24 weeks after termination of treatment. Meanwhile, HCV RNA was evaluated in PBMCs at weeks 4, 12, and 24 during the treatment. Results: Out of 100 patients treated in this study, 91 completed the course of treatment. Most patients were young males infected with HCV genotype 1. Cirrhosis and previous history of treatment was found in 16.5% and 26.5% of patients. Sustained virologic response was achieved in 65 (71.4%) patients. Among baseline parameters, only female gender was significantly associated with SVR. Undetectable serum HCV RNA at week 4 (OR = 4.74) and week 12 (OR = 11.63) of treatment predicted SVR rate while the same was not true for detection of serum HCV RNA at week 24 of treatment. Moreover, detection of HCV RNA in PBMCs at weeks 4 and 12 of treatment was not associated with the rate of SVR, while absence of HCV RNA in PBMCs at week 24 of treatment was associated with SVR (OR = 4.55). Conclusions: Detection of HCV RNA in PBMCs, especially at week 24 of treatment with PegIFN and RBV, could be considered as an additional marker for prediction of treatment response. It is recommended to assess HCV on-treatment kinetic in PBMCs of patients treated with direct-acting antiviral agents for prediction of treatment response.

Background: Despite the introduction of new drug regimens with high effectiveness for the hepatitis C virus (HCV) patients, especially in HCV genotype 1, no cost-effectiveness study on the selection of the superior drug strategy in Iran has been conducted yet.\ud \ud Objectives: This study is aimed to assess the cost-effectiveness of the three drug regimens of pegylated interferon and ribavirin (PR), sofosbuvir (SOF) + PR and ledipasvir and sofosbuvir (LDV/SOF) in patients with HCV genotype 1 in Iran in the year 2014.\ud \ud Methods: A Markov micro-simulation model was used to evaluate the cost-effectiveness of the three drug strategies for a cohort of 10000 patients. Quality-adjusted life-years (QALYs) were extracted from published studies. Cost data was estimated through the review of medical records and obtaining experts opinion.\ud \ud Results: The results showed that the SOF + PR drug compared with PR had a lower cost and was more effective, but compared with the LDV/SOF, in spite of its lower cost, it was less efficient. The QALY values obtained for PR, SOF + PR and LDV/SOF, respectively, were 10.98, 12.08 and 12.28 and their costs were $ 41,741, $ 7,676 and $ 46,993. Moreover, the results obtained from acceptability curves showed that SOF + PR were the most cost-effective treatment for thresholds below $ 45,270 PPP.\ud \ud Conclusions: The use of SOF + PR regimen or LDV/SOF can significantly reduce the incidence of complications associated with the disease. For example, short and long-term outcomes are better than the current drug regimens for HCV genotype 1 patients in all stages of the disease.

The hepatitis B virus (HBV), a type of hepatitis viruses, can lead to morbidity and mortality in the world (1). Despite the progress occurred in antiretroviral therapy, the number of people who die due to chronic HBV infection or the number of cancer cases associated with hepatitis B are increasing (1). It is estimated that about 2 billion people worldwide have serologic evidence of hepatitis B, of which 240 million are chronic carriers and one of them die due to cirrhosis or hepatocellular carcinoma every year (2).

Context: Hepatitis is a term used to describe any type of hepatitis inflammation. Screening for the virus antigen during pregnancy is mandatory in some parts of the world and is recommended in others. so that, most women are aware of and understand the disease if they have it when they are pregnant. Thus, the major concerns of these women are both the virus transmission to the fetus and the effects of hepatitis B on pregnancy outcome. Evidence Acquisition: According to a specific protocol, we searched in the Pub med, Scopus, ISI web of science from 1990 to February 2015 to find the original articles, which investigated the hepatitis B effects in pregnant women with normal singleton pregnancy who were previously diagnosed with inactive CHB or were incidentally found to be HBsAg positive in routine antenatal blood test. We included any cohort, case control and cross sectional studies if they had a healthy control group and reported one or more considered maternal or prinatal outcomes in pregnant women. Meta-analysis was performed with Review manager 5.4 and Stata 11 software. We assessed the effect size that was pooled odds ratio (OR) and 95% confidence intervals (CIs) using the random effects model. We explored statistical heterogeneity using the chi-squared (Chi2), I2 and tau-squared (Tau2) statistical tests. Results: From a total of 156 identified studies, 56 studies were chosen for a detailed review, and 18 studies which met the inclusion and exclusion criteria were included in the meta analysis. Among the included studies, the outcomes were small for gestational age (SGA) large for gestational age (LGA), intra uterine growth restriction (IUGR), fetal distress, fifth minutes apgar score, first minute Apgar score, low birth weight (LBW) and Fetal Macrosomia. Conclusions: In this study, hepatitis B had a cause effect on LGA and fetal Macrosomia. Among the other considered adverse pregnancy outcomes; it didn’t have any significant effect.

Dear Editor, Migraine, defined as a recurrent unilateral pulsatile headache, which is usually accompanied by nausea, vomiting, phonophobia, and photophobia, is a major cause of chronic headaches. It has been ranked the eight most disabling disorder, and its prevalence is higher in females (17% vs. 6%) (1). Hepatitis C virus (HCV) infection infects more than 170-million individuals worldwide and is as an important healthcare problem. According to published studies, the prevalence of HCV is less than 1% in the general population. A combination of ribavirin, an antiviral nucleoside analogue, and interferon is the most common treatment for chronic hepatitis C (2-5). This method of treatment is also used in occult hepatitis C infections, which is a chronic form (6). HCV treatment was reported to be associated with severe migraine attacks, with the source of the attacks attributed to ribavirin-related hemolytic anemia. Hemolytic anemia is a common and reversible side effect of ribavirin therapy, caused by the hemoglobin (Hb) level decreasing by at least 30 g/L in more than 50% of patients treated with this drug. About 7–10% of ribavirin-treated patients develop severe anemia, with a Hb level of 2 mg/dL or more in the Hb level 2 weeks after the start of treatment require special care (8). The ribavirin dose has to be reduced significantly more often in females than in males. Normally, females have lower baseline Hb levels. This may explain why females have a higher risk of hemolytic anemia then males. Older patients (≥ 55 years) are much more likely than younger patients (≤ 55 years) to require a dose reduction of ribavirin. The underlying reason for the increased prevalence of dose reductions among elderly people is unknown, but it may be associated with the presence of erythrocyte membrane anomalies and renal dysfunction among the elderly. A low baseline platelet count was reported to be another risk factor for the development of more severe ribavirin-induced anemia (2). A significant relationship was reported between the ribavirin dose per kilogram and the incidence of anemia. Anemia was observed to be more common in patients receiving > 12 mg/kg than in those receiving 2 g/dL within 2 weeks after starting the treatment, female sex, older age (≥ 55 years), receiving ribavirin of > 12 mg/kg, and a low baseline platelet count. Patients with these risk factors must receive more care for better management and prevention of developing migraine attacks during the treatment.