Hepatitis E Virus Infection in HIV-Infected Persons

Hepatitis E Virus Infection in HIV-Infected Persons Hepatitis E virus (HEV) infection is a global disease (1,2). HEV infection represents a major global public health issue especially in developing countries, where the global death rate is 1-15% and up to 30% in pregnant women (3). Every year there are an estimated 20 million hepatitis E infection (HEV) are registered over the world. it is known that chronic liver disease by hepatitis E develops in persons who are undergoing immunosuppression, including individuals infected with HIV(4). Recently, many studies have demonstrated cases of chronic HEV infection (characterized by detection of HEV RNA greater than or equal to 6 months in plasma) and cirrhosis in immunocompromised patients, including organ transplant recipients(5) patients with lymphoma and haematological malignancies (4,6 ) and in persons infected with the human immunodeficiency virus (HIV) (7). A number of studies have suggested that In persons infected with HIV may acquire HEV infection more often than individuals without HIV (8,9). The first verified case of chronic infection E in 2008 (10), which can to lead to liver damage and develops of hepatic fibrosis and even cirrhosis in immunosuppressed patients such as Patients with human immunodeficiency virus (HIV) infection and solid organ transplant recipients (11-14). Immunosuppression has been shown that facilitates chronicity of HEV infection, Therefore HIV infection is one of the possible causes for HEV persistence (15) and there are published reports of high HIV/HEV co-infection rates for particular regions (16,17). There are some data that suggest that HEV may promote the progression of liver disease due to other causes (18). There are only a few reports regarding HEV seroprevalence in Individuals who are immunocompromised. The seroprevalence of anti- HEV IgG in HIV-positive cohorts ranges varies from one geographic location to another from 1.5% to 11.2% (19,20). Incidence of infections caused by HEV, defined by detecting HEV RNA in the serum, i s low, ranging from 0 to 1.3% (21-23). However, studies regarding co-infection of HIV and HEV and HEV associated chronic liver disease in HIV-infected patients are limited in IRAN. The present study aimed to determine the prevalence of HEV RNA in HIV infected patients in Iran a country with moderately high prevalence of both infections. Therefore, in order to better understand the clinical impact of HEV infection in these populations we have conducted a study determining HEV RNA in HIV-infected patients. In the present study, we determined whether HEV RNA were present in serum samples obtained from HIV-infected patients to investigate the prevalence of, and factors associated with, HEV infection in HIV-infected individuals. In addition, epidemiological, clinical and analytical factors were analyzed in order to identify potential risk factors associated with HEV seropositivity. The aim of this study was to define the degree of prevalence of HEV RNA in the group of HIV infected patients in Iran. For this study real-time RT-PCR assays targeting ..genes have been developed. We report 6 cases of hepatitis E infection in HIV-infected patients that   none of our patients received ribavirin treatment. Methods and materials:       Study population and samplecollection: A total of 80 Iranian patients with HIV-1 infection attending the Tehrans hospitals were enrolled in this study from February 2015 to April 2016. The exclusion criteria considered as patients who had been received anti-retroviral therapy. This study followed the principles of the Declaration of Helsinki and study has been approved by a local research ethics committee of the Iran University of Medical Sciences, Tehran, Iran. The participants were informed all aspects of the current study, and Informed consent was obtained from all of the participants prior to their enrollment for current study. About 5 ml of peripheral whole blood Sample from each participant was collected into a sterile EDTA-containing Vacutainer tube and plasma was separated from blood via centrifugation and frozen at -70 oC until analysis. HEV RNA Extraction: Efficient HEV RNA extraction using the High Pure Viral Nucleic Acid Kit generates purified HEV RNA was extracted from 200 ml of plasma (Roche Diagnostics, Germany). RNA pellets eluted with the provided elution buffer and stored at -70 °C until analysis. cDNA Synthesis: For detection HEV RNA, Reverse transcription polymerase chain reaction (rReal Time PCR) was was performed by using the first strand cDNA synthesis kit by Revert AidcDNA synthesis kit from RNA templates (Thermoscientific, USA). In a nutshell, RNA samples were heated in 65 °C for 10 minutes, then chilled on ice. The uniform suspension of bulk first-strand cDNA reaction mix was added according to the manufacturers protocol, then One ÃŽ ¼l of DTT solution, and 1 ÃŽ ¼l of random hexamer (24) primer (0.2 ÃŽ ¼g) were added to the RNA After heat denaturation and RNA and RT primers were mixed properly by pipetting up and down for several times, then incubated for an hour at 42 °C. For Real time PCR, the QuantiTect Probe PCR Kit (Qiagen, Germany) was used, based on its instruction kit. HIV-1 viral load quantification: Measurement of blood plasma HIV-1 RNA concentration performed by COBAS TaqMan 48 (Roche Diagnostics, Hacienda Drive Pleasanton, CA, USA) kit in the patients plasma samples (500 ÃŽ ¼l) and high pure extraction was used according to the manufactures recommendation. This method is a Real-Time PCR based on dual-labeled hybridization probe which targets the highly conserved region of HIV-1 gag gene. Limit of Detection of the COBAS TaqMan HIV-1 Test is 48 to 107 copies/mL. Hepatitis E Virus real time PCR assay: A Real Time PCR assay was developed for detection of HEV RNA. The primers amplify a bp region containing the . variable regions of the .. Primers sequences and their position with melting temperature are shown in . So, after alignment of complete genomes, HEV consist of Nucleotide sequences based on pubmed database. Reactions contained 5 µl of cDNA, 2.5 mmol/L MgCl2, 800 mmol/L of dNTPs, 100 ng of each primer,30 ng of probe and 1.5 units of QuantiTect Probe PCR Kit (Qiagen, Germany) to a total volume of 15  µL. Thermal cycling conditions were as follows: 95 °C for 10 min; 40 cycles of 95 °C for 15 sec, 60 °C for 40 sec, Quantitative determination of the amplified products have done by the BioRad CFX-96 instrument (BioRad, USA). In order to synthesis our ideal genes, tests should be done by two pairs of forward and reveres primers. Our specific probes were designed by different fluorescent labels to track our targets separately. Statistical analysis:The statistical analysis was performed using the Statistical Package for Social Sciences software version 21 (SPSS Inc, Chicago, IL, USA). Categorical variables were compared by Fishers exact test or the chi-square test as appropriate. Continuous variables was analyzed using Students t test. Data are presented as absolute counts, proportions [95% binomial exact confidence intervals (CI)], medians [interquartile range (IQR)], and means [standard deviation (SD)]. For all comparisons, p-value less than 0.05 was considered statistically significant. Results: The study population consisted of 80 participants with HIV-1 infection that were enrolled in the current study . The mean age of the patients was 36.51  ± 12.75 (range 4-64) years. Among 150 participants, 95 (63.3 %) were male and 53 (35.3 %) were female. . Real-Time PCR assay for HEV nucleic acid detection results in 6 (.%) positive samples out of 80 subjects, including . males (69/2%) and .. females (30/8%). Based on the analysis by Fisher exact test, no significant association was observed between HEV and gender of the patients (p value= 0.79) (Table 2). In our study, half of the HIV-1 infected patients were over 30 years of age, while the other half were under 30 years. The mean age for 6 HEV positive patients and 74 HEV negative ones was 40.9 and 35.8 years respectively. There was no significant correlation between age and HEV s RNA positivity (p value= 0.18) (Table 3). By measuring the viral load, we could examine the relationship between HIV viral load and HEV infection. The average HIV viral load in positive and negative HEV patients was 14471.92 and 17016.66 respectively but t-test analysis showed no association between HEV -positive RNA and HIV Viral Load (p value= 0.61) (Table 4).   Discussion: The aim of this study was to evaluate the presence of HEV RNA in blood samples which have been collected from HIV-1-infected patients in Tehran, Iran. In current study we used Real-Time PCR method mainly because it has been shown to be more sensitive and reliable than other methods for identify the infection. Since HEV could be potentially inhibited by anti-retroviral therapy (ART), especially ribavirin (25), none of our HIV-1-infected patients received ribavirin treatment. Thus, our data is not influenced by the viral suppression of antiretroviral therapy. immunosuppressive agents have been shown to facilitate severity or risk of chronicity of hepatitis E infection, HIV infection being one of the possible causes that may lead to HEV persistence (15), and there are Studies of high prevalence of HEV/ HIV co-infection for particular regions (16,17). Moreover, an relationship between exposure to HEV and cirrhosis has been reported in patients with cirrhosis (26), and chronic HEV infection is a leading cause of chronic liver disease in an HIV co-infection patient has been recently described (15). The presence of HEV RNA indicates current infection. This study is the first report to show HEV RNA in HIV-1-infected patients in Tehran, Iran. In this cross-sectional analysis, the overall HEV molecular infection was 7.5% (6/80). The seroprevalence of anti- HEV IgG in HIV-positive cohorts ranges varies from one geographic location to another from 1.5% to 11.2% (19, 20). Incidence of infections caused by HEV, defined by detecting HEV RNA in the serum, is low, ranging from 0 to 1.3% (21-23). In our study, we find HEV-RNA in 6 HIV patients, Unlike studies by Amitis Ramezani et al did not identify any case of HEV-RNA. An explanation for this finding could be the viral suppression observed in HIV-1-infected patients with antiretroviral therapy in their study. our results adapted with results of studies by Madejon et al., (27) Renou et al. (28) and Pischke et al. (29)Therefore, our data also support HEV infection as a viral hepatitis among HIV patients with With relatively moderate prevalence. Hepatitis E virus infection recently has been described as an emerging infection among patients with immunosuppressing conditions of such human immunodeficiency infection (30-32). In current study we found a moderate prevalence (7.5%) of HEV RNA among HIV positive individuals attending the Tehrans hospitals in Iran. Although this rate is higher than the previous studies among Similar patient population in the industrialized countries (33-35), it is lower than the rates of HEV infection reported among some population groups HEV endemic areas of Africa (36) and Asia (15). Carry et al. (39) and Keane et al. (40) have also suggested that the chronic HEV infection may be averted by use of highly active antiretroviral. A sufficiently large sample size is also necessary to establish this finding. The main conclusion of our study is that HEV infection important to consider in the differential diagnosis of otherwise unexplained chronic hepatitis in Iranian HIV-1-infected patients. Furthermore, our study revealed that HEV infection has moderate prevalence in the HIV-infected population of Tehran. Due to the HEV infection that may cause rapidly progressing chronic hepatitis in immunosuppressed HIV co-infection patients, with development of cirrhosis in the short term, Screening for HEV in HIV-infected individuals presenting Symptoms of Hepatitis or with hepatic fibrosis of unknown origin is warranted.

Psychology of Guido Orifice in “Life Is Beautiful” Essay

Guido Orefice, the main character from ‘La Vita E Bella,’ is a very optimistic person. He works for his uncle in a hotel in Italy. He keeps bumping into a lady, whom he considers to be his princess, Principessa Dora. Guido does many things and takes many risks just to see Dora. So they fall in love with each other and get married. They have a boy name Joshua. Their life is very great until the Nazis come and take them all away to a concentration camp. On that very same day it is Joshua’s 7th birthday. Guido says that he has planned a birthday surprise and that they are going to a fun place to play fun games. Guido tells his son that he needs to be quiet and do what the guards say while the adults go and play games. He also said that every game they win and for every time they do something correctly they get a certain number of points. The first person to win 1,000 points gets a real tank. Joshua really wants it so he does what he is told to. So while Joshua is hiding all the other kids are being gassed and killed. Also Guido is working very hard so he does not get killed and can make his son happy. He gives up his food and other basic needs to have his son think they are playing a game. By the end of the war, Guido says they have 940 points; the Nazis are mercilessly killing the Jews. Guido tell Joshua to hide in a little box, and not to come out until he comes back or until it is totally quiet, and that this will get him to 1,000 points and he will him the game. Guido then dresses up as a girl and goes looking for his wife. A Nazi comes and takes him into an alley and shoots him. Soon the gunshots die down and everyone leaves. Then Joshua comes out of his box and looks around. He sees a large tank coming towards him and is excited because he won the game and got his tank. In the end, Joshua is a grown man and you hear him say, â€Å"This is my story. This was the sacrifice my father made. This was his gift to me.† Erik Erikson identified eight psychosocial stages during which an individual’s primary goal is to satisfy desires associated with inborn social needs. He hypothesized that from infancy through adulthood, we proceeds through these stages, each of which is related to a different problem that needs to be resolved. If the potential problem is dealt with  successfully it will result in a positive personality trait. If not dealt with properly he or she may become anxious, worried, or troubled and develop social and personality problems. Guido has gone through every stage with a successful result. He has trust, autonomy, initiative, industry, identity and intimacy. Generativity versus stagnation is the Stage 7 problem. So far, Guido is leaning towards generativity, but it could change. If Guido had remained alive till Stage 8, he would have integrity instead of despair. Sigmund Freud hypothesized five psychosexual stages during which a child’s primary goal is to satisfy desires associated with innate biological needs. Freud believed that the interactions between parent and child greatly influenced the child’s social development and future social interactions. Guido is currently in the genital stage, the last stage that lasts from puberty through adulthood. It is the time when an individual has renewed sexual desires that he or she seeks to fulfill through relationships. Guido must have had a problem during the oral stage so therefore he had an oral fixation. Guido loves to talk and make people laugh, that is how we figure that out. Lawrence Kohlberg developed a theory to explain moral development. His theory had some similar features to the other analysts. He classified moral reasoning into 3 levels, pre-conventional, conventional, and post-conventional. The three levels are each divided into two stages. Also, he suggested that everyone progresses through the levels in order, from lowest to highest. Not many people make it to the higher stages of moral development. Guido is considered to be in Stage 3 because his wife and his son guide his moral decisions. Guido can understand the actions and talk of Stage 4 where moral reasoning is determined most by confirming laws of society. Abraham Maslow was interested in human motivations, especially in how humans go about choosing which biological or social needs to satisfy. He proposed the hierarchy of needs. It is an ascending order with biological needs at the bottom and social needs at top. This shows that we first satisfy our biological needs before social ones. Before the Nazis came and took Guido  and his family away, Guido was on the highest level, the level of Self-Actualization. It involves developing and reaching our full potential as a unique human being. When he was in the concentration camp, his whole hierarchy of needs started all over again and he was back at level one. When he was shot he was still at level one because he had no protection and harm. Carl Rogers had a personality theory that was often called the self-theory because of his emphasis on the ‘self.’ Our society also leads us astray with conditions of worth. As we grow up, our parents, teachers, peers, the media, and others, only give us what we need when we show we are â€Å"worthy,† rather than just because we need it. We get a drink when we finish our class, we get something sweet when we finish our vegetables, and most importantly, we get love and affection if and only if we behave. These actions of only getting positive regard on condition are called conditional positive regard. Because we do indeed need positive regard, these conditions are very powerful, and we bend ourselves into a shape determined by a society that may or may not truly have our best interests at heart. A good little boy or girl may not be a healthy or happy boy or girl. Over time, this â€Å"conditioning† leads us to have conditional positive self-regard as well. We begin to like ourselves only if we meet up with the standards others have applied to us, rather than if we are truly actualizing our potentials. And since these standards were created without keeping each individual in mind, more often than not we find ourselves unable to meet them, and therefore unable to maintain any sense of self-esteem. Guido had unconditional positive regard and unconditional positive self-regard. This is the opposite of what is above. Guido was loved no matter what happened and he loved himself because of that. He did not keep and high goals and was always happy and had a high self-esteem. The last, and probably the most detailed analysis of Guido’s personality would be Myers-Briggs. According to the Myers-Briggs test, Guido is an ENFP. This stands for Extrovert, Intuitive, Feeling, and Perceiving. ENFPs want to both help and be liked and admired by other people, on an individual and a humanitarian level. They have a large amount of passionate charm. They are outgoing, fun, and genuinely like people. They are warm, affectionate, and  disconcertingly spontaneous. However, their attention span can be short. ENFPs are easily intrigued and distracted by new friends and acquaintances, forgetting about the older ones. ENFPs are pleasant, easygoing, and usually fun to work with. They come up with great ideas, and are a major asset in brainstorming sessions. Follow-through tends to be a problem because they get bored quickly, especially if a newer, more interesting project comes along. They also tend to be procrastinators, both about meeting hard deadlines and about p erforming any small, uninteresting tasks that they’ve been assigned. Guido meets almost all of the traits of an ENFP.

Essential French Vocabulary

Righ and Wrong - 656 Words

Each one of us has been accused of something in our lives that we didn’t do. And to be sent to prison for that crime would be very hard to except. If you were sent to jail for something you felt was right, and just, and had the chance to escape and not be caught again, would you? That is that is the dilemma Socrates had to face. He had the chance and the means yet he chose not to escape. Did he do the right thing by not escaping from jail? Socrates was a man who believed that is was immoral for him to escape his sentence because he had accepted the ruling of the courts. And for him to escape he would be sending the wrong message to his peers. He would be telling them that all of his ideals and believes really had no meaning to him and†¦show more content†¦Obedience to our parents, after all, is a temporary obligation that we eventually outgrow by learning to make decisions for ourselves, while Socrates means to argue that obeying the state is a requirement right up until we die. Here it might be useful to apply the same healthy disrespect for moral authority that Socrates himself expressed in the Euthyphro. The second argument is that it is always wrong to break an agreement, and since continuing to live voluntarily in a state constitutes an agreement to obey it, it is wrong to disobey that state. (Crito 52e) This may be a better argument; only the second premise seems open to question. Explicit agreements to obey some authority are common enough—in a matriculation pledge or a contract of employment, for example—but most of us have not entered into any such agreement with our government. Even if we suppose, as the laws suggest, that the agreement is an implicit one to which we are committed by our decision to remain within their borders, it is not always obvious that our choice of where to live is entirely subject to our individual voluntary control. Nevertheless, these considerations are serious ones. 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