Form Of Chronic Hepatitis Research Articles

Inflammation and Digestive Cancer.

Chronic inflammation is linked to carcinogenesis, particularly in the digestive organs, i.e., the stomach, colon, and liver. The mechanism of this effect has, however, only partly been focused on. In this review, we focus on different forms of chronic hepatitis, chronic inflammatory bowel disease, and chronic gastritis, conditions predisposing individuals to the development of malignancy. Chronic inflammation may cause malignancy because (1) the cause of the chronic inflammation is itself genotoxic, (2) substances released from the inflammatory cells may be genotoxic, (3) the cell death induced by the inflammation induces a compensatory increase in proliferation with an inherent risk of mutation, (4) changes in cell composition due to inflammation may modify function, resulting in hormonal disturbances affecting cellular proliferation. The present review focuses on chronic gastritis (Helicobacter pylori or autoimmune type) since all four mechanisms may be relevant to this condition. Genotoxicity due to the hepatitis B virus is an important factor in hepatocellular cancer and viral infection can similarly be central in the etiology and malignancy of inflammatory bowel diseases. Helicobacter pylori (H. pylori) is the dominating cause of chronic gastritis and has not been shown to be genotoxic, so its carcinogenic effect is most probably due to the induction of atrophic oxyntic gastritis leading to hypergastrinemia.

Different presentation of autoimmune hepatitis in children: Case series.

Autoimmune hepatitis (AIH) is a disorder causing chronic hepatic inflammation. Its clinical presentation is highly variable from the affected child might have only biochemical evidence of liver dysfunction or present in hepatic failure. It is important to distinguish AIH from other forms of chronic hepatitis because a high percentage of cases respond to immunosuppressive therapy. In this article, we describe the clinical presentation, biochemical and histological findings, treatment, and clinical outcome of the four children with AIH in a tertiary care center in Mumbai. Most patients with AIH have high levels of immunoglobulin. All four cases showed high serum Ig G levels and responded to oral prednisolone only. AIH should be excluded for all patients with symptoms or signs of prolonged, relapsing, or severe liver disease so that treatment can be promptly initiated and morbidity can be reduced.

The Role of Thiazolidinediones in the Amelioration of Nonalcoholic Fatty Liver Disease: A Systematic Review.

Non-alcoholic fatty liver disease (NAFLD) is a broad term encompassing hepatic steatosis and non-alcoholic steatohepatitis (NASH), a form of chronic hepatitis. This may, unfortunately, lead to terminal complications like cirrhosis and hepatocellular carcinoma (HCC). NAFLD is strongly associated with obesity, type 2 diabetes (T2DM), hypertension, and metabolic syndrome. The growing prevalence of NAFLD, its associated conditions, and its complications are alarming. The insulin sensitizer group "thiazolidinediones" has shown some therapeutic benefits in this condition. This systematic review is intended to focus on the clinical efficacy of this group in patients with NAFLD, employing PubMed, Google Scholar, and the Cochrane Library as databases.We discovered 10 randomized control trials (RCTs; nine involving pioglitazone and one involving rosiglitazone) involving 887 participants. All studies varied in duration from 6 to 24 months. Most of the involved trials had a small number of participants, and the intrinsic quality of the studies was mixed. Pioglitazone consistently improved histological parameters and normalized liver transaminases, although evidence supporting the benefits of other drugs in this class was minimal. Thiazolidinediones, particularly pioglitazone, have proven efficacious in patients with NAFLD/NASH. However, more extensive trials need to be carried out to investigate this drug class's benefits further. Unfortunately, this drug has attendant side effects like weight gain and fractures, limiting its widespread use; hence, careful selection for likely candidates is imperative.

HBV - infection in children with perinatal infection. Clinical report of familial hepatitis B

Hepatitis B, despite of being a controlled infection today, is one of the most common form of hepatitis in the world. According to the experts' evaluation there are about 3 million patients with chronic hepatitis B in our country. The global strategy of the World Health Organization includes the elimination of viral hepatitis by 2030.The program used in the North-West Federal District to eliminate acute hepatitis B has reduced the incidence rate due to the widespread vaccination coverage of children and the annual increase in adult immunization coverage.However, the relevance of HBV-infection in children still remains high which is associated with a high infection by hepatitis B virus in women of childbearing age and the possibility of the transmission of the infection from mother to her child. In case of perinatal infection the formation of chronic hepatitis B in children reaches up to 90%. The natural course of chronic hepatitis B is characterized by a change in pathogenetically determined phases, and HBsAg-negative infection, which is a latent (occult) form of hepatitis, was added to them in 2009. Occult hepatitis B is an epidemiological danger, for the child as well, if the mother suffers from this form of chronic hepatitis B. Monitoring of pregnant women is often limited to identifying only HBsAg, which is not enough to detect occult hepatitis B. Lately diagnosed occult HBV-infection can become a source of the infection for the baby, especially in cases when due to some reasons there are disorders in hepatitis B vaccination schedule after birth. The article presents an interesting clinical case of family hepatitis B.

ВОЗМОЖНОСТИ ЭТИОТРОПНОЙ ТЕРАПИИ ПРИ ОСТРОЙ И ХРОНИЧЕСКОЙ ФОРМАХ ГЕПАТИТА В

Background. Currently, etiotropic therapy of hepatitis B in most cases is carried out using nucleot(s)ide analogues. The ultimate goal of the therapy depends on the period of its administration – in acute or chronic hepatitis. The influence of the molecular genetic profile of the hepatitis B virus on the effectiveness of therapy in both acute and chronic forms of the disease has not yet been established, which requires further research. Objective. To assess the possibilities of modern etiotropic therapy in acute and chronic forms of hepatitis B. Material and methods. The article analyzes the indicators of clinical, laboratory and instrumental data of patients who received etiotropic therapy with nucleot(s)ide analogues. Results. Etiotropic therapy resulted in a viral load decrease to an undetectable level in all patients regardless of the course of hepatitis B and infection with either a "mutant" or "wild" virus strain. In acute hepatitis B, HBV DNA was not detected in 100% of cases after 24 weeks of therapy, in HBsAg seroconversion - after 36 weeks; in chronic hepatitis B - after 36 weeks without HBsAg seroconversion. Six months after the completion of the treatment, the patients with chronic hepatitis B developed relapse in 89.7% of cases, but the viral load was less than 2000 IU / ml, and the severity of liver fibrosis was insignificant. In the rest of the cases, resumption of therapy was required. Conclusions. It was found that mutations of the hepatitis B virus do not affect the effectiveness of etiotropic therapy. The rate of viral load decrease correlates with the form of hepatitis B and is significantly higher in acute disease.

Особливості клінічного перебігу хвороби Вільсона в дітей

Purpose — to discover peculiarities of Wilson disease course in children dependently on the variant of liver affection. Materials and methods. Anamnesis of the disease and clinical and paraclinical peculiarities of the course of the disease with consideration of liver affection severity have been studied in 50 children aged 5–17 years. Results. It was estimated that in 52% of children the disease had a form of chronic hepatitis with minimal clinical symptoms, 44% of patients had liver cirrhosis with predominant signs of edematous and ascitic syndrome and 4% had fulminant hepatitis in a debut of the disease. Complicated family anamnesis was detected in 4% of patients. Syndrome of cytolysis predominated in patients with liver damage in the form of chronic hepatitis (р<0.05). Typical biochemical changes in cirrhotic patients were hepatocellular insufficiency with hypoalbuminemia and coagulopathy, hyperbilirubinemia and minimal hypertransaminasemia (р<0.05). Children with cirrhosis in contrast to patients with chronic hepatitis had reliably lower serum ceruloplasmin concentration and reliably higher excretion of copper with urine. Specific for Wilson disease Kayser—Fleischer rings were found out in 36% of patients only. Conclusions. Wilson's disease in children is characterized by progressing course in the form of either chronic hepatitis or liver cirrhosis or, rarely, fulminant hepatitis. Clinical and paraclinical symptoms of the disease are estimated by the severity of liver affection and vary from a course with minimal symptoms in patients with chronic hepatitis to edematous and ascitic syndrome and hepatocellular insufficiency in patients with cirrhosis and fulminant hepatitis. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Wilson's disease, children, chronic hepatitis, liver cirrhosis, course of the disease.

Autophagy, Mitophagy and MicroRNA Expression in Chronic Hepatitis C and Autoimmune Hepatitis

Although the role of autophagy has been implicated in several forms of chronic hepatitis, it is still not fully understood. Active autophagy eliminates damaged molecules and organelles (such as mitochondria) by lysosomal degradation. In the present study, we aimed to examine and compare autophagy activity in chronic hepatitis C (CHC) and autoimmune hepatitis (AIH) by detecting the expression of autophagy (LC3 and p62) and mitochondrium-related (TOMM20) proteins, as well as the levels of selected microRNAs (miR-101, -155, -204 and − 224) known to be involved in the regulation of autophagy. In addition, the expression levels were related to pathohistological parameters. Liver biopsy samples, including 45 CHC and 18 AIH cases, were immunohistochemically stained for LC3, p62 and TOMM20 and the expression of miRNAs was determined using real-time PCR. We found elevated LC3 and p62 in AIH samples as compared with CHC ones, indicating an activated autophagy that is impaired in AIH as no degradation of p62 seemed to occur. Moreover, p62 showed strong correlation with necroinflammatory grades in the AIH group. The observed elevated levels of TOMM20 and p62 suggest a less efficient elimination of damaged mitochondria in AIH as opposed to CHC, in which autophagy seems to have a more active function. The level of miR-101 was increased in case of CHC as compared with AIH, however, miR-155, -204 and 224 resulted in no expressional. Furthermore, miR-224 level correlated with steatosis and miR-155 expression with fibrosis stage in CHC. In conclusion, dissimilar autophagic activity was observed in CHC and AIH, suggesting a close association between impaired autophagy and severity of necroinflammation. This impairment may not be regulated by the analyzed miRNAs. Nevertheless, miR-224 and − 155 seem to be associated with CHC progression.

Functional State of the Thyroid Gland and Lipid Peroxidation and Antioxidant Protection System in Women of Reproductive Age with Chronic Form of Parenteral Viral Hepatitis

Background. Chronic viral hepatitis is a complex global problem and is still far from being solved. Many researchers point out influence of viral hepatitis on the reproductive system of women.Aim. To identify features of the functional state of pituitary-thyroid units of neuroendocrinal regulation, and to evaluate lipid peroxidation – antioxidant protection with determination of the oxidative stress coefficient in perimenopausal women with chronic form of hepatitis.Materials and methods. Study included 44 women with chronic viral hepatitis and 28 healthy women of the same age. Immunoabsorbent, spectrophotometric, fluorometric and statistical methods were used.Results. In patients with chronic viral hepatitis, we detected an increase in thyroxine levels – by 29.6% (р < 0.001) and free triiodothyronine values – by 65.7% (р = 0.008) in comparison with the control group. In the group with chronic viral hepatitis, the TBA-reactive products level increased by 1.9 times (р = 0.006), and superoxide dismutase activity decreased by 1.3 times (р < 0.001), total antioxidant activity – by 1.7 times (р < 0.001) and α-tocopherol level – by 1.3 times (р = 0.005) in comparison with the control group.Conclusions. The obtained data demonstrate the features of the pituitary-thyroid system functioning and the lipid peroxidation – antioxidant protection system in patients with chronic hepatitis. The chronic form of hepatitis is characterized by metabolic disorders that require a more careful approach in diagnosis and management.

Genetic diversity of hepatitis D virus genotype‐1 in Europe allows classification into subtypes

Hepatitis delta virus (HDV) is an RNA virus which leads to both acute and chronic forms of hepatitis. At present, HDV isolates have been classified into eight major genotypes distributed over different geographical regions. Recent increase in HDV sequences in Europe and worldwide has enabled us to revisit the taxonomic classification of HDV. A total of 116 large hepatitis delta antigen (L-HDAg) nucleotide sequences and 13 full-length HDV genome sequences belonging to genotype-1 from our European cohort, as well as 621 L-HDAg nucleotide sequences belonging to genotype-1 to genotype-8 retrieved from the GenBank NCBI were included in this study. All 116 isolates of our cohort and 341 of 621 isolates (60%) account for genotype-1, while the remaining 40% of isolates were unevenly distributed across genotype-2 to genotype-8. Phylogenetic analysis of 98 L-HDAg sequences selected after elimination of redundant sequences of all 737 isolates was performed to identify plausible subtypes within HDV genotype-1. Pairwise genetic distances for L-HDAg sequences were calculated to estimate the inter-genotype and inter-subtype differences. The HDV genotype-1 isolates phylogenetically formed five distinct clusters (genotype 1a-1e), each of them corresponding to a distinct geographic region. Two distinct subtypes for HDV genotype-2 and -4 (ie -2a and -2b; -4a and -4b, respectively) could be identified based on isolate sequences from GenBank. The previously defined genotype-1 to genotype-8 have an inter-genotypic difference of ≥10%, while the newly defined subtypes of genotype-1, -2 and -4 show an inter-subtype difference of ≥3% to <10% from the average diversity. In addition, we identified unique amino acid residues, known as specificity-determining positions, amongst the proposed subtypes.

Retrospective Analysis of Viral Hepatitis B Incidence in Russia from 2013 to 2017 in the Context of Preventive Vaccination

The article presents the results of a retrospective analysis of viral hepatitis B incidence in the Russian Federation from 2013 to 2017, taking into account the use of vaccines included into the National Immunisation Schedule and the Immunisation Programme in Case of Epidemic Outbreaks. The analysis of the data revealed a trend towards a reduction in the incidence of acute and chronic forms of hepatitis B in the territory of the Russian Federation during the past five years. The reduction of viral hepatitis B incidence was achieved thanks to a higher vaccination coverage of both children and adults. The article presents an overview of monovalent and combination recombinant hepatitis B vaccines licensed in the Russian Federation. It describes the WHO position on preventive vaccination against viral hepatitis B, and pays special attention to vaccination of people at risk. The article considers promising areas for improving immunobiological products for hepatitis B prevention, including new technologies used in vaccine production, development and introduction of new adjuvants or adjuvants systems, and development of therapeutic vaccines.

Opportunistic diseases in patients with HIV infection in the intensive care unit

The aim of the study was to analyze the incidence and prevalence of opportunistic diseases and comorbidities in patients admitted in the intensive care unit. Materials and methods. A specialized intensive care unit (ICU) for patients with severe HIV infection was set up in 2014 at the infectious diseases 2nd state hospital Moscow. It provides intensive care and treatments for HIV patients with severe co-morbidities and opportunistic infections. Retrospective analysis of medical records from 2014-2016 was carried out. Also carried out was a comparative study of the most common presentation of secondary diseases with available data of HIV patients in Russia from 1993-1997. Results. The number of patients treated increased from 455 to 852, and the death rate in the department decreased from 64.8 to 50.2% since it began operating. The opportunistic infections noted were cytomegalovirus, pneumocystis pneumonia, esophageal candidiasis, tuberculosis and toxoplasmosis of the brain. The most common comorbidities were chronic hepatitis C and mixed form of chronic hepatitis with cirrhosis complications. Despite the vast diagnostic possibilities, bacterial pneumonia and encephalitis of unknown origin significantly occurred. Comparative study of secondary disease since the early 1990s revealed a significant increase in cerebral toxoplasmosis (from 1.7 to 10.4%), pneumocystis pneumonia (from 5.2 to 16.0%) and encephalitis of unspecified etiology (from 13.8 to 39.4%) Conclusion. Disease severity among HIV patients is increasing. CMV and pneumocystis pneumonia were predominant opportunistic diseases. There were significant changes in the presentation of secondary diseases compared to data from 1993-1997.

COMPARATIVE CHARACTERISTIC'S OF IMMUNE STATUS OF PAT I ENTS WITH CHRONIC FORMS OF VIRAL HEPATITIS В, C, D AND HEALTHY INDIVIDUALS

Evaluate immune status in patients with chronic hepatitis (CH) depending on type of causative agent and severity of the infectious process. 232 residents of Yakutia including 127 patients with various forms of chronic hepatitis and 105 healthy individuals were examined. Relative levels of mature T-lymphocytes (CD3⁺), T-helpers (CD4⁺), T-suppressors (CD8⁺), B-lymphocytes (CD72⁺) and naturalkillers (CD16⁺) were studied by flow cytometry, as well as concentration of sera immune globulins of classes A, M and G by ELISA. In patients with chronic hepatitis of various forms, a decrease of expression of differentiating antigens - CD3⁺, CD4⁺, CD72⁺ on the surface of lymphocytes and concentration of sera immune globulins was established. In CHD patients in phase of monoreplication high activity of the infectious process is accompanied by a shift of immune regulatory index to the increase of activity of cytotoxic cells with simultaneous development of deficiency of mature functionally active T-lymphocytes. In the -group of patients with hepatitis D virus with liver cirrhosis normal concentration of sera immune globulins is retained against the decrease of the number of T-helpers and B-lymphocytes. In patients with various forms of viral hepatitis acquired immune deficiency can emerge, which is often accompanied by enhancement of NK-cell activity. The noted reduction of the number of mature functionally active T-cells, as well as main classes of sera antibodies could be con- nected with immune system load during a chronic infectious process.

Modern Epidemic Situation of Parenteral Viral Hepatitis and Drug Addiction in the Russian Federation and Moscow

Study aim - a comparative analysis of dynamics and trends in the prevalence of viral hepatitis B and C and drug addiction in Russia and Moscow in the period from 1999 to 2014. Materials and methods. A retrospective analysis of the prevalence of viral hepatitis B and C, and drug addicts was performed among the population of Moscow and the Russian Federation for the period from 1999 to 2014. The forms of federal statistical observation were applied. To assess the significance of differences between the compared values, the statistical significance error (p) were calculated based on the calculation of Student's test (t). Results and discussion. The tendency of growth in prevalence of drug addiction was verified over the study period in Moscow and in Russia as a whole (in Moscow, 166.3 (1999) to 257.37 100 ths people (2013), in Russia 154.75 (1999) to 227.19 100 ths people (2013)). However, the growth rate of drug addiction prevalence has decreased in recent years mainly due to the decrease in the number of patients who applied for medical help for the first time. It was shown that a composition of the consumed drugs has changed in the studied period in Russia: Portion of cannabinoid addiction has decreased in 2 times, the abuse of stimulants in 19 times. The opium addiction compiled the main portion of consumed drugs (74.5%), the poly addiction - 18.3%, the proportion of addiction to stimulants was 3.5%. Epidemiologic features of the of parenteral viral hepatitis B and C was demonstrated: Reduced prevalence of acute forms and an increased incidence of chronic forms of hepatitis B and C in the population of Moscow; changes toward older age in representation of hepatitis B and C; sexual transition was defined as a main transition way for hepatitis B and C. For the first time it shows a very strong positive correlation (r = from 0.95 to 0.96) between the primary drug addiction and the incidence of acute forms of hepatitis B and C in Moscow and the Russian Federation in 2000 - 2013. Conclusion. The retrospective analysis of the prevalence of drug addiction and viral hepatitis B and C showed the presence of common factors affecting the course of the epidemic process in the studied nosology; drug addicts still represent a risk group for infection with viral hepatitis B and C.

Hyaline droplets in Kupffer cells: a novel diagnostic clue for autoimmune hepatitis.

Pediatric autoimmune hepatitis (AIH) is relatively common and has a characteristic but relatively nonspecific histopathology with a usually prominent lymphoplasmacytic infiltrate. Herein, we describe for the first time the presence of characteristic hyaline droplets in the cytoplasm of Kupffer cells on routine hematoxylin and eosin (H&E) sections in AIH. The medical records and pathologic material over a 20-year period (1992 to 2012) were reviewed from children with AIH (n=30), hepatitis B virus (n=30), and hepatitis C virus (n=30) from the pathology files at Boston Children's Hospital. All children had percutaneous needle liver biopsies. We reviewed sections stained with H&E, PAS, and PAS with diastase for the presence of hyaline droplets in all 90 biopsies. We also performed immunohistochemical analysis for IgG, IgA, and IgD in 6 biopsies with AIH. Hyaline droplets were identified in Kupffer cells throughout the lobules in 15 of 30 biopsies (easily found in 13 and rare in 2); conversely, no droplets were identified in 15. Droplets were identified in 10 AIH type 1 biopsies, 1 in AIH type 2, 3 in overlap syndrome, and 1 in unclassified. Serum IgG levels, when available, were correlated with biopsy findings. Seventeen patients had serum IgG levels available for review. The average IgG level in patients without droplets in their biopsies was 1364 mg/dL, in contrast to 3424 mg/dL in patients with droplets (P=0.021). Immunohistochemical analysis performed in 6 biopsies revealed that droplets were nearly always positive for IgG, occasionally for IgA, and rarely for IgD. None of the biopsies in patients with hepatitis C contained hyaline droplets. One biopsy of a patient with hepatitis B revealed hyaline droplets; this biopsy had an unusually prominent plasmacytic infiltrate, and the patient was found to have an elevated IgG serum level and antibodies to smooth muscle actin. As far as we are aware, hyaline droplets in Kupffer cells on routine H&E sections have never been described. They should be distinguished from the nonspecific granular lysosomal structures frequently found in Kupffer cells in a variety of chronic liver diseases and from erythrophagocytosis. Hyaline droplets may occur in AIH regardless of the type and correlate with a >2-fold increase in serum level of IgG as compared with patients without droplets in their biopsies. Identification of hyaline droplets in Kupffer cells provides a useful diagnostic clue to distinguish AIH from other forms of chronic hepatitis.

Ductular reaction in alcoholic steatohepatitis, nonalcoholic steatohepatitis and hepatitis C virus infection (immunohistochemical study)

Background and aim. Alcoholic steatohepatitis (ASH), nonalcoholic steatohepatitis (NASH) and hepatitis C virus infection (HCV) are the most frequent causes of liver cirrhosis in the Western world. The course of the disease depends on the balance in fibrogenesis, angiogenesis and regeneration. But if fibrosis was studied intensively during the last decades, mechanisms and signs of reparative regeneration in these diseases remain unknown. Ductular reaction is one of the morphologic signs of regeneration, but it was examined mostly in diseases associated with cholestasis. The aim of our work is to study ductular reaction associated with expression of immunohistochemical marker CK19 in alcoholic steatohepatitis, nonalcoholic steatohepatitis and hepatitis C virus infection.Material and methods. 45 autopsies with diagnosed alcoholic steatohepatitis, nonalcoholic steatohepatitis and viral hepatitis C were enrolled in this study. Diagnosis of ASH was based on the data of alcohol abuse and morphologic signs of alcoholic disease – cardiomyopathy, chronic pancreatitis, alcoholic encephalopathy and typical liver changes. Viral genesis was proved by serological study (RNA HCV) and morphologic signs of HCV (METAVIR criteria). Diagnosis of NASH was verified by the features of metabolic syndrome and hepatic changes (Brunt criteria). The employed measures of reparative regeneration were CK19-positive cells with “biliary phenotype”, evaluated in the liver tissue (area of ductular reaction). Marker quantification was performed by assessing the ratio of stained tissue to the total area of the liver section using image analysis. Histotopographic features of ductular reaction and cellular phenotype were also studied. “STATISTICA FOR WINDOWS6.0” was used to analyze the data. The data were expressed as mean value ± standard deviation (M±s). Differences between groups were analyzed using ANOVA analysis (LSD test). P &lt; 0,05 was considered significant.Results. Evaluation of CK19-positive cells area in the liver section showed the highest degree in HCV group (10,17±0,23). Differences of this marker from the markers revealed in NASH (1,17±0,25) and ASH (1,99±0,4) were statistically significant. In addition to quantitative parameters localization of ductular reaction and cellular phenotype were analyzed. Diffuse spreading of the cells with “biliary phenotype” within the thickness of connective tissue septas was found in NASH and ASH. Most ductules were laid by homogenous cuboidal cells and contained distinct lumens. Probably these findings may be a result of biliary epithelial cell proliferation from the preexisting ductules. In HCV CK19-positive cells were revealed mostly in the site of marginal plate between the lobular parenchyma and connective tissue septa. In histologic examination cellular population with “biliary phenotype” was more heterogenous and some ductules had no lumens. Genesis of such lesions may be associated with activation and proliferation of immature precursors – intermediate hepato-biliary cellsConclusions. Severe ductular reaction associated with marginal localization of CK19-positive cells between the parenchymal and connective tissue compartments is revealed in hepatitis C virus infection. In chronic steatohepatitis (alcoholic and nonalcoholic) diffuse spreading of the cells with “biliary phenotype” within the thickness of connective tissue septas is found. Quantitative and qualitative differences in morphologic signs of ductular reaction revealed in our examination confirm the variable role of new-formed ductules in the pathogenesis of different forms of chronic hepatitis which may be the aim for future researches.

Review: Occult hepatitis C virus infection: still remains a controversy.

Occult hepatitis C virus (HCV) infection is characterized by the presence of HCV RNA in the liver cells or peripheral blood mononuclear cells of the patients whose serum samples test negative for HCV RNA, with or without presence of HCV antibodies. The present study reviews the existing literature on the persistence of occult hepatitis C virus infection, with description of the clinical characteristics and methods for identification of occult hepatitis C. Occult hepatitis C virus infection was detected in patients with abnormal results of liver function tests of unknown origin, with HCV antibodies and HCV RNA negativity in serum, and also in patients with spontaneous or treatment-induced recovery from hepatitis C. The viral replication in the liver cells and/or peripheral blood mononuclear cells was present in all clinical presentations of occult hepatitis C. The peripheral blood mononuclear cells represent an extra-hepatic site of HCV replication. The reason why HCV RNA was not detectable in the serum of patients with occult hepatitis C, could be the low number of circulating viral particles not detectable by the diagnostic tests with low sensitivity. It is uncertain whether occult hepatitis C is a different clinical entity or just a form of chronic hepatitis C virus infection. Data accumulated over the last decade demonstrated that an effective approach to the diagnosis of HCV infection would be the implementation of more sensitive HCV RNA diagnostic assays, and also, examination of the presence of viral particles in the cells of the immune system.

English

There are acute and chronic forms of hepatitis, which may result in nausea, jaundice, fatigue and abnormal liver function blood tests. Acute hepatitis is characterized by the parenchymal liver damage by any agent on an underlying normal liver which produces similar clinical and biochemical features. Chronic hepatitis is defined as hepatic necro- inflammation continuing for more than 6 months. Liver disease is often associated with an increased prevalence of impaired glucose tolerance and diabetes mellitus. The effect of HbA1c on Acute and Chronic liver diseases is not well studied. The present study is to know whether acute and chronic liver diseases have same effect on HbA1c or different effects on HbA1c and also to know the enzyme levels (ALT, AST and ALP) in these cases. OBJECTIVES: To study the effect of Acute Liver Disease and Chronic Liver Disease on Glycated hemoglobin (HbA1c), Alanine transaminase (ALT), Aspartate transaminase (AST) and alkaline phosphatase (ALP) levels. METHODS: A total number of 80 patients diagnosed and treated by Medical Department were taken for the study. Out of 80 patients, acute liver disease patients were 40 and Chronic liver disease patients were 40. Forty people who are age and sex matched, apparently healthy normal subjects were also studied as controls. Samples were analyzed for HbA1c, Alanine Transaminase (ALT), Aspartate transaminase (AST) and alkaline phosphatase (ALP). Statistical analysis: It is case control study. Analysis was done by Student's 't' test using Grphpad software. RESULTS: HbA1c values of acute liver disease shows no statistical significance when compared with controls. But HbA1c of Chronic liver disease shows statistical significance when compared with control. ALT, AST and ALP values of acute liver disease and chronic liver disease when compared with control shows very high significance. CONCLUSION: Chronic liver disease group shows significant increase in HbA1C when compared with control group, which may be due to endogenous insulin resistance which causes impaired glucose tolerance. Chronic liver disease has significant impact on hepatic glucose metabolism. ALT, AST and ALP values of Acute and Chronic liver diseases increased and show very high significance due to Liver disease and biliary obstruction in certain cases.

LATENT FORM OF CHRONIC HEPATITIS B

Latent form of chronic hepatitis B can often occur in family practice. Only a complete clinical examination, using all the modern techniques, including immunohistochemistry, allows to identify the etiology of liver disease process pathology and to establish the correct diagnosis in patients with suspected chronic hepatitis

Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report

Background: Autoimmune hepatitis (AIH) is a form of chronic hepatitis with unclear causative factors and is characterized by immunological and auto-immunological manifestations. Several extrahepatic manifestations, such as other autoimmune disorders, are associated with AIH. AIH with dermatological conditions as the initial manifestation is rare. We report the case of AIH in which erythema nodosum (EN) was the first manifestation. Case Presentation: An 8-year-old girl with several persistent dermatological lesions was referred to our hospital several months ago. Her skin had nodular, painful, dry, and erythematous lesions, predominantly on the extensor areas of both the legs, with some erythematous patches on her face. Physical examination revealed that she had hepatosplenomegaly as well. Skin biopsy indicated EN. The results of the laboratory tests showed increased levels of several liver enzymes. The patient\'s International Autoimmune Hepatitis Group (IAIHG) score was a definite indicator of AIH. The results of liver biopsy indicated AIH. Other causes of EN and abnormal liver function were ruled out. The only obvious cause of skin lesions was chronic inflammation due to an autoimmune response. The patient was treated for AIH, and her skin lesions along with other signs and symptoms resolved. Conclusions: AIH can present with protean clinical manifestations, and is thus associated with the risk of delayed diagnosis. Dermatological manifestations, including EN, could indicate a serious disease, and further investigation might be required. AIH should be considered as the possible diagnosis in such cases.

Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report

Autoimmune hepatitis (AIH) is a form of chronic hepatitis with unclear causative factors and is characterized by immunological and auto-immunological manifestations. Several extrahepatic manifestations, such as other autoimmune disorders, are associated with AIH. AIH with dermatological conditions as the initial manifestation is rare. We report the case of AIH in which erythema nodosum (EN) was the first manifestation. An 8-year-old girl with several persistent dermatological lesions was referred to our hospital several months ago. Her skin had nodular, painful, dry, and erythematous lesions, predominantly on the extensor areas of both the legs, with some erythematous patches on her face. Physical examination revealed that she had hepatosplenomegaly as well. Skin biopsy indicated EN. The results of the laboratory tests showed increased levels of several liver enzymes. The patient's International Autoimmune Hepatitis Group (IAIHG) score was a definite indicator of AIH. The results of liver biopsy indicated AIH. Other causes of EN and abnormal liver function were ruled out. The only obvious cause of skin lesions was chronic inflammation due to an autoimmune response. The patient was treated for AIH, and her skin lesions along with other signs and symptoms resolved. AIH can present with protean clinical manifestations, and is thus associated with the risk of delayed diagnosis. Dermatological manifestations, including EN, could indicate a serious disease, and further investigation might be required. AIH should be considered as the possible diagnosis in such cases.