Diagnosis Of Chronic Hepatitis Research Articles

Application of transient elastic wave scanner in diagnosis of liver fibrosis in patients with chronic hepatitis B

Objective To explore the application value of transient elastic wave scanner in the diagnosis of chronic hepatitis B (CHB) patients with liver fibrosis. Methods 124 patients with CHB were randomly selected.The instantaneous elastic wave scanner (LSM) was taken in patients with liver stiffness measurement, an average of 10 consecutive measurements of the value, and the abdominal MRI examination and the indicators of serum fibrosis of the patients were checked.The coincidence rate of the diagnosis of the two kinds of examination was compared. Results The LSM value of patients with severe liver fibrosis was (24.65±8.54), which was significantly higher than (5.46±2.11) of patients with mild liver fibrosis and (8.96±6.75) of patients with moderate hepatic fibrosis, the differences were statistically significant(t=12.871, 8.254, all P<0.05). The LSM value between serum liver fibrosis and spectrum diagnosis rate was 87.8%, with abdominal MRI examination of patients, results suggested that the two cirrhosis diagnosis coincidence rate was 79.2%, the difference was statistically significant (χ2=2.866, P<0.05). Conclusion The clinical value of the instantaneous elastic wave scanner is high in the diagnosis of hepatic fibrosis in patients with CHB, with no trauma to the patients, the diagnosis coincidence rate is high, easy to be accepted, it is worthy of widely used. Key words: Chronic hepatitis B; Liver fibrosis; Transient elastic wave scanner; Application

Trazodone in treatment of interferon-induced anxiety in persons with viral hepatitis C

IntroductionThe interferon therapy is associated with numerous adverse psychiatric effects, such as tension, irritability, insomnia, etc.GoalThe goal of this study was to examine the severity and the frequency of anxiety in persons with chronic hepatitis C receiving pegylated interferon alpha combined with ribavirin. We have also tried to assess the efficiency of trazodone in treatment of symptoms of anxiety in patients receiving pegylated interferon.MethodThe total of 36 patients whose diagnosis of chronic hepatitis C has been confirmed both serologically and patohistologically, receiving interferon therapy, ages 22 to 60, participated in this study. The control group consisted of 32 patients, all with same diagnosis, corresponding with those in the study group in terms of gender, age duration of the illness and the level of education. All patients received pegylated interferon alpha 2a, administered subcutaneously once per week, along with oral ribavirin. The research used the following instruments of clinical assessment: structural clinical interview–SCID, ICD–10; Hamilton anxiety rating scale–HAM-A, and the self-report scale for assessment of anxiety–state-trait anxiety inventory–STAI-Form Y. The testing using these instruments was conducted four weeks after the start of the treatment, then after eight weeks, after 12, 24 and 48 weeks, i.e. at the end of the treatment. The patients in the study group received 150–300 mg of trazodone per day, starting at the week 6 of interferon treatment.ResultsThe research showed that in the beginning of the interferon treatment approximately one quarter of the patients exhibited symptoms of anxiety in both groups. The administration of trazodone showed beneficial effects in reduction of anxiety induced by the treatment with pegylated interferon.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Angiopoietin-like protein 3 and 4 expression 4 and their serum levels in hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is the 6th most common cancer and the 3rd leading cause of cancer causing death allover the world. The aim of this research to explore the clinical relevance of blood angiopoietin-like protein-3 (ANGPTL3) and ANGPTL4 expression and their proteins levels as non invasive biomarkers in cirrhotic and HCC patients and their influence on the clinicopathological features of HCC. Material and methodsThis work comprised 200 patients with chronic hepatitis (120 cases complicated with cirrhosis, 80 patients with primary HCC) and 100 controls. circulating ANGPTL3 and ANGPTL4 expression was estimated by real-time polymerase chain reaction (RT-PCR). ANGPTL3 and ANGPTL4 protein levels were determined by enzyme-linked immunosorbent assay (ELISA). ResultsThe circulating ANGPTL3 and ANGPTL 4 expression was significantly elevated in HCC cases compared to chronic hepatitis patients and controls. There were much more serum ANGPTL3 and ANGPTL4 values in HCC and chronic hepatitis patients as compared to controls, but we couldn't detect this significance between chronic hepatitis and HCC cases as regards ANGPTL4. By Multiple stepwise linear regression analysis, an increased ANGPTL3 expression, alpha-fetoprotein (AFP), serum ANGPTL 3 levels, Child–Pugh grade were significantly assosciatedassociated with increased risk of HCC. Logistic regression analysis revealed that ANGPTL 3 expression and AFP levels were the only pridectorspredictors of HCC (odd's ratio (OR)=8.9; 8.6 respectively, P=0.003). Receiver operator characteristic (ROC) demonsterated that serum ANGPTL3 and ANGPTL4 levels were usufuluseful biomarkers discriminating chronic hepatitis cases from controls (AUC=0.820,0.887, respectively P<0.001). However, they fail to discriminate HCC patients from chronic hepatitis patients (P=0.27,0.12 respectively). Moreover, ANGPTL3 and ANGPTL 4 expression were promising biomarkers discriminating chronic hepatitis cases from controls and those HCC cases from chronic hepatitis patients (P<0.001). Combined ANGPTL3 expression and serum level wasn't useful in discriminating HCC patient from chronic hepatitis (P=0.09). In contrast, combined ANGPTL4 expression and serum level was an useful biomarker discriminating HCC cases from chronic hepatitis. ConclusionANGPTL3 and ANGPTL 4 expression and serum levels can be promising non invasive biomarkers in diagnosis of chronic hepatitis and HCC especially their expression could be useful in discriminating HCC from chronic hepatitis patients.

Safety and Efficacy of Direct-Acting Antiviral Drugs in Patients with Haemoglobinophaties and Chronic Hepatitis C Infection

Background and Aim: Direct-acting antiviral drugs (DAAs) have a very high efficacy in patients with hepatitis C virus (HCV) infection, but they have not been extensively used in patients with haemoglobinophaties. To evaluate the safety and efficacy of DAA regimens in this subset we used the ITHACA-SITE dataset, which includes patients with haemoglobinophaties and chronic HCV liver disease treated in Italy.Patients and methods: Between March 2015 and June 2016, 121 patients included in the ITHACA-SITE dataset started DAA regimens. Cirrhosis was defined by FibroScan®showing≥12 kPa performed within 6 months before the treatment. Regimen choice and use of ribavirin were based on viral genotype and stage of disease, according to guidelines. Negative HCV RNA at week 12 of post-treatment follow up was considered as Sustained Virological Response (SVR).Results: The mean age of 121 patients was 42 years, 75 (62%) were males, 101 (83.5%) had β-thalassemia major, 9(7.5%) had β-thalassemia intermedia and 10 (8.3%) had sickle cell disease. Sixty-six patients (54%) had the diagnosis of chronic hepatitis and 55 (46%) hadthe diagnosis of cirrhosis. The prevalence of HCV genotypes (G) was: G1a 6 (5%), G1b 70 (57.8%), G2 31 (25.6%), G3 6 (5%), G4 8 (6.6%). Fifty-six patients (46.3%) were Peg-interferon (P) and Ribavirin (R) naïve and 65 (53.7%) were P/R experienced, 20 patients (16.5%) had diabetes and 29 (24%) had heart disease. By June 2016 63 patients (52%) had concluded the treatment and 33 (27.3%) had concluded the post-treatment follow-up. By ITT, the rate of response at the end of treatment (ETR) was 100% (63/63) and 94% (31/33) of patients achieved a SVR. No patients stopped treatment because of adverse events. No interference with chelation therapy was observed.Conclusions: Use of DAAs regimens in practice is safe and effective in patients with haemoglobinophaties and cirrhosis or chronic hepatitis due to HCV. The therapy is indicated also in patients with co-morbidity. The lifetime utility of HCV eradication in terms of reduction of events and overall survival needs evaluation in long-term observational cohorts. DisclosuresPiga:Novartis: Research Funding; Apopharma: Honoraria. Di Marco:Gilead: Research Funding. Forni:Novartis, Celgene: Research Funding.

Incidental diagnosis of chronic hepatitis B. Report of two cases

Incidental diagnosis of chronic hepatitis B. Report of two cases

Chronic Liver Disease Management Among Primary Care Providers

Introduction: The role of primary care providers (PCP) in the management of chronic liver diseases (CLD) is vital. Of the CLD guidelines that have been published, there is no clear mention which aspects of care are in the sphere of Gastroenterologist (GI) versus the PCP. The goal of this study was to analyze the care provided to CLD patients by PCPs in a residency program practice. Methods: This retrospective cohort study was performed on patients with diagnosis of Chronic Hepatitis C (HCV), Chronic Hepatitis B ( HBV) or liver cirrhosis, from three different practices. Patients that died or were not seen in the PCP office between January 2015 and April 2016 were excluded from the study. Implementation of commonly accepted American Association for the Study of Liver Diseases (AASLD) guidelines for the management of CLD was reviewed depending upon the diagnosis of the patient. Differences between PCP and PCP and GI co-managed cirrhosis patients were derived. Care provided to Hepatitis C patients and the impact of the type of insurance the patient had was analyzed. Results: 382 patients met Inclusion criteria. GI referral was provided in 76% (283/382) of patients. Follow up with GI was documented in 61% (174/382) of patients. Results regarding cirrhosis patients are summarized in Table 1. Chronic HCV was present in 278 patients. The percent of patient who received treatment for HCV was 41% (114/278), and 59% (164/278) did not receive treatment. Among HCV patients, 44% (81/183) of total private insurance patients received treatment while 52% (30/58) of total Medicare patients received treatment. Seventeen percent (3/18) of patients with no documented insurance at the time of our study were treated.Table 1: Results in Cirrhosis PatientsConclusion: Management of CLD patients by PCPs in our study group is suboptimal. Co-management with Gastroenterology does provide better patient care as demonstrated by higher compliance with immunization and screening guidelines. No significant difference was found between the treatments of HCV among different insurance plans. A large-scale study needs to be done to assess practice patterns among other residency practices and to figure out barrier to adherence to guidelines.

Kronik hepatit C enfeksiyonunda tedavi yaklaşımı

Purpose: We aimed to evaluate retrospectively the results of treatment of patients with chronic hepatitis C in our clinic. Material and Methods: We evaluated the treatment results of 109 patients who treated with the diagnosis of chronic hepatitis C between the years of 2003-2015 in our clinic. Results: The 52.3% of the patients were male, the mean age was 52.3, mean ALT value 58.3 IU/ml and average HCV-RNA levels was 3,7x106 IU/ml. Previous treatment history in 47 patients (43%) was available. Eigthy-one patients (74.3%) received treatment of pegylated interferon and ribavirin and 28 patients(25.7%) received combination of pegylated interferon, ribavirin and telaprevir. Early virologic response were obtained in 99(90.8%) of 109 patients. Sustained virologic response was more higher in patients who achieved early virologic response. Sustained viralogic response in group of PegIFN/R was %74.1 and in group of PegIFN/R/T was 76.9%. At least one of complaints as rash, itching, taste disorder and anorectal pain were observed in PegIFN/R/T group. All patients had anemia as the most common hematologic side-effect. Depressive symptoms was observed in 19% of patients. Conclusion: With available treatment options in our country, patients who can not be achieved to SVR rates are available. There is a need for new antiviral drugs that used in the world for the patients infected with genotype 1 who had unsuccessful treatment.

Hepatitis C Core Antigen Testing for Diagnosis of Hepatitis C Virus Infection: A Systematic Review and Meta-analysis.

Diagnosis of chronic hepatitis C virus (HCV) infection requires both a positive HCV antibody screen and confirmatory nucleic acid testing (NAT). Testing for hepatitis C virus core antigen (HCVcAg) is a potential alternative to NAT. To evaluate the accuracy of diagnosis of active HCV infection among adults and children for 5 HCVcAg tests compared with NAT. EMBASE, PubMed, Web of Science, Scopus, and Cochrane Database of Systematic Reviews from 1990 through 31 March 2016. Case-control, cross-sectional, cohort, or randomized trials that compared any of 5 HCVcAg tests with an NAT reference standard. 2 independent reviewers extracted data and assessed quality using an adapted QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. 44 studies evaluated 5 index tests. Studies for the Abbott ARCHITECT HCV Ag assay had the highest quality, whereas those for the Ortho HCV Ag enzyme-linked immunosorbent assay (ELISA) had the lowest quality. From bivariate analyses, the sensitivity and specificity of the assays were as follows: Abbott ARCHITECT, 93.4% (95% CI, 90.1% to 96.4%) and 98.8% (CI, 97.4% to 99.5%); Ortho ELISA, 93.2% (CI, 81.6% to 97.7%) and 99.2% (CI, 87.9% to 100%); and Hunan Jynda Bioengineering Group HCV Ag ELISA, 59.5% (CI, 46.0% to 71.7%) and 82.9% (CI, 58.6% to 94.3%). Insufficient data were available for a meta-analysis about the Fujirebio Lumipulse Ortho HCV Ag and Eiken Lumispot HCV Ag assays. In 3 quantitative studies using Abbott ARCHITECT, HCVcAg correlated closely with HCV RNA levels greater than 3000 IU/mL. Insufficient data were available on covariates, such as HIV or hepatitis B virus status, for subgroup analyses. Few studies reported genotypes of isolates, and data for genotypes 4, 5, and 6 were scant. Most studies were conducted in high-resource settings and reference laboratories. The HCVcAg assays with signal amplification have high sensitivity, high specificity, and good correlation with HCV RNA levels greater than 3000 IU/mL and have the potential to replace NAT in settings with high HCV prevalence. National Institutes of Health.

Ситуация по заболеваемости различными формами HBV и HCV-инфекций у детей в Кировской области

In the present article discusses the dynamic changes in the epidemiological situation with regard to the various forms of HCV infection in HBV- and children, from the beginning of their registration on the example of the Kirov region. Also analyzed clinical case of an unfavorable course of chronic hepatitis C with the outcome in the development of liver cirrhosis in boys 22 years as a result of infection in early childhood. Objective: To analyze the epidemiological situation with regard to the various forms of HBV and HCV- infection in children living in the northern part of the Volga Federal District (on the example of the Kirov region) for the period 1994-2013 yy.; evaluate the clinical situation as an example one adverse outcome of chronic hepatitis C in 22-year-old boys. To assess the nature of the epidemic process in patients with chronic HCV infection and HBV- children used official data recording and reporting of Hygiene and Epidemiology in the Kirov region for the period 1994-2013 gg (statistical reporting forms №2). Diagnosis of chronic hepatitis C and B based on the clinical and anamnestic data, increased ALT> 6 mo., the results of the ultrasound of the abdomen, liver fibroelastometrii, detected amounts. anti-HCV, anti-HCV IgM, NS3,4,5; HBsAg, HBeAg, anti -HBcor IgM/G; anti -Hbe IgM/G, ELISA and RNA HCV, DNA HBV PCR. To the exclusion of other viral hepatitis markers were determined by ELISA as follows: anti-HAV IgM/G, anti-HDV IgM/G. The children in the Kirov region revealed the absolute predominance of chronic over acute. Since 1996, there has been a significant reduction in the incidence of all forms of HBV- infection in children by universal vaccination of infants against hepatitis B. However, the incidence of chronic hepatitis C in children is on the rise and in the last 2 years the incidence of chronic hepatitis C higher than that at chronic hepatitis B. When infected in early childhood and subsequent long-term persistence HCV (15-20 years) increases the risk of adverse outcomes of chronic hepatitis C.

The effect of long-term entecavir therapy on liver histopathology in patients with chronic viral hepatitis B

Objectives: The aim of this study was to evaluate histopathological improvement and virological, biological and serological response rates in patients receiving long-term entecavir therapy who were followed with the diagnosis of chronic hepatitis B (CHB).Materials and Methods: Ninety-eight nucleoside(t)e-naive CHB patients who were receiving 0.5 mg/day entecavir (ETV) were included in the study. Virological, serological and biochemical test results were assessed baseline and every 12-week intervals. Liver biopsy specimens were assessed according to the modified Ishak scoring.Results: Forty-six CHB patients receiving ETV treatment underwent liver biopsy. The mean age of the patients was 44 ± 12.9, 26.1% of them were female. The mean duration of follow-up was 44.9 ± 10.8 months. All patients had hepatitis B virus (HBV) genotype D infection. Of 21 patients who were HBeAg positive at baseline, HBeAg loss occurred in 9 and seroconversion occurred in 5. HBsAg loss occurred in none of the patients. Serum HBV DNA levels became undetectable in 93.5% patients. Of the patients, 50% achieved ≥ 2 point improvement in HAI scores and 30.4% achieved ≥ 1 point improvement in fibrosis scores with treatment. The mean improvement in HAI and fibrosis score were 1.94 ± 1.93 and 0.11 ± 0.9 points, respectively.Conclusion: ETV is an effective treatment in histological improvement and virological response in CHB patients. Large-scale, long-term studies are still warranted to evaluate the long-term outcomes of entecavir therapy.

Hepatitis B viral load in diagnosing different clinical stages of chronic hepatitis B in a tertiary care hospital in North Kerala

Background: The diagnosis of chronic hepatitis B (CHB) infection has progressed from serological to molecular diagnostic methods. The newer sensitive technique of quantitation of hepatitis B virus (HBV) DNA by real-time polymerase chain reaction (RT-PCR) has helped in understanding the clinical stages of CHB, deciding on treatment and monitoring treatment response. Aim: This study aimed to determine the HBV DNA load by quantitative RT-PCR in the various clinical stages of CHB. Materials and Methods: Blood samples of CHB patients from the Gastroenterology Department received from June 2014 to December 2014 in the Microbiology Department were subjected to quantitative PCR analysis for HBV DNA. However, to facilitate analysis, only those patients' samples where hepatitis B e antigen (HBeAg) and alanine aminotransferase (ALT) status were known were selected for the study. Statistical analysis was done using SPSS (PASW statistics 18) for windows software. Chi-square test was used to analyse the differences in DNA level between the study groups. Results: A total of 71 CHB patients were included in the study. Of these, 29 (40.8%) were inactive carriers (HBeAg-negative ALT normal) and 42 (59.2%) were chronic active hepatitis B patients (ALT elevated with HBeAg-positive and HBeAg-negative cases). HBeAg was positive in 26 (36.6%) and negative in 45 (63.3%) patients. Among the 45 HBeAg-negative patients, 16 (22.5%) had CHB. Of the 71 CHB patients, 61 (85.9%) had detectable viral load. Serum HBV DNA load of 16 patients who were HBeAg-negative was significantly lower (median 5.5 × 105) than that of 26 patients who were HBeAg-positive (median 2.4 × 108) and higher than the 29 inactive carriers (median 1.6 × 103). Based on HBV load, 14 CHB patients who were HBeAg-positive and seven who were HBeAg-negative were started on antiviral therapy. Conclusion: Quantitation of HBV DNA based on HBeAg and ALT status helps to determine the stages of CHB. It could play an important role in assessing the status of those patients who are HBeAg-negative and inactive carriers with respect to viral load, as the former require treatment. The major role of HBV DNA determination is to evaluate patients with CHB (HBeAg-positive or HBeAg-negative) and to decide on antiviral therapy.

Correlation between METAVIR scores and Raman spectroscopy in liver lesions induced by hepatitis C virus: a preliminary study.

The viral hepatitis C is one of the most important causes of chronic hepatic illness worldwide, affecting around 3 % of the world population. Raman spectroscopy has been employed to distinguish normal from hepatic lesions through differences in the spectral features related to the METAVIR score system. This preliminary study evaluated 11 patients with diagnoses of chronic hepatitis C who underwent hepatic biopsies; the biopsies were submitted to near-infrared Raman spectroscopy using a dispersive spectrometer (830-nm wavelength, 300-mW laser power, and 20-s exposure time). The METAVIR was further scored, and the spectra were submitted to principal component analysis (PCA). The results show a good correlation between the Raman spectroscopy features and the stage of hepatic inflammation and fibrosis. PCA showed that samples with a higher degree of fibrosis presented a higher amount of protein features (collagen), whereas samples with a higher degree of inflammation presented higher features of hemoglobin, in accordance to the expected evolution of chronic hepatitis. Quinone was found to be an important biomarker in early hepatic lesions with a spectral feature at 1595 cm(-1). This study demonstrates that Raman spectroscopy may become an important tool for diagnosing liver disease.

Hepatitis C as a risk factor for carotid atherosclerosis – a systematic review

Observational studies on the association of chronic hepatitis C with carotid atherosclerosis have yielded varying results. In addition, previous related systematic reviews were limited in synthesis. By more careful selection and further synthesis, we summarize current body of evidence on the relationship between chronic hepatitis C and carotid atherosclerosis. All published observational studies related to the topic identified by systematic searches of PubMed and Scopus were screened based on diagnosis of chronic hepatitis C and diagnosis and estimation of the risk of a carotid atherosclerosis-related outcome. Selected studies were subjected to quality assessment, and eligible studies were used in subsequent narrative and quantitative syntheses. The initial search identified 190 unique publications, which were narrowed by preliminary review to 16 potentially relevant original articles. After quality assessment, seven studies were eligible and were used in narrative synthesis. Five studies assessed the risk of increased carotid intimal media thickening using B mode ultrasonography; five studies assessed the risk of carotid plaque formation using B mode ultrasonography. Five of these studies were used in subsequent meta-analysis. The risk of a person with chronic hepatitis C developing carotid intimal media thickening is about 4·03 times the risk of an uninfected person. The risk of a person with chronic hepatitis C developing carotid plaque is about 3·94 times the risk of an uninfected person. Current evidence shows that hepatitis C virus (HCV) or factors associated with HCV infection can promote the occurrence and progression of carotid atherosclerosis.

A Viral Outcome

Abstract Lichen planus is a muco-cutaneous inflammatory disease of unknown origin which affects various regions of the body, mostly skin and oral mucosa. The association of lichen planus with chronic hepatitis C infection is well known, but a primary presentation of chronic hepatitis C infection with lichen planus is quite rare. In this report, a middle aged woman is presented, who had features of isolated severe ulcerating lichen planus of the tongue in whom an eventual diagnosis of chronic hepatitis C infection was made; one which responded to antiviral therapy. Keywords: Lichen planus, Hepatitis C, tongue lesions, inflammatory lesions, muco-cutaneous disease

Influence of supplementary immunization activities for adults dynamics of chronic disease HBV-infection and its outcomes

Purpose : to evaluate the effect of additional vaccination of adult HBV- infection years 2007–2010 on the incidence of chronic hepatitis B and its outcomes on the example of the Kirov region. Materials and Methods: the evaluation of epidemiological features process in patients with chronic HBV infection in adults, depending on the vaccination carried out on the basis of official data Rospotrebnadzora in Russia and Kirov region on incidence of infectious disease for the period 1999–2012. Diagnosis of chronic hepatitis B was based on clinical and biochemical, instrumental, virological data. Structure outcomes of chronic hepatitis B was studied in 295 patients aged 18–75 years who were hospitalized in the department of viral hepatitis Kirov infectious diseases hospital in 2006–2010. Results: In the Kirov region tended to decrease the incidence of chronic hepatitis B in adults. Additional adult vaccination against hepatitis B has not led to the expected significant decrease of the number of patients with chronic forms. One reason for this is the low (20,3–64%) of the adult population immunization coverage. Chronic HBV- monoinfected was observed in 17.1% , cirrhosis in the outcome of chronic hepatitis B in 5,4% of cases, in hospital mortality from complications of HBV- cirrhosis was 0,7%. Association virus C and D have increased the total cohort, compared to a mono- infection by 3,8% and 0,5% lethality. Conclusion: Additional adult vaccination against hepatitis B in the area has led to a slight decrease in the overall incidence of chronic hepatitis B, but has not reduced the incidence of adverse events – cirrhosis and liver- mediated lethality.

Historical trends and projected hospital admissions for chronic hepatitis C infection in Canada: a birth cohort analysis.

Much of the recent increase in hospital admission rates and mortality associated with hepatitis C in Canada is believed to be because of a higher prevalence of hepatitis C virus infection among those born between 1945 and 1965 (the baby boomer generation). We explored the effects of birth cohort on the rates of and projected trends in hospital admissions associated with hepatitis C. The hospital records of 17344 inpatients with a diagnosis of chronic hepatitis C and liver disease, including liver cancer, were extracted from the Canadian Discharge Abstract Database for April 2004 to March 2011. For each 5-year birth cohort from 1915 to 1984, regression analysis was used to estimate the temporal trends associated with the average age of the cohort during the study period. Future hospital admissions were predicted based on the assumption that past trends would continue. Hospital admissions associated with hepatitis C and liver disease increased an average of 6.0% (95% confidence interval [CI] 4.4%-7.7%) a year over the study period. As of 2010, hospital admission rates were highest for the 1950-1954 and 1955-1959 birth cohorts, at 17.6 (95% CI 13.2-23.5) and 13.7 (95% CI 10.3-18.2) times the rate for the 1970-1974 birth cohort. The corresponding same-age rate ratios predicted under a status quo scenario were 3.6 (95% CI 2.3-4.9) and 3.4 (95% CI 2.1-4.7). Same-age rate ratios were significantly higher for the four 5-year birth cohorts between 1950 and 1969 compared with other birth cohorts. Hospital admissions associated with chronic hepatitis C and liver disease were significantly higher for the 1950-1954 and 1955-1959 birth cohorts than for most other birth cohorts. Without further interventions, the disease burden associated with hepatitis C will continue to increase for most birth cohorts, likely peaking after age 70 years. The substantial disease burden emerging in younger birth cohorts should be monitored.

Long-term prognosis of chronic hepatitis B virus infection in the childhood.

It was aimed to investigate the modes of transmisson and long-term prognosis of the disease in patients who were followed up with a diagnosis of chronic hepatitis B infection. The files of the patients who presented to our outpatient clinic between January 2002 and May 2013 and were being followed up with a diagnosis of chronic hepatitis B virus infection were examined retrospectively and the information related with the age, gender, age at the time of diagnosis, mode of transmission, follow-up period, transaminase levels, the amount of hepatitis B virus-deoxyribonucleic acid and treatment and responses to the treatment given were recorded. The age at the time of diagnosis of 150 patients (97 males, 64%) included in the study was 14.95±2.94 years. 59 (39.3%) of the patients were inactive carriers, 61 (40.7%) were in the immunotolerant stage and 30 (20%) were in the immunoreactive stage. Vertical transmission was present in 86 (57.3%) patients, horizontal transmission was present in 41 patients (27.3%) and the mode of transmission was not known in 23 patients (15.3%). Response to treatment was obtained in 26 (72.2%) of 36 patients who received treatment. Lamivudine (4 mg/kg/day) was given to 29 of the patients who were given treatment, interferon-α (IFN-α) (6 MU/m(2), three days a week) was given to 3 patients at the same dose and both IFN-α and lamivudine were given to 4 patients. The time to give response to treatment was 24.23±15.23 months (6-50 months). Spontaneous anti-HBe seroconversion occured in four (7.2%) of 55 immuntolerant children who were followed up without treatment. The time to development of seroconversion in these children was 2.50±1.91 years (1-5 years). Chronic hepatitis B virus infection has a more benign prognosis in children compared to adults, though it may lead to development of hepatic failure, cirrhosis and hepatocellular cancer. In addition, a decrease in the frequency of infection is expected in children in the years ahead owing to vaccination programs. However, we think that studies related with use of different drugs in patients who do not respond to treatment should be performed.

Childhood Hepatitis in Osh Province of Southern Kyrgyzstan.

ABSTRACTAbbreviations: CHC: Chronic hepatitis C; HCV: Hepatitis C virus; LC: Liver cirrhosis.How to cite this article: Toichuev R, Leybman E, Omorbekova C, Rakhimova G, Zhumabek Kyzy B, Nikolaeva L. Childhood Hepatitis in Osh Province of Southern Kyrgyzstan. Euroasian J Hepato-Gastroenterol 2014;4(2):117-118.

PROSPECTS OF THE USE "STIMFORTE" IN CHRONIC HEPATITIS B

Despite the fact that over the last few years downward trend in the incidence of acute forms of viral hepatitis B continues, the incidence of chronic hepatitis B (CHV) has increased by 2.5 times since 1998. To date, there are a sufficient number of antiviral drugs, but their use is associated with a set of contraindications, as well as the development of resistance. In this study there was performed an evaluation of a new national drug " Stimforte " in patients with chronic viral hepatitis B (CVHB - DNA positive, HBsAg - positive) at the stage of exacerbation. In the study there were included 28 patients with chronic hepatitis B (HBsAg positive), at different grades of activity, at a stage of viral replication. The diagnosis of chronic hepatitis B was made on the presence in a history acute viral hepatitis for more than 1 year, complaints, hepatolienal, astenovegetative, cytolytic syndromes, the presence of DNA-HBV, anti-HBcore IgM, HBsAg. After 1 course of treatment with " Stimforte " the well-being of patients has improved: in 30% of patients asthenic- vegetative syndrome had disappeared, weakness, fatigue and dyspeptic symptoms were decreased. The use of "Stimforte" in chronic hepatitis B with positive HBsAg at the stage of exacerbation contributed to a more rapid normalization of such indices as ALT, AST, compared with those in the control group. Long-term biochemical and virological remission was achieved in 40 %. It is established that during the treatment the viral load was reduced progressively until the undetectable or low level of HBV DNA and anti-HBc IgM disappeared. In only one case an allergic reaction was observed, which has not hindered to perform a complete course of treatment. No other side effects were detected. The inclusion of the drug "Stimforte" in the complex therapy of patients with exacerbation of chronic hepatitis B reduces the time of recovery of immune status and functional activity of IFN system and contributes to reduction of the viral load or elimination of the virus.

Expression of Matrix Metalloproteinase 1( MMP1 ) in Hepatocellular Carcinoma ( HCC ) : Immunohistochemical and Biochemical Studies

Background: The present study aimed to evaluate the expression of Matrix Metalloproteinase-1 (MMP1) in HepatoCellular Carcinoma (HCC) by using the Immunohistochemical technique, which allows us to integrate the biological aspects of this enzymatic expression in the morphological context of HCCs. Material and Methods: The study was performed on 70 subjects from out and in patients of Tropical medicine Department, Thiodor Billhars Institute during the period from January 2011 until June 2012. The present study included 60 patients with chronic hepatitis C who had undergone liver biopsy. They consisted of 42 men and 28 women with ages ranging from 36 to 66 years. The diagnosis of chronic hepatitis C was made on the basis of positivity for anti-HCV (by the second generation ELISA), and confirmed by HCV-RNA reverse transcription polymerase chain reaction (RT-PCR). Patients were divided into four groups: Group I: included 10 normal persons with no history of liver disease with normal liver enzymes and free ultrasonographic finding as normal control. It included 6 males, 4 females, with ages ranging from 34 to 48 years. Group II: included 20 HCV infected patients without cirrhotic changes. It included 11 males, 9 females, with ages ranging from 39 to 53 years. Group III: included 20 HCV infected patients with liver cirrhosis, 12 males, 8 females, with ages ranging from 48-63 years. Group IV: included 20 HCV infected patients with HCC, 16 males, 4 females, with ages ranging from 53-64 years. Results: Blood Picture, (Hb, WBCs, RBCs, Plts, PC and ESR). Liver Function Test (ALT, AST, ALB, GGT, ALP, T. BIL and D. BIL). Matrix Metalloprotenase 1(MMP1) Measurements: Serum MMP1. Histopathological investigation Including histopathological changes in the liver tissue. Conclusion: our results suggest that MMP-1 is overexpressed in a large proportion of patients with HCC and the high expression level of protein correlated with the disease progression and poor clinical outcome in HCC. Furthermore, MMP-1 high expression proved to be a risk factor for tumor recurrence and independent molecular marker of prognosis in HCC and may become a novel target in the strategies for the prediction of tumor progression and prognosis of this disease.