High Prevalence Of Viral Hepatitis Research Articles

The Gender Effect of Health-Related Quality of Life in Hemodialysis Patients

Dear Editor, We read with great interest the recent published outstanding article in your esteemed journal by Rostami et al. (1) entitled “Health-related quality of life in hemodialysis patients: an Iranian multi-center study”. The message of this valuable and huge study focused on drawing the attention to the biographic, socio-economic, and biochemical factors, which can influence on health-related quality of life (HRQoL) of hemodialysis (HD) patients. The impact of gender on quality of life (QoL) has remained a challenge yet. Although Rostami and coworkers (1) showed that men had better QoL than women, other studies found that females had better (2) or equal (3) QoL when compared to males. There are some important subjects to note about gender effects on QoL which can help this matter: 1) higher prevalence and severity of psychological disorders such as major depressive disorder and anxiety disorder in females cause poorer HRQoL in women than men (4). 2) It seems females are more capable than males in providing and receiving emotional support. 3) Women benefit more from family support, but men receive more support from health care professionals (5). 4) Females with chronic kidney disease (CKD) have lower handgrip force, lower exercise tolerance, greater arm fat region, and less muscle area than males (6). 5) Higher prevalence of viral hepatitis in males on hemodialysis (7) can influence HRQoL in them. 6) It has been shown that other chronic disorders in HD patients can influence HRQoL (3). Anyway, it is important to note that there is a different for perception of QoL among various countries, areas, religious, ethnic groups, and races between both genders. It seems that a meta-analysis is needed to evaluate whether gender has any influence on QoL in HD patients. Although Rostami et al. (1) showed no difference between QoL among HD patients with and without diabetes , Anees et al. (8) found the QOL of HD patients with diabetes was poor in comparison to patients without diabetes. In addition, they showed HD patients with non-diabetic causes of CKD had a better QOL in physical health scope than HD patients with diabetes (8). Patients with diabetes have multiorgan damage such as vision and cardiac problem, renal failure, cerebrovascular and peripheral vascular disease, which can lead to amputation and diminished physical health. Moreover, high rate of sleep disorders were demonstrated in patients with diabetes (9). Hence, it seems that HD patients who suffer from diabetes have worse QoL than others. We agree that QoL in HD patients are poorer than normal population. It seems that besides preparing these patients for kidney transplantation and treatment of biochemical disorders, HD patients counseling can improve QoL. Abraham and coworkers (10) conducted a study to evaluate the effect of patients counseling on QoL and concluded patients counseling would improve QoL of HD patients in all domains; therefore, we can help these patients with our attention and counseling in addition to focus on treatment only.

Risk factors for developing hepatocellular carcinoma in Egypt.

Hepatocellular carcinoma (HCC) is a common disorder worldwide and ranks 2nd and 6th most common cancer among men and women in Egypt. HCC has a rising incidence in Egypt mostly due to high prevalence of viral hepatitis and its complications. Proper management requires the interaction of multidisciplinary HCC clinic to choose the most appropriate plan. The different modalities of treatment include resection (surgery or transplantation), local ablation, chemoembolization, radioembolization and molecular targeted therapies. This paper summarizes both the environmental and host related risk factors of HCC in Egypt including well-established risk factors such as hepatitis virus infection, aflatoxin, as well as possible risk factors.

Diabetes mellitus and risk of hepatocellular carcinoma: findings from the Singapore Chinese Health Study

Background:The increasing prevalence of diabetes may contribute to the rising incidence of hepatocellular carcinoma (HCC) in the US and other developed countries where HCC incidence is relatively low. Data from prospective studies on diabetes and risk of HCC in at-risk populations due to high prevalence of viral hepatitis in southeast Asia are sparse.Methods:The Singapore Chinese Health Study is a prospective cohort of 63 257 middle-aged and older Chinese men and women enrolled in 1993–1998. Besides an in-person interview administered to all participants at baseline, testing of serologic markers of hepatitis B or C infections were performed on a subset of cohort subjects. After a mean follow-up of 14 years, 499 cohort participants developed HCC.Results:A history of diabetes at baseline was associated with a hazard ratio of 2.14 (95% confidence interval, 1.69–2.71). This statistically significant association was comparable in magnitude between men and women, and remained equally strong across strata of subjects defined by the number of years between their first clinical diagnosis of diabetes and time of enrolment in this cohort. Within a nested case-control set of cohort subjects tested for serological markers of hepatitis B or C infections, the diabetes–HCC association was found to be present mainly among those devoid of any markers.Conclusion:A history of diabetes at baseline is highly associated with non-viral HCC. Future studies are warranted to elucidate the biological mechanism underpinning the role of diabetes in nonviral-related hepatocarcinogenesis.

FIB-4 Index Is Associated with Hepatocellular Carcinoma Risk in HIV-Infected Patients

Chronic inflammation caused by hepatitis B virus infection, hepatitis C virus infection, and/or heavy alcohol use can lead to fibrosis, cirrhosis, and eventually hepatocellular carcinoma (HCC). FIB-4 is an index score calculated from platelet count, alanine transaminase, aspartate transaminase, and age that predicts fibrosis and cirrhosis. We hypothesized that high FIB-4 would be associated with development of HCC in HIV-infected persons, who are at high risk due to high prevalence of viral hepatitis and alcohol consumption, and possibly due to HIV infection itself. Using proportional hazards models, we tested this hypothesis among 22,980 HIV-infected men from the Veterans Aging Cohort Study. We identified incident HCC cases from the Veterans Affairs Central Cancer Registry. During follow-up, there were 112 incident HCC diagnoses. The age- and race/ethnic group-adjusted HR was 4.2 [95% confidence interval (CI), 2.4-7.4] for intermediate FIB-4 and 13.0 (95% CI, 7.2-23.4) for high FIB-4, compared with low FIB-4. After further adjustment for enrollment year, CD4 count, HIV-1 RNA level, antiretroviral therapy use, hepatitis B and C virus infection, alcohol abuse/dependency, and diabetes, FIB-4 remained a strong, significant, independent risk factor for HCC. The multivariate-adjusted HR was 3.6 (95% CI, 2.1-6.4) for intermediate FIB-4 and 9.6 (95% CI, 5.2-17.4) for high FIB-4. Calculated from routine, noninvasive laboratory tests, FIB-4 is a strong, independent HCC risk factor in HIV-infected patients. FIB-4 might prove valuable as an easily measured index to identify those at highest risk for HCC, even prior to development of clinical cirrhosis.

Association between chronic viral hepatitis infection and breast cancer risk: a nationwide population-based case-control study

BackgroundIn Taiwan, there is a high incidence of breast cancer and a high prevalence of viral hepatitis. In this case-control study, we used a population-based insurance dataset to evaluate whether breast cancer in women is associated with chronic viral hepatitis infection.MethodsFrom the claims data, we identified 1,958 patients with newly diagnosed breast cancer during the period 2000-2008. A randomly selected, age-matched cohort of 7,832 subjects without cancer was selected for comparison. Multivariable logistic regression models were constructed to calculate odds ratios of breast cancer associated with viral hepatitis after adjustment for age, residential area, occupation, urbanization, and income. The age-specific (<50 years and ≥50 years) risk of breast cancer was also evaluated.ResultsThere were no significant differences in the prevalence of hepatitis C virus (HCV) infection, hepatitis B virus (HBV), or the prevalence of combined HBC/HBV infection between breast cancer patients and control subjects (p = 0.48). Multivariable logistic regression analysis, however, revealed that age <50 years was associated with a 2-fold greater risk of developing breast cancer (OR = 2.03, 95% CI = 1.23-3.34).ConclusionsHCV infection, but not HBV infection, appears to be associated with early onset risk of breast cancer in areas endemic for HCV and HBV. This finding needs to be replicated in further studies.

Is Screening for Hepatitis B and Hepatitis C Useful in Patients with Recent-Onset Polyarthritis? The ESPOIR Cohort Study

To evaluate the seroprevalence of hepatitis B (HBV) and C (HCV) in patients living in France with recent-onset polyarthritis suggesting rheumatoid arthritis. The 813 patients in the ESPOIR cohort were screened for anti-HCV antibodies and HBs antigen. Seroprevalence was 0.86% for HCV (n = 7) and 0.12% for HBV (n = 1). HCV-related arthritis was diagnosed in 4 (0.5%) patients; no patient had HBV-related arthritis. HCV-seropositive patients had significantly higher transaminase levels (ALAT, 41.5 IU vs 23.2 IU, p = 0.02; and ASAT, 39.2 IU vs 21.8 IU, p = 0.001) but only 2 patients had ASAT or ALAT levels > 40 IU. No significant differences were found for anti-CCP antibodies, C-reactive protein, erythrocyte sedimentation rate, or other test. HCV seroprevalence was significantly higher in the subgroup with history of blood transfusion than in other patients (3.7% vs 0.42%, p = 0.02). Two of the 7 HCV positive patients and the single patient with confirmed hepatitis B infection were born in areas with higher prevalence of viral hepatitis (Togo, Senegal, Vietnam). Positive hepatitis status was known before study inclusion in 4 of the 7 HCV-positive patients and in the HBV-positive patient. The prevalence of HBV and HCV in a population of patients with recent-onset polyarthritis suggestive of RA was not greater than expected based on data from the general population in the same geographic area. Routine HBV and HCV serological testing did not contribute substantially to the diagnosis of recent-onset polyarthritis. Although advisable before initiating immunosuppressive or hepatotoxic drugs, serological testing for HCV and HBV is unnecessary in routine diagnostic evaluation of recent-onset polyarthritis.

Viral hepatitis and proteinuria in an area endemic for hepatitis B and C infections: another chain of link?

Virus hepatitis may lead to nephropathy as one of its multiple extrahepatic manifestations. Proteinuria by dipstick, a simple test in practice, is a useful and cardinal sign of underlying renal abnormalities. The aim of this study was to elucidate the impact of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infections on the occurrence of proteinuria amongst adults. A prospective, cross-sectional, community-based study was conducted in an HBV/HCV endemic area of southern Taiwan. Eligible subjects aged 40-65 years (n=9934) underwent testing of hepatitis B surface antigen (HBsAg), HCV antibody (anti-HCV) and other related biochemical profiles. Urinalysis with repeated dipstick for proteinuria detection was performed. Anti-HCV-positive rate amongst proteinuria subjects was significantly higher than nonproteinuria subjects (9.6% vs. 6.2%, P<0.001). By contrast, HBsAg-positive rate did not differ between subjects with and without proteinuria (13.0% vs. 13.8%, P=0.57). Prevalence of proteinuria amongst anti-HCV-positive subjects (10.2%) was significantly higher than that in HBsAg-positive subjects (6.4%, P=0.004) and in HBsAg-negative or anti-HCV-negative subjects (7.0%, P=0.004). The difference persisted even after excluding diabetics. Multivariate logistic regression analyses showed that diabetes was the most important significant factor associated with proteinuria, followed by hypertension, anti-HCV seropositivity, body mass index, age and triglyceride levels. We demonstrated the significant association between proteinuria and HCV, but not HBV, infection in this HBV/HCV-endemic area.

Pioglitazone with sulfonylurea: glycemic and lipid effects in Taiwanese type 2 diabetic patients

Although the insulin-sensitizer pioglitazone is effective in improving glycemic control, decreasing triglyceride (TG) and increasing high-density lipoprotein cholesterol (HDL-c), its effects on low-density lipoprotein cholesterol (LDL-c) or total cholesterol (TC) are not consistent [1–6]. Most clinical trials were carried out in white populations and its efficacy and safety in the Taiwanese population with a high prevalence of viral hepatitis is unknown. In order to evaluate the efficacy and safety of pioglitazone in the Taiwanese type 2 diabetic patients, we carried out a small-scale, double-blind, randomized, placebo controlled trial to determine whether the addition of pioglitazone 30mg to existing SU treatment improves glycemic control and lipid profiles in Taiwanese patients with type 2 diabetes.

Pediatric knowledge about acute viral hepatitis.

Knowledge about hepatotropic viruses is crucial for pediatricians because of the high prevalence of viral hepatitis during childhood. The multiplicity of hepatotropic viruses, the spectrum of acute and chronic infections, and the sequels of viral hepatitis result in a need for physicians to better understand the clinical and epidemiological context of patients with viral hepatitis, as well as the importance of prevention measures for hepatitis. A descriptive cross-sectional study was made of pediatrician's knowledge about viral hepatitis, through questionnaires to 574 pediatricians, with no obligation of identification. The pediatricians were recruited among those who attended a national Congress of Pediatrics in Brasília, Brazil. Among these pediatricians, 50.1% frequently treated cases of hepatitis, and 74.7% indicated that they had knowledge of the existence of five hepatotropic viruses; 14.5% knew about at least four types of hepatitis complications, while only 7.7% and 4.3% were able to correctly diagnose viral hepatitis A and B, respectively. Many (28.4%) did not know how to treat the patients adequately. Only 37.5% had already recommended vaccination against hepatitis B. Only 50.2% of the pediatricians had been vaccinated against hepatitis B. We concluded that it is crucial to make pediatricians more knowledgeable about viral hepatitis, through continued education programs, especially emphasizing prevention procedures.

“No-exclusion criteria” for donor referral and utilization of marginal donors—positive effects on liver transplantation in Hong Kong

THE HIGH prevalence of viral hepatitis B and its associated chronic complications in Hong Kong has produced many patients in need of liver transplantation. However, similar to other Asian countries, the persistent shortage of donor livers is a problem. Chinese people have the tradition of not parting with their organs after death. Consequently, requests for organ donation have only been successful in about 25% to 30% of cases during the past few years. Meanwhile, suboptimal management of potential donors has also resulted in graft losses. Potential organ donors are often not admitted to intensive care units, partly due to inadequate resources. Inadequate awareness of organ donation and transplantation within the medical profession has also been reported previously.

Risks of bloodborne diseases to emergency personnel in traumatic wound management.

High prevalence of viral hepatitis, increasing HIV infection and other bloodborne diseases in Taiwan have made the health care provider exposed to an increased risk of disease transmission unless adequate precautions and protections have been undertaken. Furthermore, emergency personnel must face the patient with limited information, and neither a reliable predictor nor appropriate tools have been found to assist in identifying emergency patients who pose a risk. The Centers for Disease Control (CDC) in the United States thus issued a specific caveat advocating all body fluids should be treated as potentially infectious under uncontrolled emergency circumstances. Unfortunately, in Taiwan, personnel in emergency service practice with limited protection, often without mask and only gloves as the only barrier device used. We tried to determine the risk of facial exposure during traumatic wound management. One hundred and fifteen wounds of 107 patients were enrolled. Most of them were not life-threatening and thus could be managed under more controlled conditions. Standard procedures of wound management were applied and facial exposure was assessed after each wound closure. Positive exposure rate in such controlled conditions remained as high as 46/115 (40%). Exposure rate in uncontrolled conditions should be, therefore, much more significant. Therefore, we should put more emphasis on adequate precaution and protection against bloodborne diseases.

Infectious diseases in Africa.

As a result of inadequate surveillance systems and definitive diagnostic standards, it is impossible to quantify the incidence and true pattern of infectious diseases in Africa. Nonetheless, it is clear that viral, bacterial, spirochetal, protozoal, helminthic, and mycotic infections contribute the greatest proportion of health afflictions among all age groups and population subgroups. Particularly alarming is the high prevalence of viral hepatitis in tropical Africa. By the age of 30 years, 70-90% of Africans show indications of past or current hepatitis B virus infection. Scarification, blood sucking vectors, sexual intercourse, and multiple uncontrolled injections are considered the major risk factors associated with this infection, which appears to be etiologically related to primary liver carcinoma. At least 25% of children born to mothers with antigens to hepatitis B become infected. Hepatitis B immunization--demonstrated to be safe and effective in infants as well as adults--is the best strategy to curb the infection rate. Human T-cell lymphotropic retroviruses have a higher prevalence in Africa than any other continent and are linked to T and B-cell neoplasia. In terms of human immunodeficiency virus (HIV) infection, a minimum of 5-10 million Africans are infected and there are well over 100,000 cases of acquired immunodeficiency syndrome (AIDS). The major risk factor for HIV infection is heterosexual promiscuity. Another problematic infection is Lassa fever virus, which can reach epidemic proportions but has not led to significant mortality.

Viral hepatitis in dentists in Norway.

Exceptions have occurred to the generally reported high prevalence of viral hepatitis in dentists. Thus a recent questionnaire survey (1) indicated a low risk of hepatitis in dental professionals in Norway. The present supplementary study was based on frequencies of serological markers of viral hepatitis and disclosed an exposure rate to hepatitis B insignificantly higher than that of the general population. The frequency of antibody to hepatitis A virus was equal to that of the general population.