Non-hepatitis Patients Research Articles

Fatigue and Health-Related Quality of Life among Hepatitis and Non-Hepatitis Patients Undergoing Hemodialysis

Background: A common problem in hemodialysis patients, fatigue is a personal perception of extreme tiredness that impairs their quality of life, physical and mental abilities, activity levels, and performance. Study objective(s): This comprehensive study aims to assess the impact of fatigue on health-related quality of life in hemodialysis patients. Methodology: A descriptive A-non-probability (purposive sample) of (205) male and female hemodialysis patients in AL-Diwaniyah City with end-stage renal disease and undergoing hemodialysis. Most patients were diagnosed with ESRD > one year ago, including those who have been on a maintenance hemodialysis programmer for more than a year. A validated and comprehensive health-related quality of life questionnaire (SF-36) tailored for individuals undergoing hemodialysis was utilized to assess fatigue and health-related quality of life among hepatitis and non-hepatitis patients undergoing hemodialysis. The study was conducted at hemodialysis centers, ensuring representation from different geographic regions and patient populations. Result: A total of 205 hemodialysis patients participated in the study. The results revealed that most participants had moderate fatigue (88 (42.9%), mild fatigue (61 (29.8%), and severe fatigue (56 (27.3%). The patient's overall health-related quality of life was found to be low, with a mean score of 19.82. conclusion: Fatigue is a prevalent symptom in hemodialysis patients, affecting their ability to engage in routine activities and self-care, negatively impacting self-confidence and health-related quality of life. Addressing fatigue is crucial for improving physical well-being and mental health.

SERUM AFP (ALPHA FETO PROTEIN) LEVELS PROFILE OF HEPATOCELLULAR CARCINOMA PATIENTS IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA

Higlight:1. The USG results of AFP level can be used for early detection and therapy of hepatocellular carcinoma that can prevent metastasis, progressivity, and recurrence. 2. The most common patients with high AFP levels are those with hepatitis B depending on etiology, younger age, male, gender, high SGOT level and BCLC B patients.Abstract:Background: Hepatocellular carcinoma (HCC) accounts for more than 90% of liver cancer which is the second most common cause of cancer-related death worldwide. The incidence of HCC was 626.000 cases every year worldwide. Early detection and therapy can prevent metastasis, progressivity, and recurrence. AFP level ≥ 400 ng/ml and USG results can be used as a diagnosis parameter of hepatocellular carcinoma. Objective: To analyze the AFP level’s profile in hepatocellular carcinoma. Materials and Methods: Descriptive methods used in this study with data collected from medical records on patients that fulfilled the inclusion criteria in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia during the periods of 1st January 2013- December 31st 2015. This study used various variables such as age, gender, etiology and size of the tumor, number of a nodule, hepatic function with child classification, staging BCLC, and AFP level. Results: This study found that the 98 patients with hepatocellular carcinoma with high AFP level or >400 ng/ml were dominated by younger patients with average age of 49.91 years, the most common etiology was hepatitis B (56.8%), poor results of laboratory tests (SGOT, SGPT), patients with all level of hepatic function based on Child-Pugh classification and staging B of the tumor (70.5%). Patients with normal AFP ≤20 ng/ml were dominated by female patients, with the most common etiology of fatty liver and others, and with BCLC A and C staging. Descriptively, there was no difference in AFP level based on the number of nodules and size of tumor. Conclusion: The most common patients with high AFP level are those who have hepatitis B as etiology, younger age, male gender, high SGOT level and BCLC B staging. Meanwhile, patients with normal AFP level dominated with female and non-hepatitis patients. In this research, we found no differences of AFP level based on number and size of tumor descriptively.

Two-stage exchange Arthroplasty for knee Periprosthetic joint infection exhibit high infection recurrence rate in patients with chronic viral hepatitis

BackgroundCurrently, there is little evidence about the outcome of two-stage exchange arthroplasty for the treatment of knee periprosthetic joint infection (PJI) in patients with chronic viral hepatitis. To evaluate it, we set the primary outcome as infection recurrence, and the secondary outcome as the difference between patients diagnosed with hepatitis B virus or hepatitis C virus.Patients and methodsBetween June, 2010 and December, 2016, 172 patients with knee PJIs were treated with two-stage exchange arthroplasty at our institute. Treatment success was defined using Delphi-based consensus. These patients were further divided into groups with or without chronic hepatitis. Variables were analyzed, including age, sex, comorbidities, microbiology, and operative methods. Minimum follow-up was 12 months (mean, 35 months; range, 12-85 months).ResultsOf the 172 knee PJI patients, 25 were identified with chronic hepatitis. The infection recurrence rate in the hepatitis group (28%, 7 in 25) was significantly higher than that in the non-hepatitis group (9.5%, 14 in 147), p = 0.017. However, there was no significant difference in the infection recurrence rates between patients with HBV (24%, 4 in 16) and HCV (33.3%, 3 in 9). Regarding the outcomes of patients with infection recurrence, 4 of the non-hepatitis patients were treated with the debridement, antibiotic treatment, irrigation, and retention of prosthesis (DAIR) procedure, with a success rate of 75%. The other 17 patients (7 with hepatitis and 10 without) were treated with repeated two-stage exchange arthroplasty with 100% infection elimination rate until the final follow-up.ConclusionsKnee PJI patients with chronic hepatitis have higher infection recurrence rate after two-stage exchange arthroplasty (28%).

The value of anti-rods and rings antibodies in patients with nonhepatitis virus infection: A single-center retrospective study from Southwest China.

The aim of this study was to retrospectively investigate the clinical significance of anti-rods and rings (anti-RR) antibodies in nonhepatitis virus infection patients from Southwest China.Anti-RR antibodies were determined by indirect immunofluorescence assay in a group of 19,935 individuals with antinuclear antibodies test from January 2017 to December 2019. The laboratory and clinical data were collected. Finally, 66 samples with anti-RR antibodies (0.33%) were detected.In Wilcoxon rank sum test, gamma glutamyl transferase (Z = −3.364, P = .001), alpha-l-fucosidase (AFU) (Z = −2.312, P = .021), uric acid (Z = −1.634, P = .047) and red blood cell distribution width (Z = −2.285, P = .022) were higher in metabolic disease group than nonmetabolic disease group. In independent-samples t test, endogenous creatinine clearance was higher in metabolic disease group than nonmetabolic disease group (t = 2.061, P = .045). During the follow-up period of 37 patients with anti-RR antibodies for 1 to 60 months, the titers of anti-RR were significantly increased in the metabolic disease group (Z = −2.346, P = .019). In binary logistic regression analysis, triglycerides (odds ratio 3.679, 95% confidence interval 1.467–24.779, P = .048) was associated with elevated titers of anti-RR antibodies.In summary, anti-RR in non-hepatitis patients may be a manifestation of metabolic disorders, and has a certain correlation with routine laboratory indicators, which is worthy of the attention from clinicians.

Effects of HBV and HCV infection on oxidative stress and inflammation in hemodialysis patients

Background and purpose: Chronic renal failure is a syndrome characterized by progressive and irreversible loss of nephrons depending on various diseases. Especially infection such as HBV and HCV is among the major causes of mortality and morbidity in hemodialysis patients. In the present study we aimed to determine the levels of 3-nitrotyrosine (3-NT), TNF-like weak inducer of apoptosis (TWEAK) and heat shock protein (HSP70) in chronic renal failure patients diagnosed with HBV, HCV and non-hepatitis undergoing hemodialysis treatment. Materials and methods: Samples of 235-patients receiving hemodialysis treatment and 25-healthy individuals were included in the study. Firstly, HBV and HCV positivity were diagnosed by serological Enzyme-Linked ImmunuSorbent Assay (ELISA) method. Then, 3-NT levels were determined using High-Performance Liquid Chromatography (HPLC), while TWEAK and HSP70 were determined using high sensitivity ELISA. The numbers of patients used in the studies were determined according to statistical power analysis.Results: The values of 3-NT and HSP70 were found to be significantly higher non-hepatitis patients, HBV and HCV patients receiving hemodialysis treatment to compared with the control group (p‹0.05). Concentration of TWEAK in non-hepatitis and HBV patients receiving hemodialysis therapy was found to be significantly higher to compared with the control group (p‹0.05). However, unlike the other two groups, an increase in the TWEAK of HCV patients on post-dialysis was determined.Conclusions: To prevent the increase of inflammation and oxidative stress in hemodialysis patients or to keep it under control, investigating certain parameters such as TWEAK, 3-NT and HSP70 from time to time is of great importance in terms of minimizing the level of risk for many diseases such as cardiovascular diseases. Infection also increases the burden on oxidative stress and immunity system in these patients.

MicroRNAs versus traditional biomarkers in predicting reperfusion injury in Hepatitis C Patients after major surgery

Background: Exposure to anesthesia in patients with chronic hepatitis C (CHC) may induce hepatic ischemia / reperfusion (I/R) with subsequent biochemical changes, provoked by alteration in molecular processes. This study explored miR-122 and miR-223 expression changes induced by anesthesia in CHC patients and their role in predicting hepatic I/R injury. Methods: This study included two hundered ASA II - III adult patients, scheduled for major surgery under general anesthesia. Patients were divided into 2 main groups; CHC patients group and non-hepatitis patients group. Each group was further divided into 2 equal subgroups (50 patients each) according to type of anesthesia received either Sevoflurane SC /S or Propofol PC/P ). Blood samples were analyzed for liver enzymes, prothrombin time, and serum lactate at several intervals; preoperative, 12 and 48 hours postoperative. Also, plasma miR-122 and miR-223 were estimated by Reverse Transcription PCR preoperative and 12 hours postoperative.Results: CHC groups showed significantly increased preoperative expression of both miR-122 and miR-223 compared to non-hepatitis groups (P<0.05). Moreover, postoperative samples revealed more exaggerated expression miR-122 and miR-223. Receiver operating characteristic curve (ROC) results revealed;values for area under the ROC for miR-122, miR-223, ALT and serum Lactate were 0.991, 0.965, 0.746 and 0.732 respectively. Based on the ROC finding, for prediction IR in CHC patients receiving anesthesia miR-122 had best Accuracy, sensitivity, and specificity.Conclusion: Our results suggested that both miR-122 and miR-223 could be regarded as more sensitive and specific biomarkers for predicting hepatic I/R injury than traditional biomarkers particularly in CHC patients undergoing major surgery. DOI: 10.21276/APALM.1718

Different Impacts of Hepatitis B Virus and Hepatitis C Virus on the Outcome of Kidney Transplantation

Previous studies had shown that HBV and HCV infections lead to increased morbidity and mortality after kidney transplantation when compared with the nonhepatitis group. However, few studies have compared the impact among a population with a high prevalence of HBV and HCV infections. We studied the outcomes of 346 recipients including 23 HBsAg (+) patients (6.6%; group 1), 22 patients with anti-HCV+ (6.3%, group 2), and 301 nonhepatitis patients (group 3) in a single center during a 6-year period. No patient had evidence of precirrhosis or cirrhosis before transplant. The primary end point was graft and patient survival rates. Secondary end point was the rate of progression of chronic allograft, nephropathy. The median follow-up time was 3.7 (0.5–6.8) years. Five-year actuarial graft survival was 80% for group 1, 61% for group 2, and 88 % for group 3 ( P = .005). Cox regression showed HCV (hazards ratio 2.96; 95% CI = 1.03–8.51) and acute rejection episode (HR 3.01; 95%CI = 1.86–4.87) to be significant predictors of graft survival. Actuarial 5-year patient survival of group 1 was significantly lower than group 2 or group 3 (79 % vs 89% and 96%; P = .003). Cox regression revealed that the hazards ratio of HBV for death was 7.63 (95%CI = 1.88–30.86; P = .004). In contrast, HCV infection had no significant effect on patient survival (HR 1.59; 95%CI = 0.28–9.02). The rate of chronic allograft nephropathy progression was significantly faster in group 1 (−6.74 mL/min per year) and group 2 (−6.14 mL/min per year) than the controls. We concluded that HBV infection decreased patient survival earlier than HCV and that HCV decreased graft survival more significantly than HBV. Both HBV and HCV were associated with rapid progression of chronic allograft nephropathy. HBV was the strongest risk factor for mortality compared with HCV, with acute rejection episode, with diabetes mellitus, or other hazardous factors.

Investigation of HGV and TTV infection in sera and saliva from non-hepatitis patients with oral diseases.

To determine the frequencies of HGV and TTV infections in serum and saliva samples of non-hepatitis patients with oral diseases in Hangzhou area, and to understand the correlation between detected results of HGV RNA and/or TTV DNA in sera and in saliva from the same patients. RT-nested PCR for HGV RNA detection and semi-nested PCR for TTV DNA detection were performed in the serum and saliva samples from 226 non-hepatitis patients with oral diseases, and nucleotide sequence analysis. Twenty-seven (11.9 %) and 21 (9.3 %) of the 226 serum samples were only positive for HGV RNA and TTV DNA, respectively. 10 (4.4 %) and 9 (3.9 %) of the 226 saliva samples were only positive for HGV RNA and TTV DNA, respectively. And 7 (3.1 %) of the serum samples and 2 (0.9 %) of the saliva samples showed the positive amplification results for both HGV RNA and TTV DNA. 12 saliva samples from the 34 patients (35.3 %) with HGV or HGV/TTV viremia and 11 saliva samples from the 28 patients (39.3 %) with TTV or HGV/TTV viremia were HGV RNA detectable, respectively, including two patients positive for both HGV RNA and TTV DNA in serum and saliva samples. No saliva samples from the 226 patients were found to be HGV RNA or TTV DNA detectable while their serum samples were negative for HGV or TTV. Homologies of the nucleotide sequences of HGV and TTV amplification products from the serum and saliva samples of the two patients compared with the reported sequences were 88.65-91.49 % and 65.32-66.67 %, respectively. In comparison with the nucleotide sequences of amplification products between serum and from saliva sample from any one of the two patients, the homologies were 98.58 % and 99.29 % for HGV, and were 98.65 % and 98.20 % for TTV, respectively. Relatively high carrying rates of HGV and/or TTV in the sera of non-hepatitis patients with oral diseases in Hangzhou area are demonstrated. Parts of the carriers are HGV and/or TTV positive in their saliva. The results of this study indicate that dentists may be one of the populations with high risk for HGV and/or TTV infection, and by way of saliva HGV and TTV may be transmitted among individuals.

Impact of hepatitis on renal transplantation.

In order to delineate the incidence, etiology, and impact of liver disease in renal transplant patients, we reviewed 405 consecutive transplants performed between 1970 and 1980. Hepatic dysfunction of at least 2 weeks' duration was diagnosed in 42 patients (10.4%). Of 28 patients acquiring hepatitis in the first post-transplant year, 26 (92.8%) developed chronic hepatitis; of 14 acquiring hepatitis after the first year, 9 (64.2%) developed chronic hepatitis. Of the 42 patients, 19 (45.2%) died, as compared with 16% of the nonhepatitis patients (P less than 0.001). Only one of these patients died of liver failure, with 15 of the 19 (78.9%) dying of extrahepatic infection. In addition, 12 of the 23 survivors (52.1%) suffered life-threatening infections from which they recovered, as compared with 20% of the nonhepatitis patients (P less than 0.01). Conversely, graft survival was significantly increased among the hepatitis patients (73% 1-year cadaveric allograft survival as compared with 50% for the nonhepatitis patients (P less than 0.01)). The etiology of the liver disease was identified in the minority of patients: 5 (11.9%) with hepatitis B, with none occurring since 1973; 10 (23.8%) with evidence of cytomegalovirus infection; and 1 (2.3%) with azathioprine toxicity. We conclude that the major cause of liver disease in renal transplant patients is non-A, non-B hepatitis, and furthermore, that this disease has a marked immunosuppressing effect resulting in increased allograft survival and a marked increase of life-threatening extrahepatic infection.

Patterns of “Lipovirus” Antibody in Human Populations

Summary Lipovirus antibody in human and animal sera was surveyed using the newly devised sensitized erythrocyte agglutination and complement-fixation tests. The following pertinent results were obtained: Fifty-nine per cent of 332 serum samples from the general population in the Boston area were positive for lipovirus antibody. The highest incidence of positives occurred in the 5- to 9.9-year-old group (83%) and the lowest in the 1-year-old group (33%) and in those over 40 years of age (24%).The incidence of positives as well as the antibody titers in 28 infectious hepatitis patients belonging to two noninstitutional epidemics, and in five sporadic cases, were significantly higher than those of the nonhepatitis patients of comparable age.In the Ely, Nevada, hepatitis epidemic, the incidence of positives or antibody titers were not higher than in the nonhepatitis population.No lipovirus antibody was demonstrated in the sera of two serum hepatitis patients.Sera from 27 guinea pigs, 10 white Swiss mice, 6 rats, 6 hamsters and an unknown number of calves were negative for lipovirus antibody. One of 56 rabbit sera gave positive SEA test. Five of 27 chick sera were positive in the SEA test; the agglutination was, however, weak and inconsistent. Four of nine horse sera agglutinated lipovirus-sensitized erythrocytes at dilutions of 1:160 to 1:640, but their CF antibody titers were low. It is concluded that the lipovirus is a common infectious agent of man or is antigenically related to a common human pathogen, and that the lipovirus is immunologically related to an agent capable of causing infectious hepatitis in man.