Hepatitis Patients Research Articles

ANXA4 restricts HBV replication by inhibiting autophagic degradation of MCM2 in chronic hepatitis B

BackgroundHepatitis B virus (HBV) is an enveloped DNA virus that causes chronic hepatitis B (CHB) infection. Annexin, a Ca2+-activated protein, is widely expressed in various organs and tissues and has potential utility in disease diagnosis and treatment. However, the relationship between the annexin family and CHB remains unclear.MethodsClinical samples from hepatitis patients and donors or healthy individuals were collected. Transcriptome sequencing in CHB liver tissues and HBV-infected cells were performed. HepG2.2.15 cells with the full-length HBV genome and HBV-infected HepG2-NTCP cell models were established. HBV-infected mouse model was constructed and adeno-associated virus was utilized.ResultsANXA4 expression was elevated during CHB infection. ANXA4 knockdown promoted HBV replication and aggravated liver injury, while ANXA4 overexpression alleviated that. Mechanistically, autophagy pathway was activated by ANXA4 deficiency, promoting autophagic degradation of minichromosome maintenance complex component 2 (MCM2). MCM2 inhibition activated HBV replication, while MCM2 overexpression attenuated ANXA4 deficiency-induced HBV replication and liver injury. Clinically, the expression of hepatitis B viral protein was negatively correlated with the ANXA4 levels, and CHB patients with high ANXA4 levels (> 8 ng/ml) showed higher sensitivity to interferon therapy.ConclusionsANXA4 functions as a protective factor during HBV infection. ANXA4 expression is elevated under HBV attack to restrict HBV replication by inhibiting autophagic degradation of MCM2, thereby alleviating liver injury and suppressing the CHB infection process. ANXA4 also enhances the sensitivity of CHB patients to interferon therapy. Therefore, ANXA4 is expected to be a new target for CHB treatment and prognostic evaluation.Graphical

Is ChatGPT a reliable tool in Autoimmune Hepatitis?

Artificial intelligence-based chatbots offer a potential avenue for delivering personalized counselling to Autoimmune Hepatitis (AIH) patients. We assessed accuracy, completeness, comprehensiveness and safety of ChatGPT-4 responses to 12 inquiries out of a pool of 40 questions posed by four AIH patients. Questions were categorized into three areas: Diagnosis(1-3), Quality of Life(4-8) and Medical treatment(9-12). 11 Key Opinion Leaders (KOLs) evaluated responses using a Likert scale with 6 points for accuracy, 5 points for safety and 3 points for completeness and comprehensiveness. Median scores for accuracy, completeness, comprehensiveness and safety were 5(4-6), 2 (2-2) and 3 (2-3); no domain exhibited superior evaluation. Post-diagnosis follow-up question was the trickiest with low accuracy and completeness but safe and comprehensive features. Agreement among KOLs (Fleiss's Kappa statistics) was slight for accuracy (0.05) but poor for the remaining features (-0.05, -0.06 and -0,02, respectively). Chatbots show good comprehensibility but lack reliability. Further studies are needed to integrate Chat-GPT within clinical practice.

Clinical validation of peripheral blood mononuclear cell DNA methylation markers for accurate early detection of hepatocellular carcinoma in Asian patients

BackgroundHepatocellular carcinoma (HCC), a leading cause of cancer-related deaths globally, poses significant challenges in early detection. Improved diagnostic accuracy can drastically influence patient outcomes, emphasizing the need for innovative, non-invasive biomarkers.Methods:This study utilized a cohort of 402 participants, including healthy controls, chronic hepatitis patients, and HCC patients from Bangladesh, to evaluate DNA methylation signatures in peripheral blood mononuclear cells (PBMC). We performed targeted next-generation sequencing on selected genes previously identified to assess their methylation dynamics. The development of M8 and M4 scores was based on these dynamics, using Receiver Operating Characteristic (ROC) analysis to determine their effectiveness in detecting early-stage HCC alongside existing markers such as epiLiver and alpha-fetoprotein (AFP).Results:Integration of M8 and M4 scores with epiLiver and AFP significantly enhances diagnostic sensitivity for early-stage HCC. The M4+epiLiver score achieves a sensitivity of 79.4% in Stage A HCC, while combining M4 with AFP increases sensitivity to 88.2–95.7% across all stages, indicating a superior diagnostic performance compared to each marker used alone.Conclusions:Our study confirms that combining gene methylation profiles with established diagnostic markers substantially improves the sensitivity of detecting early-stage HCC. This integrated diagnostic approach holds promise for advancing non-invasive cancer diagnostics, potentially leading to earlier treatment interventions and improved survival rates for high-risk patients.

Increased Risk of Non-Hodgkin Lymphoma in Autoimmune Hepatitis: A Large Retrospective Cohort Study.

Background/Objectives: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease caused by an autoimmune attack on hepatocytes. The first-line treatment for AIH comprises two core components: glucocorticoids and thiopurine analog inhibitors and mycophenolate mofetil (MMF). Numerous studies have suggested an increased risk for lymphoma among patients with either rheumatoid arthritis or inflammatory bowel disease (IBD) who are treated with azathioprine/6-mercaptopurine (6-MP). The relative risk of non-Hodgkin lymphoma (NHL) among autoimmune hepatitis patients treated with these immunosuppressive drugs remains unclear. We aimed at investigating the risk of NHL across a large retrospective AIH cohort after a long-term follow-up. Methods: This retrospective, population-based study comprised approximately 2.7 million adults over two decades. It included adult patients aged 20 years or older at the time of autoimmune hepatitis diagnosis who had initiated treatment with azathioprine, 6-MP, or MMF. The primary outcome was the development of non-Hodgkin lymphoma. Results: The study initially included 834 patients diagnosed with AIH. A total of 685 patients remained in the research cohort after matching the data to the local cancer registry. Compared to the predicted NHL rate in the general population, NHL incidence was considerably higher in AIH patients (Standardized Incidence Ratio, SIR = 36.5). Subgroup studies showed that lymphoma mainly affected patients 45 years of age and over and was detected primarily during the first seven years following the AIH diagnosis. No correlation was found between the incidence of NHL and the treatment drug used. Conclusions: Patients with AIH exhibit a markedly higher risk of NHL compared to the general population.

Toward Universal Health Coverage: What Socioeconomic and Clinical Factors Influence Health Insurance Coverage and Restrictions in Access to Viral Hepatitis Services in Nasarawa State, Nigeria?

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36-40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38-50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67-65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85-87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55-10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO's 2030 elimination goals.

Real-world trends in acute viral hepatitis in Japan: A nationwide questionnaire-based survey.

The actual incidence of acute viral hepatitis in Japan remains unclear. We aimed to investigate trends in the incidence of acute hepatitisB and C infections in Japan. A nationwide, multicenter, retrospective questionnaire-based survey was conducted. Participating hospitals received questionnaires through nationwide geographically distributed regional core centers certified as specialists in hepatitis treatment. The questionnaire included hospital size and the number of patients diagnosed with acute hepatitisB or C during each fiscal year (FY) from 2015 to 2022. The sex distribution in each FY was also documented. Comparisons were made before and during the COVID-19 era (2015-2019 vs. 2020-2022), and between populous and non-populous prefectures. Responses to the questionnaires were obtained from 127 institutions in 29 prefectures covering eight regions in Japan. A median of 127.0 patients with acute hepatitisB (interquartile range [IQR] 106.5-131.8 patients) were reported during each FY, and the incidence significantly decreased during the fiscal years 2020-2022 compared with the fiscal years 2015-2020 (median 96.0 [IQR 91.0-103.0] patients vs. 131.0 [IQR 128.0-134.0] patients; p=0.03). A median of 10.0 (IQR, 7.8-13.5) patients were reported with acute hepatitisC during each FY. The proportions of men in acute hepatitis B and C were significantly higher in populous prefectures. Populous prefectures had a higher proportion of men among viral hepatitis patients than non-populous prefectures. Estimating the high-risk populations in each area could provide insights to advance the elimination of viral hepatitis.

Development and validation of a prognostic score for TIPS placement in patients with viral hepatitis cirrhosis-related portal hypertension: a multi-center retrospective study.

There is no established scoring model focused on viral hepatitis patients to predict the prognosis after transjugular intrahepatic portosystemic shunt (TIPS). We aimed to develop and validate a novel model based on the largest cohort for better prediction of both short-term (1 year) and long-term (3 years) postoperative prognoses after TIPS in viral hepatitis cirrhosis-related portal hypertension patients. A total of 925 viral hepatitis cirrhosis-related portal hypertension patients who underwent TIPS from nine hospitals were divided into the training and external validation cohorts. A novel Viral-associated Index of Post-TIPS score (VIPs) model was developed after performing Cox regression analysis. The VIPs model was compared to five previous models, namely, Child-Pugh, MELD, ALBI, CCG, and FIPS. Furthermore, X-tile software was used to stratify patients into low-, medium-, and high-risk groups. The VIPs model included age, ascites, albumin, prothrombin time, total bilirubin, and sodium for post-TIPS prognosis prediction. The model demonstrated satisfying predictive efficiency in both discrimination and calibration, with an area under the curve of 0.781/0.774 (1 year/3 years) in the training cohort and 0.771/0.775 (1 year/3 years) in the external validation cohort, respectively. We first developed and externally validated a novel VIPs model for better prediction of both short-term and long-term postoperative prognoses after TIPS in Chinese patients with viral hepatitis cirrhosis-related portal hypertension.

Psychological Distress and Quality of Life in Hepatitis Patients: The Mediating Role of Hope

This study examined the association between psychological distress, hope, and quality of life in patients with hepatitis. A correlational research design was employed, and 200 hepatitis patients (100 males &amp; 100 females) were chosen using purposive sampling from various hospitals in Faisalabad city. The variables were evaluated using the Kessler psychological distress scale, hope index, and quality of life scale. The data was analyzed using the Statistical Package for Social Sciences (SPSS). The results indicate a substantial negative association between psychological distress and both hope and quality of life, and a strong positive association between hope and life quality. The finding of the mediation analysis also showed that hope was a significant partial mediator in the association between psychological distress and quality of life. The t-test analysis revealed no statistically significant variations in the mean scores for psychological distress, hope, and quality of life between man and women hepatitis patients. The findings of the present research have implications for a range of health-related areas, including the use of the study findings by healthcare professionals in treating patients suffering from life-threatening chronic conditions such as hepatitis.

Evaluation of autoimmune liver disease antibodies in hepatitis patients.

Autoimmune hepatitis (AIH) is characterized by the presence of auto-antibodies and high blood immunoglobulin G (IgG) levels. In this study, the line immunoassay (LIA) was designed to assess various autoantibodies. In total, 1371 patients who underwent autoimmune liver disease antibody testing between July 2019 and November 2022 were enrolled. Autoantibodies including antinuclear antibody (ANA) and anti-mitochondrial antibody (AMA) were tested, and clinical data were collected. Statistical analyses were performed by categorizing the data based on diagnosis and IgG quantification separately. A scoring system was applied to identify individuals with AIH. Patients were also classified into the AIH and non-AIH groups. The positivity rate for ANA was 80.2% in the AIH group. The IgG-high group had a high likelihood of the presence of detectable autoantibodies, with anti-Ro-52 being the most frequently detected antibody using LIA. The "Consider AIH" and "AMA" groups had 3-4 times more patients in the IgG-high group than in the "Not Considered" group. Among autoantibodies, the prevalence of ANA was the highest. As per LIA results, anti-Ro-52 was the most prevalent. AIH cannot be diagnosed based on IgG levels alone and must be distinguished via autoantibody testing. Therefore, extensive testing, including autoantibodies, IgG, ANA, and liver enzyme levels, will help accurately diagnose AIH.

Sarcopenia, frailty and growth hormone-insulin like growth factor axis among decompensated and alcohol-associated hepatitis patients

Sarcopenia, frailty and growth hormone-insulin like growth factor axis among decompensated and alcohol-associated hepatitis patients

Predictors of survival for severe alcoholic hepatitis patients treated with low volume centrifugal plasma exchange and low dose steroid

Predictors of survival for severe alcoholic hepatitis patients treated with low volume centrifugal plasma exchange and low dose steroid

Worse fibro-inflammatory activity on diagnostic liver biopsy adversely impacts biochemical remission in autoimmune hepatitis

BackgroundAutoimmune hepatitis (AIH) patients can present with advanced fibrosis at diagnosis or may progress to the same if biochemical remission on treatment is not achieved. MethodsWe conducted a single-center retrospective analysis of 34 pediatrics and 39 adult AIH patients. Three pathologists, blinded to clinical information, reviewed the diagnostic liver biopsy (DLB) slides of AIH patients. We evaluated the impact of clinical, laboratory, and histopathologic parameters on outcomes including biochemical remission (BR). ResultsIncidence of advanced (Ludwig stage 3 or 4) fibrosis on DLB was 45.2 %. AIH patients with advanced fibrosis had higher median Ishak score (p < 0.001) and higher IgG level (p = 0.01) at diagnosis. The incidence of BR at 6-month (31.2% vs. 88.6 %, p = 0.001) and 1-year (68.8% vs. 88.6 %, p = 0.04) post-diagnosis was significantly lower in AIH patients with advanced fibrosis. Although not statistically significant, a higher proportion of AIH patients with advanced fibrosis were on high dose of steroids (58% vs. 37.9 %, p = 0.1) at 1 year post diagnosis. Higher serum IgG level at diagnosis was associated with lower odds of achieving BR at 6-month (p = 0.004) and 1-year (p = 0.03) post-diagnosis in multivariate analysis. Pediatric age at diagnosis (p = 0.02) was associated with higher steroid dose at 1-year post-diagnosis in univariate analysis. ConclusionsFindings of advanced fibrosis on DLB of AIH patients was accompanied by more pronounced necro-inflammatory activity and higher serum IgG level, which translated to lower rates of BR and higher exposure to steroids during the first year after diagnosis.

Liver stiffness in hepatocellular carcinoma and chronic hepatitis patients: Hepatitis B virus infection and transaminases should be considered.

Liver condition is a crucial prognostic factor for patients with hepatocellular carcinoma (HCC), but a convenient and comprehensive method to assess liver condition is lacking. Liver stiffness (LS) measured by two-dimensional shear wave elastography may help in assessing liver fibrosis and liver condition. Chronic hepatitis B (CHB) is an important risk factor for HCC progression, but LS was found to be less reliable in assessing liver fibrosis following hepatitis viral eradication. We hypothesize that the status of hepatitis virus infection would affect the accuracy of LS in assessing the liver condition. To test the feasibility and impact factors of using LS to assess liver condition in patients with HCC and CHB. A total of 284 patients were retrospectively recruited and classified into two groups on the basis of serum CHB virus hepatitis B virus (HBV)-DNA levels [HBV-DNA ≥ 100.00 IU/mL as Pos group (n = 200) and < 100.00 IU/mL as Neg group (n = 84)]. Correlation analyses and receiver operating characteristic analyses were conducted to evaluate the relationship between LS and liver condition. A significant correlation was found between LS and most of the parameters considered to have the ability to evaluate liver condition (P < 0.05). When alanine aminotransferase (ALT) concentrations were normal (≤ 40 U/L), LS was correlated with liver condition indices (P < 0.05), but the optimal cutoff of LS to identify a Child-Pugh score of 5 was higher in the Neg group (9.30 kPa) than the Pos group (7.40 kPa). When ALT levels were elevated (> 40 U/L), the correlations between LS and liver condition indices were not significant (P > 0.05). LS was significantly correlated with most liver condition indices in patients with CHB and HCC. However, these correlations varied according to differences in HBV-DNA and transaminase concentrations.

Assessing Hepatitis Awareness in Punjab: A Comprehensive Study on Public Service Message Effectiveness, Knowledge, and Health Beliefs

The study assessed the effectiveness of public service messages on hepatitis in Punjab, Pakistan, focusing on knowledge, preventive measures, and health beliefs using the Health Belief Model. The study utilized a multistage sampling technique and systematic random sampling to survey 760 respondents, including 384 general population members and 376 hepatitis patients, from the top five districts with the most common hepatitis, finding that public service messages’ effectiveness was insignificant among Hepatitis negative and hepatitis patients. The study found significant differences in knowledge about hepatitis among demographic variables such as age, background, educational qualification, respondent type, family history, and participation in health awareness activities, as tested through ANOVA and Pearson Chi-square tests. Moreover, the perceived susceptibility and perceived severity of hepatitis had a significant impact (R 2 =.635, F = 605.71, β1 =.36, β2 =.58, p-value =0.000 < 0.05.) on preventive measures to avoid hepatitis. The perceived barriers and perceived benefits of hepatitis had a significant impact (R 2 =.407, F = 238.96, β1 =.56, β2 = −.42, p-value =0.000) on the self-efficacy to execute positive behavior toward avoiding hepatitis. Perceived barriers negatively impact self-efficacy, while media exposure and health-related awareness about hepatitis do not significantly influence its knowledge.

Clinical, Biochemical, Serological, Virological and Sonological Profile of Newly Diagnosed Patients of Chronic Hepatitis B Virus Infection – 422 Cases

Introduction: This retrospective study was done to see biochemical, serological and sonological status of newly diagnosed hepatitis B virus infected patients. Material and methods: Consecutive newly detected patients of chronic hepatitis B were included. Their epidemiological, clinical, biochemical, serological and sonographic findings were recorded. Data were analysed using (SPSS version20). Mean and percentage were calculated for continuous and categorical data respectively. Chi-square test was done and P value &gt; 0.05 was taken as significant. Result: Total 422 patients, age from 11 to 75 years (mean 33.4) were included. Of them 317 (75.1%) and 105 (24.9%) were male and female respectively. Of them 320 (75.8%) were from rural areas, 253 (60.0%) were poor. Among them 216(51.18%) were detected during medical checkup for foreign job. And 173 (40.88%) had history saloon shave. In this series 144 (34.12%) patients were below 25 years and 216(51.18%) patients were within 26 to 45 years age group . ALT of patients varied from 10 iu/dl to 715 iu /dl (mean 51.63±48.40). Around50.5 % (n=213) had ALT within normal range (up to 40 iu/dl). HBeAg was positive in 97 (23.4%) patients. Hepatitis DNA (PCR) was not detectable in 135(32%) patients while it was above 100,000 copies / dl in 107(24.4%) patients. In this study 175 (53.84%) of patients with HBeAg negative had normal ALT and 83(61.48%) of patients with undetectable HBV DNA had normal ALT. Sonological examination was normal in 221 (%). Chronic liver disease, Hepatocellular carcinoma, ascites, fatty liver disease were detected in 60, 06(1.4%), 14 &amp; 75 cases respectively. In this series, significant difference was found in DNA level (P= 0.029), hypertension status (P=0.013), ALT levels (P=0.00) and HBeAg status (P=0.000)in between sexes. HBeAg also varied significantly with ALT levels (P=0.011). ALT level also varied significantly between sexes (p= 0.00). Conclusion: Newly detected asymptomatic or symptomatic patients of chronic hepatitis B virus infected patients may have significant biochemical and serological viral activity requiring antiviral treatment. So mass screening and early detection of disease activity may improve outcome.

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 &gt; 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.

Evolving trends and outcomes on the US liver transplant waitlist of alcohol-associated hepatitis patients with very high MELD scores.

Liver transplantation (LT) in patients with alcohol-associated hepatitis (AH) has rapidly increased following the coronavirus disease 2019 pandemic and the implementation of the Acuity Circle policy, raising questions of equity and utility. Waitlist mortality among high (≥37) Model for End-Stage Liver Disease LT candidates with AH and post-transplant survival were assessed with a semiparametric survival regression and a generalized linear mixed-effect model with LT centre- and listing date-level random intercepts. These models demonstrate a lower mortality for the candidates listed with AH (adjusted sub-hazard ratio .58_.72_.90 and odds ratio .44_.66_.99) when compared to other diagnoses (autoimmune hepatitis, metabolic dysfunction-associated fatty liver disease and primary biliary cholangitis). Post-LT survival was comparable. This study highlights the limitations of current tools in characterizing the risk of mortality, and thus need for the modifications in prioritizing LT candidates with AH. Policy revision may be needed to ensure equivalent access to LT regardless of diagnosis.

Idiosyncratic Drug-Induced Liver Injury and Amoxicillin-Clavulanate: Spotlight on Gut Microbiota, Fecal Metabolome and Bile Acid Profile in Patients.

Several hepatic disorders are influenced by gut microbiota, but its role in idiosyncratic drug-induced liver injury (iDILI), whose main causative agent is amoxicillin-clavulanate, remains unknown. This pioneering study aims to unravel particular patterns of gut microbiota composition and associated metabolites in iDILI and iDILI patients by amoxicillin-clavulanate (iDILI-AC). Thus, serum and fecal samples from 46 patients were divided into three study groups: healthy controls (n = 10), non-iDILI acute hepatitis (n = 12) and iDILI patients (n = 24). To evaluate the amoxicillin-clavulanate effect, iDILI patients were separated into two subgroups: iDILI non-caused by amoxicillin-clavulanate (iDILI-nonAC) (n = 18) and iDILI-AC patients (n = 6). Gut microbiota composition and fecal metabolome plus serum and fecal bile acid (BA) analyses were performed, along with correlation analyses. iDILI patients presented a particular microbiome profile associated with reduced fecal secondary BAs and fecal metabolites linked to lower inflammation, such as dodecanedioic acid and pyridoxamine. Moreover, certain taxa like Barnesiella, Clostridia UCG-014 and Eubacterium spp. correlated with significant metabolites and BAs. Additionally, comparisons between iDILI-nonAC and iDILI-AC groups unraveled unique features associated with iDILI when caused by amoxicillin-clavulanate. In conclusion, specific gut microbiota profiles in iDILI and iDILI-AC patients were associated with particular metabolic and BA status, which could affect disease onset and progression.

Clinical audit of quality of care among patients with viral hepatitis in primary care in a low endemic region.

The current hepatitis B (HBV) and hepatitis C virus (HCV) screening practices may fail to detect many infected patients who could benefit from new therapeutic agents to limit progression to cirrhosis and hepatocellular carcinoma. This study assessed the test positivity rate and cascade of care of viral hepatitis patients in primary care in a low endemic region as well as the testing policy of abnormal alanine aminotransferase (ALT) level. This is a retrospective clinical audit among primary health care practices in Flanders, Belgium, assessing patients with an active medical file between 2019 and 2021. A total of 84/89 (94.4%) primary health care practices participated representing 621,573 patients of which 1069 patients (0.17%) were registered as having viral hepatitis, not further specified. Detailed information was available from 38 practices representing 243,723/621,573 (39.2%) patients of which 169 (0.07%) were HBsAg positive and 99 (0.04%) anti-HCV positive. A total of 96/134(71.6%) chronic HBV-infected and 31/77(40.3%) chronic HCV-infected patients were referred to a hepatologist. A total of 30,573/621,573(4.9%) patients had an abnormal ALT level, and by at random selection, more detailed information was obtained on 211 patients. Information on high-risk groups was missing in up to 60%. In patients with abnormal ALT level, HBsAg and anti-HCV testing were conducted in 37/211(17.5%) and 25/211(11.8%), respectively. In a low endemic region, the testing rate and cascade of care of HBV and HCV-infected patients can be improved in primary care, especially in high-risk groups and patients with abnormal ALT levels.

Fabrication of superior laccase-mimicking enzyme with catalytic oxidative and photothermal properties for anti-bacterial and dual-mode glutathione S-transferase monitoring

A novel laccase mimic enzyme Cu–Mn with excellent photothermal properties was firstly prepared via a combination of hydrothermal and in situ synthesis. Cu–Mn nanozymes could catalyze the typical laccase substrate 2,4-dichlorophenol (2,4-DP) to generate the red quinone imine. Further, loading the MnO2 nanosheets with photothermal properties, Cu–Mn nanozymes possessed not only excellent laccase catalytic activity, but also high photothermal conversion efficiency. The presence of glutathione S-transferase (GST) recovered the glutathione (GSH)-induced weakness of the laccase activity and photothermal properties of Cu–Mn. Hence, a GST enzyme-regulated dual-mode sensing strategy was established based on Cu–Mn nanozymes. The detection limits of GST monitoring based on colorimetric and photothermal methods were 0.092 and 0.087 U/L with response times of 20 min and 8 min, respectively. Furthermore, the proposed method enabled the measuring of GST levels in human serum and was successfully employed in the primary evaluation of hepatitis patients. Another attraction, the impressive photothermal behavior also endowed the Cu–Mn nanozymes with promising antimicrobial properties, which exhibited significant antimicrobial effects against Escherichia coli (E.coli) and Staphylococcus aureus (S.aureus). Unsurprisingly, multifunctional Cu–Mn nanozymes certainly explore new paths in biochemical analysis and antimicrobial applications.