Hepatitis Patients Research Articles

Autoantibodies profile in autoimmune liver diseases and chronic viral hepatitis

liver failure. Autoantibodies are confirmed to have significance in the early screening of AILD patients, especially in those who are asymptomatic before onset of clinical signs. This study aimed to assess levels of liver autoantibodies and their association with clinical manifestations of autoimmune liver diseases and chronic viral hepatitis (CVH) patients. This case-control study included 50 patients (case group of 25 patients with AILD and control group of 25 patients with CVH). They were investigated for presence of antibodies against LKM-1, AMA-M2, PML, M2-3E (BPO), gp210, Sp100, LC-1, Ro52 and SLA/LP using the line immune blot technique, and for the presence of antinuclear antibodies (ANA), as non-organ specific autoantibodies, using indirect immunofluorescence technique. Specific autoantibodies were detected in all AILD cases and some of their levels were significantly higher when compared with CVH group. Among AILD patients, 52% were positive for ANA, whereas 61.1% of chronic hepatitis C and 28.6% of chronic hepatitis B patients were positive for ANA with no significant difference (p=0.3). In conclusion, early diagnosis of autoimmune liver diseases has been linked to assessment of autoantibodies, allowing for prompt therapeutic intervention to stop the progression of liver cirrhosis and the accompanying complications.

Clinical performance of AMA-M2, anti-gp210 and anti-sp100 antibody levels in primary biliary cholangitis: When detected by multiplex bead-based flow fluorescent immunoassay.

Primary biliary cholangitis (PBC) is a chronic autoimmune cholangiopathy, characterized by the presence of some autoantibodies in the serum. This study aimed to evaluate the clinical significance of AMA-M2, anti-gp210 and anti-sp100 antibody levels detected by multiplex bead-based flow fluorescent immunoassay (MBFFI) in PBC. This study cohort included 238 PBC patients, 81 autoimmune hepatitis (AIH) patients, 62 systemic lupus erythematosus (SLE) patients, and 118 healthy controls. Serum AMA-M2, anti-gp210 and anti-sp100 antibody were detected by MBFFI and immunoblotting assay (IBT). The relationship between three antibody levels and cirrhosis, liver function, cholestasis markers and therapeutic effect to ursodesoxycholic acid (UDCA) was evaluated in PBC. MBFFI were presented good coincidence rate (87.39%-95.38%) with IBT. The level of AMA-M2, anti-gp210 and anti-sp100 antibodies in PBC patients were higher than other disease group and healthy controls (p ＜ .01). When compared with the healthy controls group, the AUC of AMA-M2, anti-gp210 and anti-sp100 antibodies were 0.9245, 0.7619, and 0.6789, respectively. In addition, gp210 antibody levels have diagnostic value in patients with liver cirrhosis (AUC: 0.7567). We found that when combine detect these three antibodies, the sensitivity was higher than individually detection. High level of serum anti-gp210 antibody could be related to worse liver function and more severe cholestasis in PBC patients. Moreover, serum antibody levels may decrease or remained flat in patients who responded well to UDCA. The detection of AMA-M2, anti-gp210 and anti-sp100 antibody levels by MBFFI showed good performance in the diagnosis of PBC. Serum anti-gp210 antibody level is related to cirrhosis, poor liver function and severe cholestasis in PBC.

Renal Doppler Velocimetric Indices among Adult Seropositive Viral Hepatitis Patients Attending Tertiary Care Facility in Kano State, Nigeria

Context: Viral hepatitis is associated with an increased risk of renal disease leading to hepato-renal syndrome. Currently, urine and blood tests are the primary tools used to detect and monitor kidney disease among seropositive viral hepatitis patients. However, these biomarkers are affected by co-existing liver disease, age, and BMI, making their use unreliable in some patients with renal impairments. Renal Doppler sonography has been explored as a viable non-invasive alternative for the diagnosis of subclinical renal changes among asymptomatic patients with viral hepatitis. Aim: This study aimed to evaluate renal Doppler velocimetric indices of asymptomatic adult patients with viral hepatitis and compared Doppler values between carrier serotypes with correlations with prothrombin time (PT) at Aminu Kano Teaching Hospital, Kano. Settings and Design: This was a hospital-based cross-sectional observational study conducted at the Radiology Department of AKTH. Materials and Method: This study was conducted between March 2022 and January 2023, among seropositive viral hepatitis patients grouped into acute hepatitis B (AHB), chronic hepatitis B (CHB), and chronic hepatitis C (CHC). The resistive index (RI) and pulsatility index (PI) for the different serotypes were obtained following renal Doppler sonography among study subjects. Also, PT was recorded for each serotype. Statistical Analysis Used: Relevant data obtained were entered and analyzed using SPSS version 23. The significance level was considered at P < 0.05. Results: The study had 153 patients. The resistive index (RI) was significantly higher among AHB than CHB serotypes, and PI was also higher among CHB than CHC serotypes − likewise, the PT. Positive correlations (r = 0.75, P = 0.01) and (r = 0.78, P = 0.01) were seen between RI and PT in both male and female patients, respectively. Conclusion: The RI, PI, and PT values were higher among acute and chronic hepatitis B serotypes than in chronic hepatitis C serotypes.

Fecal gelatinase does not predict mortality in patients with alcohol-associated hepatitis.

Alcohol-associated liver disease is highly prevalent worldwide, with alcohol-associated hepatitis as a severe form characterized by substantial morbidity, mortality, and economic burden. Gut bacterial dysbiosis has been linked to progression of alcohol-associated hepatitis. Fecal cytolysin secreted by the pathobiont Enterococcus faecalis (E. faecalis) is associated with increased mortality in patients with alcohol-associated hepatitis. Although gelatinase is considered a virulence factor in E. faecalis, its prevalence and impact on alcohol-associated hepatitis patient outcomes remains unclear. In this study, 20 out of 65 (30.8%) patients with alcohol-associated hepatitis tested positive for gelatinase in their stool. There were no significant differences in 30-day and 90-day mortality between gelatinase-positive and gelatinase-negative patients (p=0.97 and p=0.48, respectively). Fecal gelatinase had a low discriminative ability for 30-day mortality (area under the curve [AUC] 0.50 vs fibrosis-4 Index (FIB-4) 0.75) and 90-day mortality compared with other established liver disease markers (AUC 0.57 vs FIB-4 0.79 or 'age, serum bilirubin, INR, and serum creatinine' (ABIC) score 0.78). Furthermore, fecal gelatinase was not an important feature for 30-day or 90-day mortality per random forest analysis. Finally, gelatinase-positive patients with alcohol-associated hepatitis did not exhibit more severe liver disease compared with gelatinase-negative patients. In conclusion, fecal gelatinase does not predict mortality or disease severity in patients with alcohol-associated hepatitis from our cohort.

Serum procalcitonin as a marker of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD)

BackgroundNeonatal Intrahepatic Cholestasis (NICCD), as the early-age stage of Citrin deficiency involving liver dysfunction, lacks efficient diagnostic markers. Procalcitonin (PCT) has been identified as a biomarker for infection as well as various organ damage. This study aimed to explore the potential of PCT as a biomarker for NICCD. MethodsIn a single-center retrospective case-control study. Serum PCT concentrations before and after treatment of 120 NICCD patients, as the study group, were compared to the same number of cholestatic hepatitis patients, as the control group. The potential value of PCT to discriminate NICCD from control disease was further explored using Receiver Operating Characteristic (ROC) curve analysis and compared to those of other inflammatory markers. ResultsThere was a significantly higher level of PCT in NICCD patients than in the control group. PCT concentrations were only weakly correlated with neutrophil counts and CRP levels (p ˂ 0.05). At a cut-off value of 0.495 ng/mL, PCT exhibited a significantly higher diagnostic value compared to other inflammatory markers for discriminating NICCD from the control, with a sensitivity of 90.8 % and specificity of 98.3 %. ConclusionPCT might be used as an initial biomarker to discriminate children with NICCD from another hepatitis disease.

High immunocompetence in chronic hepatitis patients with normal alanine transaminase levels and and negative hepatitis B e-antigen for the progression of liver fibrosis.

This study aimed to investigate the role of immunocompetence in chronic hepatitis B (CHB) patients with normal alanine transaminase (ALT) levels and negative hepatitis B e antigen (HBeAg) in the risk assessments of the progression of liver fibrosis. We collected the clinical data of 57 patients with CHB, with normal ALT levels and negative HBeAg from December 2020 to December 2022. With hepatitis B virus (HBV) DNA > 20 IU/mL and ALT ≤ 40 U/L, these patients had never undergone antiviral therapy. The levels of CD4+ , CD4+ CD25+ , CD8+ , and CD4+ CD25+ CD127LOW regulatory T cells (Tregs) in the patients were detected using flow cytometry; the liver stiffness measurement (LSM) values of the patients were detected using Fibroscan. There was a statistically significant difference between the levels of fibrosis-4 (FIB-4) and hepatitis B surface antigen (HBsAg) when the cutoff point was HBsAg ≥ 1500 (p < .001). FIB-4 was negatively correlated with HBsAg (R = -0.291, p = .028) and positively correlated with age (R = 0.787, p < .001). LSM was negatively correlated with Treg but this correlation was not statistically significant (p > .05). Findings based on the analysis using logistic regression were as follows: (i) age was the independent risk factor when FIB-4 was used as the indicator for assessing liver fibrosis; (ii) Treg was the independent risk factor when LSM was used as the indicator for assessing liver fibrosis. When Treg was used to predict liver fibrosis, the cutoff value, diagnostic efficacy, area under the receiver operating characteristic (ROC) curve, and p value of the ROC curve were 6.875, 0.641, 0.84, and .027, respectively. Age and Treg are independent risk factors for progressive liver fibrosis. The cutoff value of Treg > 6.81 indicates the need for timely antiviral treatment and can serve as an indicator for evaluating liver fibrosis.

Long-term entecavir therapy of chronic hepatitis B in real-life setting-Importance of quantitative HBsAg level.

The global burden of chronic hepatitis B remains high and the best possible treatment remains long-term viral suppression expecting cure. Total 154 patients of chronic hepatitis B (48 HBeAg positive, e + ve) treated with oral entecavir (0.5mg/1mg per day) were recruited from June 2007 and followed prospectively until December 2022 for persistent HBV DNA negativity, HBeAg and HBsAg loss/seroconversion and other liver and drug-related events in real-life settings. The mean duration of therapy was 6.78 (2-14) years with 1364 person-years of follow-up. All patients were HBV DNA negative by 15months and remained so until the last follow-up. As many as 16.7% lost HBeAg after eight to 13 years of therapy, but not HBsAg. The mean fall in serum HBsAg level per year was 0.158 log IU/mL, being significantly higher in e + ve patients at baseline and until two years of therapy. The decline was significant until six years in e + ve patients compared to two years in e - ve ones. None had biochemical or virological breakthrough (except eight defaulters), flares or any untoward effects. The incidence of liver-related events, hepatocellular carcinoma and death was 10.4%, 1.9% and 14.3%, respectively, and 5.2% deaths were liver-related whose predictors were presence of cirrhosis (log rank 46.5, p > 0.001) and higher HBsAg level > 4 log IU/mL (log rank 18.15, p < 0.001) at baseline. Long-term entecavir therapy provides additional benefits of continuous reduction of serum HBsAg levels beyond suppression of HBV DNA.

FREQUENCY OF DEPRESSION IN PATIENTS OF CHRONIC HEPATITIS C BEFORE STARTING TREATMENT

Introduction: Pre-existing psychiatric illnesses, such as mood and psychotic disorders, are 3–4 times more common and frequently undetected in HCV patients. This could be brought on by a diminished desire to use or access mental and primary health care services, actual or imagined stigma against HCV patients, or denial of their psychiatric symptoms. Comorbid depression can impact the outcome because it is linked to decreased HCV therapy adherence. Objectives: To quantify the prevalence of depression among Hepatitis C patients not receiving treatment. Study Design: This was a cross-sectional study. Setting: Medical Department, Faisalabad Medical University and affiliated Allied Hospital, Faisalabad. Study duration: 30th December 2021 to 29th June 2022. Materials &amp; Methods: A total of 310 patients having Hepatitis C infection, with an age range of 20 years to 60 years, were included, while the patients suffering from an additional underlying chronic medical disease like CKD, COPD and diabetes, which can cause depression, were excluded. Demographic data, including age, gender, residence (rural or urban), education of patient (Primary, middle or higher education), marital status (single, married or separated), income of patient and duration of Hepatitis C infection were recorded. The researcher interviewed the selected patients by using Beck Depression Inventory. Results: The study's age ranged from 20 to 60 years, with a mean age of 41.75 + 8.62. Most 163 patients (52.58%) were in the 20–40 age range. 166 (53.55%) of the 310 patients were men, and 144 (46.45%) were women, for a male-to-female ratio of 1.2:1. In our study, the frequency of depression in patients with Hepatitis C infection not receiving any treatment was found in 187 (60.32%) patients. Conclusion: The conclusion of the study is that the frequency of depression in patients suffering from Hepatitis C infection not receiving any treatment is very high.

Assessment of Tissue inhibitor of metalloproteinase-1 and many biochemical parameters in patients with chronic hepatitis B in Tikrit city

Abstract— The main objective of this cross-sectional investigation was to assess biomarkers associated with liver fibrosis, namely Tissue inhibitor of metalloproteinase 1 TIMP-1, Glutamate-pyruvic transaminase GPT, glutamic-oxaloacetic transaminase GOT, and Alkaline phosphatase ALP. which conduct in Tikrit University, College of Science /Biology Department the study samples collected from patients in Dialysis Unit in Tikrit Teaching Hospital, ninty subjects where sub-divided to 60 patients of age (20– 68) years, the Ages of Patients Chronic hepatitis B Ranged From (20-67) years( 19 males and 11 females ) And The Ages Of Patients with chronic hepatitis B suffered of chronic kidney diseases (24-68) Years ( 18males and 12 females) and 30 as control group aged (20-67) years, in this investigation Enzyme linked immunosorbent assay (ELISA) kites were employed to assess serum concentrations of (TIMP-1), Whereas used Monarch-240 to detect the activity of enzymes such as GPT, GOT and ALP.&#x0D; The findings of the present investigation demonstrated in chronic hepatitis patients there were significant increased (P≤0.05) in the levels of TIMP-1, and activity of GPT and ALP whereas no significant rise (P≥0.05) for activity of GOT when compared with control. In patients with chronic hepatitis B (CHB) suffered of chronic kidney diseases(CKD) there were significant raised (P&lt;0.05) in the levelsTIMP-1, ALT and ALP while no significant rised (P≥0.05) in levels of AST when compared with control.&#x0D; Current data suggest that TIMP-1 can be a promising biomarker of active fibrogenesis, after HBV chronic infection.

Survival prediction model with lion optimization for Hepatitis-B patients using supervised and unsupervised learning algorithm

The disease cancer takes millions of lives every year, although not being a contagious disease, the risk imposed by the cancer stands tall when compared to other diseases. Among those, liver cancer is one of the most commonly occurring cancers (841,080 cases diagnosed in 2018, which is 5 % of cancers that year). (HCC) is the of frequent source of liver cancer, which is the fastest improving causes of cancer death and is the second frequent occurring cancer of all. Hepatitis-B infection when moved into chronic stage causes to form cancer in the liver (HCC). Apparently 1 in 12 deaths in the world are due to liver cancer, in that 75 % of all liver cancers are caused by HCC, of which hepatitis-B virus reports 50 % cases HCC worldwide. To prognosis of survival rate using a dataset that contains lots of information or parameters about serum hepatitis patients. Initially the data will be pre-processed, to make better suitable for further processing and for being in acceptable format for the algorithms. Then, apply couple of algorithms to specify the prediction and bring out the accuracy of the model. And further compare those algorithms to specify the algorithm with most efficacy. The accuracy is calculated by comparing the predicted outcome with real-time outcome (i.e. “Class” = Live/Die) of the patient. Based on considering various parameters, the model will be predicting the risk of a patient of his survival rate.

Persistent pruritus associated with worse quality of life in patients with chronic hepatitis.

Prevalence and severity of pruritusamong US patients with chronic hepatitis B and C (HBV, HCV) are not well-documented. Chronic Hepatitis Cohort Study (CHeCS) patients were surveyed to examine pruritus prevalence and impact on quality of life (QoL). Patients who reported experiencing pruritus ≥3 on a Numeric Rating Scale (NRS) within the past 30 days were invited to participate in a 6-month study using the SF-36 questionnaire. General regression (univariate followed by multivariable modelling) was used to analyse pruritus intensity and eight QoL dimensions. Among 1654 patients (HBV = 358, HCV = 1296, HBV/HCV = 6), pruritus prevalence was significantly higher among patients with HCV than those with HBV (44% vs. 35%; p < .05). One hundred and twenty-three patients (21 HBV and 102 HCV) participated in the QoL study (72% ≥60 years; 50% men; 25% Black; 37% with cirrhosis; 66% had BMI > 25). Mean NRS was 4.9-5.3. QoL responses for social functioning and emotional well-being were higher (70-72 points) than responses for energy/fatigue (50-51). Antiviral treatment rates were higher in HCV (92%, SVR 99%) than HBV (71% ever, 43% ongoing). Multivariable analyses showed no significant effect of hepatitis type or antiviral treatments on itch. Antihistamines were associated with severe itch. Higher NRS was associated with significantly reduced QoL. Each unit increase in NRS was associated with a 2-3 unit decline in emotional well-being, general health, physical function, energy/fatigue, social functioning and emotional health. Pruritus negatively affects many viral hepatitis patients, regardless of antiviral treatment status. Improved treatment options are needed to address its impact on QoL.

Medicinal Plants in Treating Hepatitis B Among Communities of Central Region of Ethiopia.

In Ethiopia, most people rely heavily on traditional therapeutic plants that have been used for years. The practice of traditional medicines use to treat hepatitis is currently gaining popularity due to the limited availability and affordability of modern drugs. The aim of this study was, therefore, to assess the traditional medicinal plants use to treat viral hepatitis among communities of Central region of Ethiopia. Data was collected from November 2018 to December 2021 in Central Ethiopia. An open-ended semi-structured interview was used among purposively selected herbalists, traditional medicine entrepreneurs, village heads, and patients visiting traditional healers for hepatitis treatments. A 5 mL blood sample was collected from patients who visited a traditional healers' clinic for hepatitis treatment and tested for HBsAg and HCV-antibody by using ELISA. Among HBsAg-positives, further nucleic acid test for HBV-DNA load was assessed to measure the effects of prescribed medicinal plants. Herbalists cited 24 plants that were used for hepatitis treatment; of which Rumex nepalensis, Vangueria apiculata, and Solanum incanum were the most frequently cited plants. Remedies were commonly prepared by crushing or powdering, mixing them with water, and taken orally. Forty-two individuals were diagnosed and treated as hepatitis patients by herbalists, of which eight of them were HBsAg-positive but no positives for anti-HCV ELISA. At the third and sixth months of viral load assessment among HBsAg-positive, serum HBV-DNA suppression was observed in three individuals treated with different combinations of frequently cited plants. In this study, traditional healers used various plants to treat hepatitis. HBV-DNA suppressive activity was detected in three NAT-positive individuals who were treated by using a mixture of these frequently cited and highest preference-ranked plants. This suggests that these plants have antiviral properties and serve as a basis for more pharmacological research in the quest for new antiviral agents.

The Diagnostic Value of ANA and Anti-SMA in Suspected Patients with Autoimmune Hepatitis

BACKGROUND: Autoimmune hepatitis (AIH) is an unknown chronic disease characterized by hepatocellular inflammation with a tendency to progress to cirrhosis. AIH can present with symptoms of acute hepatitis with symptoms of chronic liver disease. AIH occurs globally; it is more commonly found in females. Autoantibodies such as antinuclear, smooth muscle, liver kidney microsome, and soluble liver antigen are used to aid in the diagnosis of AIH, which presents with a variety of symptoms that also contribute to the classification of AIH. AIM: Evaluation of anti-nuclear antibodies (ANA) and anti-smooth muscle antibodies (SMA) positivity in hepatic diseases, gastrointestinal diseases, viral hepatitis, and extra-hepatic diseases, providing better markers for the early diagnosis of AIH-type 1. MATERIALS AND METHODS: The study included 207 individuals. 62.4% of them were female. Regarding the diagnoses, we grouped them into 4 groups: hepatic diseases (n = 73), viral hepatitis B and C (n = 54), gastrointestinal diseases (n = 34), and extra-hepatic diseases (n = 46). Serum levels of ANA and anti-SMA were measured using an indirect immunofluorescence method following the manufacturer’s instructions (Aesku Diagnostics, Germany). Fluorescence intensity was interpreted semi-quantitatively based on negative control (0) and positive control (+4). RESULTS: The positivity of ANA and anti-SMA resulted as follows: In hepatic diseases 34.2% and 48%, in viral hepatitis B and C, ANA positivity was 14.8% and SMA positivity was 22.2%; in gastrointestinal diseases, ANA and SMA positivity were, respectively, 11.8% and 20.6%; and in extrahepatic diseases, positivity of ANA resulted in 32.6% and SMA in 26%. When compared to the viral hepatitis patient group, the ANA specificity for hemagglutination inhibition (HAI) was 85.2% and that of anti-SMA was 77.8%. The analysis of 46 extrahepatic patient groups provided an ANA specificity of 67.4% and an anti-SMA specificity of 74% for HAI. The comparison to gastrointestinal disease showed that ANA specificity for HAI was 88.2% and anti-SMA specificity was 79.4%. CONCLUSION: Diagnosing AIH is difficult because the clinical spectrum ranges from an asymptomatic presentation to an acute and severe disease. So in all cases, AIH must be suspected. Both males and females can develop AIH, but the disease is more common in females. Based on our diagnostic parameters, we can say that ANA and anti-SMA provide moderate sensitivity for AIH, but they are more specific to AIH type 1.

A nomogram for analyzing risk factors of poor treatment response in patients with autoimmune hepatitis.

The objective of this study was to identify biochemical and clinical predictors of poor response (including incomplete response and non-response) to standard treatment in autoimmune hepatitis (AIH) patients. This study retrospectively collected clinical data from 297 patients who were first diagnosed with AIH in Beijing Ditan Hospital from 2010 to 2019. Finally, 149 patients were screened out. Risk factors were screened by univariate and multifactorial logistic regression. Then they were used to establish the nomogram. The ROC curve, calibration curve, decision curves analysis (DCA) and clinical impact curves (CIC) were used to evaluate the nomogram. 149 patients were divided into two groups: the response group (n = 120, 80%) and the poor response group (n = 29, 20%). Multivariate logistic regression analysis found that IgG > 26.5 g/L (OR: 22.016; 95% CI: 4.677-103.640) in AIH patients increased the risk. In contrast, treatment response status was better in women (OR: 0.085; 95% CI: 0.015-0.497) aged >60 years (OR: 0.159; 95% CI: 0.045-0.564) with AST > 4.49 × ULN (OR: 0.066; 95% CI: 0.009-0.494). The C index (0.853) and the calibration curve show that the nomogram is well differentiated and calibrated; the DCA and CIC indicate that the model has good clinical benefits and implications. The study found that male patients aged ≤ 60 years with IgG > 26.5 g/L and elevated AST ≤ 4.49 × ULN were more likely to have a non-response/incomplete response to standard treatment.

Multimedia education program on knowledge and attitude regarding management, prevention of complication and side-effects of drugs on hepatitis-B among hepatitis patients: a pre-experimental study

Background: Hepatitis is considered a public health challenge on the Asian continent. However, due to the paucity of the data, the exact burden of the condition has not been established. Better disease-related knowledge will help to improve attitudes toward managing the complications and side effects and also prevent the further spread of infection. Methods: A hospital-based pre-experimental study was undertaken with 60 hepatitis B patients. Knowledge and attitude were assessed using demographic data, a 30-item knowledge questionnaire, and 16-item Likert scale responses, respectively. SPSS V20.0 was used for data analysis and interpretation. To do the analysis, a paired t-test and descriptive statistics, along with chi-square analysis were done to check the association level. Results: The result showed that in the pre-test, 41 (68.3%) of the participants had inadequate knowledge, 19 (31.7%) had moderate knowledge, and none of the study participants had adequate knowledge. Furthermore, 60 (100%) participants had a neutral attitude, and none of the participants had an unfavorable and favorable attitude toward hepatitis B patients. The paired “t” test value was found to be 18.67 for knowledge level and 25.25 for attitude level, which was highly significant at p&lt;0.05 level. Also, we have observed a strong positive linear correlation between knowledge and attitude, and the calculated “r” value is 0.741*. Conclusions: The findings of the study indicate that hepatitis B patients have a lack of knowledge and attitude which may lead to the further spread of infection in the community and hospital itself. Extensive health education, community reach, and health workers participation can have a rational control over the management of the disease.

METABOLIC SYNDROME AMONG PATIENTS OF HEPATITIS C PRESENTING TO A TERTIARY CARE HOSPITAL

Background and objectives: Hepatitis C has evolved to become a global pandemic, equally affecting Pakistan as well. According to one WHO report the estimated prevalence of chronic hepatitis C is 1% worldwide (71 million people) while Pakistan alone contributes more than 12 million people to this figure, with Punjab reporting the highest prevalence of 6.7%. This infection does not only affect the Liver but also produces extrahepatic manifestations in various organs like skin, blood, and gastrointestinal tract as well as leads to many autoimmune conditions. There are many more linked to hepatitis but still remains unclear hence in this study we aim to assess the frequency of metabolic syndrome and the distribution of its features among patients of hepatitis C.Methods: Conducted from 01.08.2019 to 02.01.2020 at Sheikh Zayed Hospital Lahore this cross-sectional study enrolled a total of 110 patients with hepatitis C presenting to the Outpatient Medicine Department. After informed consent, the demographic profile was noted in the proforma. The blood pressure and BMI of the patients were assessed using a standard protocol. A sample of 3ml of blood was taken for fasting lipid profile. Information regarding the study variable was recorded in the proforma and confidentiality of the data was ensured. SPSS was used to analyze the data.Results: Of the total 110 hepatitis C patients enrolled, 54.5% were male, the mean age was 41.06 ± 14.78 years and the mean duration of having hepatitisC was 6.76 ± 3.27 months. Metabolic syndrome was present in 31.8%of the total study participants. Further analysis revealed that metabolic syndrome was not significantly associated with age (p-value = 0.955), gender (p-value = 0.970), or duration of hepatitis C (p-value = 0.125).Conclusion: Metabolic syndrome affects 1 in every 3 patients of Hepatitis C presenting to the tertiary care hospital. Hence screening for metabolic syndrome must be performed among all patients suffering from hepatitis C from an early disease period and all such patients must be educated regarding prevention and control of this syndrome.

Well-controlled viremia reduces the progression of hepatocellular carcinoma in chronic viral hepatitis patients treated with lenvatinib.

Lenvatinib has been approved as one of the first-line treatments for advanced hepatocellular carcinoma (HCC) due to its high treatment efficacy being non-inferior to sorafenib. Previous studies have shown well-controlled viremia contributes to the prognosis of HCC patients receiving first-line sorafenib; hence, we postulated this association might also exist in HCC patients with lenvatinib treatment. From April 2018 to December 2021, 201 unresectable HCC patients with first-line lenvatinib treatment in our institute were assessed. High-effect nucleoside analogues were administered for hepatitis B virus (HBV) control, while direct-acting antivirals were used for hepatitis C virus (HCV) elimination. Based on our previous study, well-controlled viremia was defined as patients who had undetectable viremia, or who had been receiving antivirals at least 6 months before lenvatinib. This study enrolled 129 patients, including 85 patients with HBV-related HCC (HBV-HCC) and 44 patients with HCV-related HCC (HCV-HCC), respectively. Progression-free survival (PFS) and overall survival (OS) rates between the two groups were not different. Before administration of lenvatinib, 57.1% of the HBV-HCC patients and 88.4% of the HCV-HCC patients had well-controlled viremia, and their PFS (8.8 vs. 3.1 months, p < 0.001) and OS (30.2 vs. 12.8 months, p = 0.041) were better than those who had uncontrolled viremia; moreover, well-controlled viremia reduced tumor progression in multivariate analysis (Hazard ratio: 0.41, 95% confidence interval: 0.25-0.68, p = 0.001) after adjusting for albumin-bilirubin grade and concurrent treatment. HBV or HCV infection was not associated with tumor progression of HCC patients receiving lenvatinib, but viremia, controlled or not, was.

Pivotal Role of Serum IL-37 In Patients with Chronic HBV and HCV

Interleukin-37 (IL-37) is an anti-inflammatory cytokine that has an intrinsic role in many diseases through its extracellular and intracellular mechanisms. It was found to be in high concentrations in chronic diseases. In this study, the concentration of IL-37 was measured in 62 patients with chronic hepatitis C and 65 patients with chronic hepatitis B with 38 individuals as Healthy group using ELISA to confirm that IL-37 can be used a biomarker for hepatitis chronic diseases. Receiver operating characteristic (ROC) curves were used to support this hypothesis. IL-37 levels were significantly higher in viral hepatitis patients (Hepatitis C virus and Hepatitis B virus) than in controls (92.28 ± 47.5, 83.1±43.44, 42.8±12.14 ng/L), respectively with p= 0.00001. The ROC curve showed that all hepatitis patients (HCV and HBV) could be distinguished from the control group according to their levels of IL-37 with an AUC value for HBV was 0.886, while for HCV was 0.955. In addition, the cut-off value for IL37 in patients suffer from HBV was 58.55 ng/L with a sensitivity of 80% and a specificity of 100 %, while the cut-off value for IL37 in HCV patients was 57.27 ng /L with a sensitivity of 90% and a specificity of 97%. This study concluded there was an increase in the IL-37 concentration in patients with chronic HBV and HCV.

Seroprevalence of emerging hepatitis E virus in patients with acute hepatitis between 2004 and 2018 in Csongrád county, Hungary.

Hepatitis E virus (HEV) has recently become endemic in Europe, however, it is often a remnant neglected by clinicians as the causative agent of acute and chronic hepatitis and is often misdiagnosed as a drug-induced liver injury. The infection rate in European pig farms is estimated to be around 15-20%, therefore, the primary source of HEV infections might be poorly prepared pork meat. As HEV infections may occur more often in clinical practice than previously thought, the present paper aims to analyse the seroprevalence of HEV in patients with acute hepatitis over a period of 14 years in Csongrád County, Hungary. The sera of 4,270 hepatitis patients collected between 2004-2018 were tested for cumulative anti-HEV IgG/IgM. Furthermore, 170 IgM positive sera were tested for the presence of viral RNA by RT-qPCR. Between 2012-2018, the cumulative seroprevalence has increased 9.18 times, and between 2013-2018, IgM prevalence has increased 12.49 times. Viral RNA was detectable in 12.35% of IgM positive sera. The present paper presents data showing that the seroprevalence of hepatitis E virus has increased markedly over the course of the last decade in Hungary and in other European countries as well. The exact reason behind this phenomenon is yet to be determined. To assess the dynamics and the reason for this increase in prevalence, pan-European, multicentre studies should be conducted.

Chronic Hepatitis B, C, and stroke; association and pathophysiology

Background and Objectives:&#x0D; Hepatitis infection may raise the incidence of stroke and other cerebrovascular abnormalities, according to several studies. However, its association is controversial. This review looked to compile the most recent research on the relationship between HBV and HCV, atherosclerosis, and stroke.&#x0D; Methods:&#x0D; This article reviews the literature on the connection between hepatitis B and C viruses with stroke and atherosclerosis. The search included articles from PubMed, PakMediNet, and Google Scholar, as well as a Medline search using specific keywords and MeSH terms. A total of 2655 articles were identified. Out of these 2655 articles we identified 134 articles in English for review. These 134 articles comprised of original studies, individual case studies, and retrospective cohorts. The review included original research, individual case reports, and retrospective cohorts published after 1990. Studies addressing co-infection with HIV were excluded.&#x0D; Results:&#x0D; After the screening, many articles were selected which included several topics of discussion under the said heading. The studies were closely examined to gather pertinent information relevant to the review's objectives. Most of the literature emphasized the link between chronic hepatitis and the risk of stroke.&#x0D; Conclusion:&#x0D; Although current evidence does tilt the scale in favor of hepatitis-causing cerebrovascular disease, this review study has some limitations, such as the lack of prospective cohorts and limited evidence for the natural history of hepatitis patients in relation to cardiovascular and cerebrovascular diseases.&#x0D;