Viral Hepatitis Patients Research Articles

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.

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.

SAT-337 Serum levels of IgA inform on the transcriptomic architecture of the liver and predict hepatocellular carcinoma in chronic viral hepatitis patients

SAT-337 Serum levels of IgA inform on the transcriptomic architecture of the liver and predict hepatocellular carcinoma in chronic viral hepatitis patients

Evaluation of Dyslipidaemia in Patients with Chronic Viral Hepatitis in a Lower Socio-Economic Country

Patients having chronic viral hepatitis do have disturbances in their serum lipid profiles, still the monitoring of dyslipidemia is not a routine part of management in low socio economic countries. Objective: To investigate the status of lipid profile among patients with chronic hepatitis and compare them with non-infected individuals. Methods: A cross-sectional study was done in a Tertiary Care Hospital of Karachi, from 5th September 2022 to 31st May 2023. Patients with chronic hepatitis B and C, diagnosed within two years with a body mass index (BMI) of 25-29.9 kg/m2 were included. Their comparison was done with non-infected individuals of the same BMI. All patients were evaluated with different parameters of lipid profile along with haemoglobin, alanine aminotransferase, albumin and international normalized ratio. Results: Among 521 participants of the study, the grouping was almost equal. The age range was 12-75 years, with an increased number of females in each group. In comparing the different statuses of lipid profile, each parameter including cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, all were significantly much less in patients with chronic viral hepatitis as compared to controls with a p-value of 0.000 in all. Conclusions: It was concluded that Dyslipidaemia is not common among chronic viral hepatitis patients’ despite being overweight, particularly among patients with child’s class A.

“Ultrastructural changes of platelets in COVID-19 and chronic viral hepatitis patients “

ABSTRACT Platelet-viral interactions are evolving as a new concern. Coagulation disorder is a major consequence of the COVID-19 infection. In chronic hepatitis virus infections, defect in coagulation factors, thrombocytopenia and platelet function abnormalities are common. A SARS-CoV-2 infection on top of chronic viral hepatitis infection can be common in areas where viral hepatitis is endemic. Here, we investigate the platelet ultrastructural changes and estimate the serum platelet factor-4 (PF-4), ferritin, CRP, and D-dimer in COVID-19 patients (n = 60), COVID-19 patients with associated chronic viral hepatitis (n = 20), and healthy subjects (n = 20). Ultrastructural changes were demonstrated in all test groups, denoting platelet activation. In chronic viral hepatitis patients, Platelet ultrastrustural apoptotic changes were also seen. Significantly high levels of PF-4 were confirmed in moderate and severe COVID-19 patients (P.value <0.001), with a cut off value of 17 ng/ml for predicting disease severity. A positive correlation of PF-4 with the level of serum ferritin, CRP, and D-dimer (p value < 0.001) was noted, while negatively correlated with platelet count and platelet granule count (p value < 0.001). In our study, chronic viral hepatitis patients presented mild COVID-19 signs, and their PF-4 level was comparable with the subgroup of mild COVID-19 infection. The platelet’s critical role in COVID-19 coagulopathy and chronic viral hepatitis is evidenced by the ultrastructural changes and the high levels of PF4. Moreover, a dual viral infection poses a substantial burden on the platelets, necessitating close monitoring of the patient’s coagulation profile.

Viscoelastic parameters derived from multifrequency MR elastography for depicting hepatic fibrosis and inflammation in chronic viral hepatitis

ObjectivesThe capability of MR elastography (MRE) to differentiate fibrosis and inflammation, and to provide precise diagnoses is crucial, whereas the coexistence of fibrosis and inflammation may obscure the diagnostic accuracy.MethodsIn this retrospective study, from June 2020 to December 2022, chronic viral hepatitis patients who underwent multifrequency MRE (mMRE) were included in, and further divided into, training and validation cohorts. The hepatic viscoelastic parameters [shear wave speed (c) and loss angle (φ) of the complex shear modulus] were obtained from mMRE. The logistic regression and receiver operating characteristic (ROC) curves were generated to evaluate performance of viscoelastic parameters for fibrosis and inflammation.ResultsA total of 233 patients were assigned to training cohort and validation cohorts (mean age, 52 years ± 13 (SD); 51 women; training cohort, n = 170 (73%), and validation cohort, n = 63 (27%)). Liver c exhibited superior performance in detecting fibrosis with ROC (95% confidence interval) of ≥ S1 (0.96 (0.92–0.99)), ≥ S2 (0.86 (0.78–0.92)), ≥ S3 (0.89 (0.84–0.95)), and S4 (0.88 (0.83–0.93)). Similarly, φ was effective in diagnosing inflammation with ROC values of ≥ G2 (0.72 (0.63–0.81)), ≥ G3 (0.88 (0.83–0.94)), and G4 (0.92 (0.87–0.98)). And great predictive discrimination for fibrosis and inflammation were shown in validation cohort (all AUCs > 0.75).ConclusionThe viscoelastic parameters derived from multifrequency MRE could realize simultaneous detection of hepatic fibrosis and inflammation.Critical relevance statementFibrosis and inflammation coexist in chronic liver disease which obscures the diagnostic performance of MR elastography, whereas the viscoelastic parameters derived from multifrequency MR elastography could realize simultaneous detection of hepatic fibrosis and inflammation.Key points• Hepatic biomechanical parameters derived from multifrequency MR elastography could effectively detect fibrosis and inflammation.• Liver stiffness is useful for detecting fibrosis independent of inflammatory activity.• Fibrosis could affect the diagnostic efficacy of liver viscosity in inflammation, especially in early-grade of inflammation.Graphical

Development and Evaluation of a Self-Care Mobile Application for Viral Hepatitis Patients

Introduction: Mobile-based self-care applications can help patients with hepatitis increase their awareness about various aspects of the disease. This study aimed to develop and evaluate a self-care mobile app for viral hepatitis.Material and Methods: This study was conducted in three steps. In the first step, a questionnaire containing 24 topics in four sections was used to determine the potential app contents. In the second step, the app was developed using the Android Studio 3 development environment and Kotlin programming language. In the third step, the quality of the app was evaluated using mobile app rating scale (MARS). The Questionnaire for User Interface Satisfaction (QUIS) was used to evaluate user satisfaction.Results: A high priority was given to the following contents of the medical and health information section; describing ways of transmitting hepatitis (81.7%), dealing with high-risk behaviors (80.6%), and methods of preventing hepatitis (79.6%). The MARS and QUIS evaluations’ results showed that the quality of the app and the user satisfaction with it were at a good level.Conclusion: Since according to the participants, the topics related to the “medical and health information” section were the most important contents, we recommend addressing this part in designing other self-care apps.

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.

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 &lt; 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.

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.

Investigation of the change in seroprevalence of viral hepatitis in patients receiving hemodialysis treatment over the years: A Single-Center Study

Objective: In this study, it was aimed to evaluate HBV, HCV, and HIV seroprevalence and their 9-year changes in patients receiving hemodialysis (HD) treatment in the Giresun province in Turkey. Material-Methods: A total of 607 patients over the age of 18 who received hemodialysis treatment in Giresun – Turkey, provincial and district hospitals in 2013 and 2022 were included in our study. The files of the patients were reviewed retrospectively. Demographic characteristics of the patients and serology results of HBV, HCV, HDV, and HIV were recorded. The data was evaluated using the IBM SPSS Statistics 25.0 program. Results: A total of 607 patients, 385 of whom received HD treatment in 2013 and 222 who received HD treatment in 2022, were included in the study. 230 (59.7%) in 2013 and 135 (60.8%) in 2022 of male patients. While the mean age of the patients was 60.26±14 years in 2013, it was 63.08±13.18 years in 2022. In 2013, HBsAg positivity was detected in 9 (2.3%), HBV-DNA positivity in 4 (44.4%), anti-HCV positivity in 31 (8.1%), and HCV-RNA positivity in 8 (25.8%) patients. In 2022, HBsAg positivity was detected in 4 (1.8%), HBV DNA positivity in 2 (50%), and anti-HCV positivity in 31 (8.1%) patients. Compared with dialysis duration, the anti-HCV positivity rate was significantly increased in patients with long dialysis duration (p&amp;lt;0.001). Conclusion: In line with the health policies, the epidemiological data obtained support a decrease in the population’s seroprevalence of HBV and HCV. However, according to the results of our study, it was determined that there was no significant decrease in HBsAg seroprevalence in patients who received HD treatment over nine years. As a result, it was concluded that it would be beneficial to closely monitor the seroprevalence of viral hepatitis in patients receiving HD treatment.

Management of autoimmune and viral hepatitis in immunotherapy: a narrative review.

Cancer immunotherapy has firmly established itself as a pillar of cancer care due to its advantages over traditional anti-tumor therapy but also carries limitations due to potential for severe adverse reactions. This review highlights the current understanding and management of patients with autoimmune and viral hepatitis immune in the setting of immune checkpoint inhibitor (ICI) therapy. A literature search was conducted on PubMed, Scopus, Google Scholar SEER*Stat databases (from inception to December 2022) using search terms: "immune checkpoint inhibitor", "autoimmune hepatitis", "viral hepatitis", "HBV pathogenesis", "HCV pathogenesis", "HBV reactivation", "HCV reactivation", "cancer immunotherapy", "immune related adverse events", "immune related hepatitis". Pre-existing autoimmune disease (AD), whether active or inactive, can predispose patients receiving ICI therapy to develop autoimmune disease flares or immune-related adverse events (irAEs). Thus, patients with AD have routinely been excluded from clinical trials and data on safety of ICI therapy are limited. Hepatic irAE can be seen in ICI therapy and is a distinct entity from autoimmune hepatitis (AIH). ICI therapy alters the immune environment in patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Patients who had prior exposure to HBV are at risk for viral reactivation. However, the prevalence of viral hepatitis in patients receiving immunotherapy is underrecognized and can lead to increases in liver biochemical tests as well as deterioration of liver function ultimately limiting treatment. The high morbidity and mortality associated with immune-related hepatitis emphasizes the need for screening of underlying diseases, including autoimmune and viral hepatitis, prior to initiation of ICI. Presence of AIH or chronic viral hepatitis is the most important risk factor for hepatic adverse events in ICI therapy. Screening for AIH, HBV and HCV is paramount in patients who will undergo ICI therapy.

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.

Selected clinical and epidemiological features of tuberculosis coinfection, infection caused by human immunodeficiency virus and viral hepatitis

The study estimated the prevalence of human immunodeficiency virus infection and viral hepatitis in patients admitted to the tuberculosis hospital in 20182020. Among patients admitted for the treatment of tuberculosis, 36.8% had human immunodeficiency virus infection. Markers of viral hepatitis were also detected in 78.8% of patients with human immunodeficiency virus infection associated with tuberculosis. The most common coinfection was tuberculosis human immunodeficiency virushepatitis C, which was confirmed in 28.2% of the admitted patients. Clinical, X-ray, laboratory, and sonographic indicators were analyzed in 43 patients with tuberculosis having human immunodeficiency virus infection and viral hepatitis in various combinations. All patients were divided into three groups: group 1 included patients with tuberculosis, human immunodeficiency virus infection, and viral hepatitis, group 2 included patients with tuberculosis and human immunodeficiency virus infection, and group 3 included patients with tuberculosis and viral hepatitis. Anti-tuberculosis therapy was prescribed to all patients based on the spectrum of drug sensitivity of Mycobacterium tuberculosis, and when a human immunodeficiency virus infection was detected, antiretroviral therapy was prescribed during the first 2 weeks. Patients with viral hepatitis, if indicated, were prescribed hepatoprotective drugs. Control laboratory tests were conducted once every 2 months or more often in the presence of indications. Groups 1 and 2 were more likely to have multiple organ involvement and generalized forms, which determined the severity of the clinical course. In group 1, the activity of alanine aminotransferase and aspartate aminotransferase exceeded the normal limits upon hospital admission. Bilirubin levels were significantly higher in group 3 than in groups 1 and 2. The analysis of sonographic characteristics revealed increased size of the right liver lobe in all groups, without statistically significant differences between the groups. Adverse hepatotoxic reactions were reported in 5 (33.3%) patients of group 1, 4 (26.6%) of group 2, and 4 (30.7%) of group 3. The main manifestations of these reactions were pain in the right hypochondrium and increased activities of alanine aminotransferase and asparate aminotransferase. Patients with hepatotoxic reactions were prescribed hepatoprotective drugs, which made it possible to avoid the cancellation of complex etiotropic therapy

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.

The Liver Function Score – “ALBI” Sets Apart Melioidosis, Scrub Typhus from Viral Hepatitis, Tuberculosis, Enteric Fever in a III-II Grade Score: Useful in Machine Learning and AI

ALBI (Albumin-Bilirubin) score is routinely used in grading liver function of hepatocarcinoma and hepatitis patients. In this purposive review, the published values of serum albumin, bilirubin in Viral hepatitis, Tuberculosis, Scrub typhus, Enteric fever has been compared with that of melioidosis. Since PubMed yielded zero searches with key words “albumin, bilirubin, melioidosis”, it was searched in Google Scholar, a better retrievable search engine. This yielded 46 relevant articles with 53 ALBI scores for Melioidosis. An equivalent search to retrieve 53 ALBI scores was made in Google Scholar for other confounding diseases of Melioidosis with search words “albumin, bilirubin, hepatitis” “albumin, bilirubin, tuberculosis”, “albumin, bilirubin, scrub typhus”, “albumin, bilirubin, enteric fever”. This raw data was deposited in Harvard dataverse (https://doi.org/10.7910/DVN/QEW20J) and subsequent analysis done is documented in this article. This placed Melioidosis patients and Scrub typhus patients to be on an average grade III ALBI and the patients of Viral hepatitis, Tuberculosis, and Enteric fever in grade II ALBI.&#x0D; GRAPHICAL ABSTRACT&#x0D;

Diabetic MAFLD is associated with increased risk of hepatocellular carcinoma and mortality in chronic viral hepatitis patients.

Metabolic dysfunction-associated fatty liver disease (MAFLD) can coexist with chronic viral hepatitis. MAFLD is a heterogeneous disease because the diagnostic criteria include various metabolic traits. We aimed to identify patients at high risk of poor long-term outcomes based on MAFLD subgroups in chronic viral hepatitis patients. We evaluated 63 273 chronic hepatitis B and C patients. Patient with a fatty liver index ≥30 was defined to have hepatic steatosis. MAFLD was defined as the presence of hepatic steatosis with any one of the following three conditions, overweight/obesity, type 2 diabetes or ≥2 metabolic risk factors. The prevalence of MAFLD was 38.4% (n = 24 290). During a median 8.8-year follow-up, 1839 HCCs and 2258 deaths were documented in MAFLD patients. Among MAFLD patients, diabetes could identify patients at high risk of HCC and mortality, whereas overweight/obesity and metabolic risk factors did not. Compared with non-MAFLD patients, risk of HCC and mortality was significantly higher in diabetic MAFLD patients (adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] = 1.26-1.43 for HCC; aHR = 1.15, 95% CI = 1.08-1.22 for mortality). Risk of HCC and mortality was significantly higher in diabetic MAFLD patients (aHR = 1.40, 95% CI = 1.26-1.55 for HCC; aHR = 1.77, 95% CI = 1.63-1.93 for mortality) compared with non-diabetic MAFLD patients. Diabetic MAFLD is associated with increased risk of HCC and mortality among chronic viral hepatitis patients. Our findings highlight the need for close surveillance and effective treatment for these high-risk patients to reduce HCC and mortality in patients with chronic viral hepatitis.

Performance Analysis of Selected Machine Learning Algorithms for Prediction of Mortality and Survival Chances of Viral Hepatitis and Hepatocellular Carcinoma Patients

Performance Analysis of Selected Machine Learning Algorithms for Prediction of Mortality and Survival Chances of Viral Hepatitis and Hepatocellular Carcinoma Patients