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Hepatitis B [keywords]
- Prognostic value of M30/M65 for outcome of hepatitis B virus-related acute-on-chronic liver failure. [Journal Article]
- World J Gastroenterol 2014 Mar 7; 20(9):2403-11.
To determine the prognostic value of circulating indicators of cell death in acute-on-chronic liver failure (ACLF) patients with chronic hepatitis B virus (HBV) infection as the single etiology.Full length and caspase cleaved cytokeratin 18 (detected as M65 and M30 antigens) represent circulating indicators of necrosis and apoptosis. M65 and M30 were identified by enzyme-linked immunosorbent assay in 169 subjects including healthy controls (n = 33), patients with chronic hepatitis B (CHB, n = 55) and patients with ACLF (n = 81). According to the 3-mo survival period, ACLF patients were defined as having spontaneous recovery (n = 33) and non-spontaneous recovery which included deceased patients and those who required liver transplantation (n = 48).Both biomarker levels significantly increased gradually as liver disease progressed (for M65: P < 0.001 for all; for M30: control vs CHB, P = 0.072; others: P < 0.001 for all). In contrast, the M30/M65 ratio was significantly higher in controls compared with CHB patients (P = 0.010) or ACLF patients (P < 0.001). In addition, the area under receiver operating characteristic curve (AUC) analysis demonstrated that both biomarkers had diagnostic value (AUC ≥ 0.80) in identifying ACLF from CHB patients. Interestingly, it is worth noting that the M30/M65 ratio was significantly different between spontaneous and non-spontaneous recovery in ACLF patients (P = 0.032). The prognostic value of the M30/M65 ratio was compared with the Model for End-Stage Liver Disease (MELD) and Child-Pugh scores at the 3-mo survival period, the AUC of the M30/M65 ratio was 0.66 with a sensitivity of 52.9% and the highest specificity of 92.6% (MELD:AUC = 0.71; sensitivity, 79.4%; specificity, 63.0%; Child-Pugh: AUC = 0.77; sensitivity, 61.8%; specificity, 88.9%).M65 and M30 are strongly associated with liver disease severity. The M30/M65 ratio may be a potential prognostic marker for spontaneous recovery in patients with HBV-related ACLF.
- Gender specific medicine in liver diseases: A point of view. [REVIEW]
- World J Gastroenterol 2014 Mar 7; 20(9):2127-2135.
Gender medicine focuses on the patho-physiological, clinical, prevention and treatment differences in diseases that are equally represented in men and women. The purpose of gender medicine is to ensure that each individual man and woman receives the best treatment possible based on scientific evidence. The concept of "gender" includes not only the sexual characteristics of individuals but also physiological and psychological attributes of men and women, including risk factors, protective/aggravating effects of sexual hormones and variances linked to genetics and corporal structures that explain biological and physiological differences between men and women. It is very important to consider all the biological, physiological, functional, psychological, social and cultural characteristics to provide patients with individualized disease management. Herein, we critically analyze the literature regarding gender differences for diseases and acquired conditions of the most representative hepatic pathologies: primary biliary cirrhosis, autoimmune hepatitis, primary sclerosing cholangitis, non alcoholic fatty liver disease and alcoholic liver disease, and viral chronic hepatitis B and C. The last section addresses hemochromatosis, which is a prevalent iron overload disorder in the Caucasian population. This review aims to describe data from the literature concerning viral chronic hepatitis during pregnancy, management during pregnancy and delivery, and new effective drugs for the prevention of maternal infection transmission without significant adverse effects or complications.
- Recent insights into hepatitis B virus-host interactions. [JOURNAL ARTICLE]
- J Med Virol 2014 Mar 6.
Hepatitis B virus (HBV) poses a threat to global public health mainly because of complications of HBV-related chronic liver disease. HBV exhibits a narrow host range, replicating primarily in hepatocytes by a still poorly understood mechanism. For the generation of progeny virions, HBV depends on interactions with specific host factors through its life cycle. Revealing and characterizing these interactions are keys to identifying novel antiviral targets, and to developing specific treatment strategies for HBV patients. In this review, recent insights into the HBV-host interactions, especially on virus entry, intracellular trafficking, genome transcription and replication, budding and release, and even cellular restriction factors were reviewed. J. Med. Virol. © 2014 Wiley Periodicals, Inc.
- Epidemiology of hepatitis B virus infection among recyclable waste collectors in central Brazil. [Journal Article]
- Rev Soc Bras Med Trop 2014 Jan-Feb; 47(1):18-23.
Introduction: The collection of recyclable waste materials is a widespread activity among the urban poor. Today, this occupation attracts an increasingly large number of individuals. Despite its economic and environmental importance, this activity is associated with unsafe and unhealthy working conditions. The aim of this study was to investigate the seroepidemiological profile of hepatitis B virus (HBV) infection in a population of recyclable waste collectors in central Brazil.
Methods:Recyclable waste collectors from all 15 recycling cooperatives in Goiânia City were invited to participate in the study. The participants (n = 431) were interviewed and screened for hepatitis B surface antigen (HBsAg) and antibodies against HBsAg (anti-HBs) and hepatitis B core antigen (anti-HBc) by enzyme-linked immunosorbent assay (ELISA). HBsAg- and anti-HBc-positive samples were tested for HBV DNA and genotyped.
Results:The overall prevalence of HBV infection (HBsAg- and/or anti-HBc-positive) was 12.8%. An age over 40 years and illicit drug use were associated with HBV infection. HBV DNA was detected in 2/3 HBsAg-positive samples and in 1/52 anti-HBc-positive/HBsAg-negative samples (an occult HBV infection rate of 1.9%), in which the genotypes/subgenotypes A/A1, D/D3 and F/F2 were identified. Only 12.3% of the recyclable waste collectors had serological evidence of previous HBV vaccination.
Conclusions:These findings highlight the vulnerability of recyclable waste collectors to HBV infection and reinforce the importance of public health policies that address the health and safety of this socially vulnerable population.
- Knowledge, attitudes and practice of primary healthcare physicians concerning the occupational risks of hepatitis B virus in Al Jouf Province, Saudi Arabia. [JOURNAL ARTICLE]
- J Infect Public Health 2014 Mar 3.
Hepatitis B virus (HBV) infection is a well-recognized occupational risk for all healthcare workers (HCWs) worldwide.This study aimed to assess the knowledge, attitudes, and practices of primary healthcare (PHC) physicians regarding the occupational risks of HBV.In this cross-sectional study, a questionnaire survey was administered to 145 physicians of primary care centers in the Al Jouf Province of Saudi Arabia. The questionnaire contained questions concerning the knowledge base, attitudes and practices of physicians regarding the occupational risks of HBV.The response rate of 82.8% yielded 120 questionnaires for analysis. The majority of physicians surveyed, 99 (82.5%), felt at high risk of contracting and spreading HBV. The vast majority, 115 (95.6%), considered the HBV vaccine safe for all ages. Of the total, 101 (84.2%) were vaccinated. Only 44 (36.7%) physicians recognized that HBV is resistant to alcohol and to some detergents. During surgical procedures, only a minority of the physicians always use double gloves and wear glasses. Almost all physicians were willing to subscribe to regular training programs concerning HBV.A lack of knowledge was determined, and the practices of our physicians concerning the occupational risks of HBV appeared inappropriate. More education focusing on HBV is recommended.
- The importance of baseline viral load when assessing relative efficacy in treatment-naive HBeAg-positive chronic hepatitis B: a systematic review and network meta-analysis. [JOURNAL ARTICLE]
- Syst Rev 2014 Mar 7; 3(1):21.
To date no network meta-analysis (NMA) has accounted for baseline variations in viral load when assessing the relative efficacy of interventions for chronic hepatitis B (CHB). We undertook baseline-adjusted and unadjusted analyses using the same data to explore the impact of baseline viral load (BVL) on CHB treatment response.We searched Embase, Medline, Medline in Process and the Cochrane CENTRAL databases for randomised clinical trials (RCTs) of monotherapy interventions at licensed doses for use in CHB. Search strategies comprised CHB disease and drug terms (a combination of controlled vocabulary and free text terms) and also a bespoke RCT filter.The NMA was undertaken in WinBUGs using fixed and random effects methods, using data obtained from a systematic review. Individual patient data (IPD) from an entecavir clinical trial were used to quantify the impact of different baseline characteristics (in particular undetectable viral load (UVL) at 1 year) on relative treatment effect. Study level mean baseline values from all identified studies were used. Results were generated for UVL and presented as relative risks (RRs) and 95% credible intervals (CrIs) using entecavir as reference treatment.Overall, for all eight relevant interventions we identified 3,000 abstracts. Following full text review a total of 35 (including the contents of six clinical study reports) met the inclusion critera; 19 were in hepatitis B e antigen (HBeAg)-positive patients and 14 of the 19 contained outcome information of relevance to the NMA.Entecavir and tenofovir studies had heterogeneous patient populations in terms of BVL (mean values 9.29 and 8.65 log10 copies/ml respectively). After adjusting UVL for BVL using an informative prior based on the IPD analysis, the difference between entecavir and tenofovir was not statistically significant (RR 1.27, 95% CrI 0.96 to 1.47 - fixed effects). A similar conclusion was found in all sensitivity analyses. Adjusted tenofovir results were more consistent with observed clinical trial response rates.This study demonstrates the importance of adjusting for BVL when assessing the relative efficacy of CHB interventions in achieving UVL. This has implications for both clinical and economic decision making.
- Etiology, clinical features and outcome of fulminant hepatic failure in pregnancy. [Journal Article]
- J Pak Med Assoc 2013 Sep; 63(9):1168-71.
To determine the etiology, clinical features and outcome of fulminant hepatic failure in pregnancy.An observational hospital based study was conducted at Isra University hospital Hyderabad from 1st March 2009 to 28th February 2010. Total 1192 obstetric patients were admitted in obstetrics & gynaecology department during this period, of whom 52 were with Fulminant hepatic failure in pregnancy and were included in this study. A pre-designed structured proforma was used. All patients had clinical history and underwent a physical examination. Routine laboratory tests, liver function tests and viral serology were performed in all cases. All results were analyzed on statistical software SPSS version 11. Frequencies and percentages were calculated, the final outcome was recorded.Out of 52, 6 (11.5%) presented in the first trimester, 4 (7.6%) in the second trimester and 42 (80.7%) were in their 3rd trimester of pregnancy. Etiology of the disease was Hepatitis E in 28 (53.8%), Hepatitis B in 9 (17.3%), Hepatitis C in 7 (13.5%) HELLP syndrome in 7 (13.5%) and acute fatty liver of pregnancy in 1 (3.57%) case. Maternal mortality was 15 (28.8%) and foetal mortality was 40 (77%). Only 12 (23.1%) new born remained alive.Fulminant hepatic failure in pregnancy has very high foetal and maternal mortality which is mostly due to viral hepatitis E.
- Mutations within the HBc gene of the hepatitis B virus: a study on Iranian patients. [Journal Article, Research Support, Non-U.S. Gov't]
- Clin Lab 2014; 60(1):9-21.
Hepatitis B virus (HBV) is a serious risk factor for several severe liver diseases such as cirrhosis and hepatocellular carcinoma. HBV, like other viruses, uses several mechanisms to escape from specific immune responses including the use of mutations in the genome which lead to epitope variations. There are several immune responses, including T helper cells, cytotoxic T lymphocytes, and B cells, against the core antigen of HBV (HBcAg) that can lead to HBV eradication. Therefore, mutations within the HBc gene can lead to escape from immune responses by HBV and, hence, understanding the prevalence of HBc mutations among a specific population can be helpful for future treatment and vaccination. This review addresses the recent information regarding the prevalence of mutations within the HBc gene among Iranian HBV infected patients.The data presented here was collected gene sequences reported from Iran to the NCBI nucleotide Gen Bank.Results showed that the prevalence of HBc gene mutations is frequent in Iranian HBV infected patients.Based on our searches it seems that escape from immune responses is a plausible reason for the high prevalence of HBc gene mutations among Iranian HBV infected patients.
- An audit of chronic hepatitis B contact tracing in metropolitan Western Australia. [Journal Article]
- Aust Fam Physician 2014 Mar; 43(3):137-41.
People with chronic hepatitis B (CHB) are a source of transmission and those in contact with them are a national priority population for hepatitis B testing and vaccination. This audit examined contact tracing success rate and barriers. Success was defined as contacts tested and vaccinated if required.An online survey of 26 general practitioners (GPs), and computer-assisted telephone interviews of 40 patients with CHB notified between 1 September 2011 and 1 September 2012.Half of the patients with CHB (16/31) were asked to take responsibility for informing contacts; contacts of five patients were traced by doctors and those of three patients were traced by nurses. The overall success rate was 75%. Contact tracing by nurses was 100% successful; after excluding nurse contact tracing from the analysis, the success rate was 57%. GPs reported 'insufficient resources' as the most frequent doctor-related barrier to contact tracing and 58% of doctors reported that public health units should be responsible for contact tracing.Increasing contact tracing by nurses could improve success rates. Public health unit assistance for contact tracing of complex cases should continue.
- Characterization of Hepatitis Delta Virus in Sub-Saharan Africa. [JOURNAL ARTICLE]
- J Clin Microbiol 2014 Mar 5.
Hepatitis D virus (HDV) is a satellite virus of hepatitis B virus (HBV) infection that aggravates acute and chronic liver disease. While HBV seroprevalence is very high across sub-Saharan Africa, much less is known about HDV in the region. In this study almost 2300 serum samples from Burkina Faso (n=1131), Nigeria (n=974), Chad (n=50) and the Central African Republic (n=118) were screened for HBV and HDV. Among 743 HBsAg positive sera 74 were positive for HDV-antibodies and/or HDV-RNA, with considerable differences in prevalence, ranging from <2% (pregnant women from Burkina Faso) to 50% (liver patients from Central African Republic). HDV seems to be a lot more frequent in chronic liver disease patients in CAR than in the similar cohorts in Nigeria. In a large nested mother-child cohort in Burkina Faso the prevalence of HDV antibodies was ten times higher in the children than in the mother, despite similar HBsAg prevalences, excluding vertical transmission as an important route of infection.