Hepatitis C: the clinical spectrum of the disease

The hepatitis C virus (HCV) infects nearly 170 million people worldwide and is responsible for approximately 20% of cases of acute hepatitis and 70% of cases of chronic hepatitis. Acute hepatitis is icteric in only 20% of patients and is rarely severe. Eighty-five percent of infected patients develop chronic infection which is generally asymptomatic, resulting in most cases in fortuitous diagnosis, which may be made at a late stage. Twenty-five percent of the HCV chronic carriers have persistently normal serum alanine aminotransferase (ALT) levels despite having detectable HCV RNA in serum; 75% have elevated ALT levels. The former patients usually have mild histologic lesions, probably with a good long-term prognosis. In the latter patients, a liver biopsy is the most accurate way to distinguish patients with mild chronic hepatitis from those with moderate or severe chronic hepatitis. While most patients with mild chronic hepatitis have a slowly progressive liver disease, the patients with moderate or severe chronic hepatitis may develop cirrhosis within a few years. In patients with HCV-related cirrhosis, the incidence of hepatocellular carcinoma is 2-5% per year. At presently, HCV-related end-stage cirrhosis is the first cause of liver transplantation.     

Hepatitis C virus genotypes in Serbia and Montenegro： The prevalence and clinical significance

AIM： To investigate the prevalence of hepatitis C virus （HCV） genotypes in Serbia and Montenegro and their influence on some clinical characteristics in patients with chronic HCV infection. METHODS： A total of 164 patients was investigated. Complete history, route of infection, assessment of alcohol consumption, an abdominal ultrasound, standard biochemical tests and liver biopsy were done. Gene sequencing of 5＇ NTR type-specific PCR or commercial kits was performed for HCV genotyping and subtyping. The SPSS for Windows （version 10.0） was used for univariate regression analysis with further multivariate analysis.
RESULTS： The genotypes 1, 2, 3, 4, 1b3a and 1b4 were present in 57.9%, 3.7%, 23.2%, 6.7%, 6.7% and 1.8% of the patients, respectively. The genotype 1 （mainly the subtype 1b） was found to be independent of age in subjects older than 40 years, high viral load, more severe necro-inflammatory activity, advanced stage of fibrosis, and absence of intravenous drug abuse. The genotype 3a was associated with intravenous drug abuse and the age below 40. Multivariate analysis demonstrated age over 40 and intravenous drug abuse as the positive predictive factors for the genotypes lb and 3a, respectively.
CONCLUSION： In Serbia and Montenegro, the genotypes 1b and 3a predominate in patients with chronic HCV infection. The subtype lb is characteristic of older patients, while the genotype 3a is common in drug abusers. Association of the subtype lb with advanced liver disease, higher viral load and histological activity suggests earlier infection with this genotype and eventually its increased pathogenicity.     

Hepatitis C prevalence among the migrant population in Spain: A systematic review and meta-analysis

Introduction

Spain, which has one of the largest migrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%.

Hepatitis C in the General Adult Population of Oslo: Prevalence and Clinical Spectrum

Background: The prevalence of hepatitis C (HCV) in Northern Europe has not been well described. This study aimed to estimate the prevalence and spectrum of hepatitis C infection in the general adult population of Oslo, Norway. Methods: The study was part of the Oslo Health Study 2000-2001 and included a random selection of individuals older than 30 years living in Oslo County. Sera from 11,456 participants were screened for anti-HCV (EIA-3), positive samples were confirmed (RIBA-3) and examined for HCV RNA (PCR). All anti-HCV positive patients were offered clinical evaluation. Routine biochemical liver tests were performed. Candidates for HCV treatment were asked to undergo a percutanous liver biopsy. Results: Among 11,456 participants HCV RNA was detected in 62 (0.5%) and HCV RNA with raised serum alanine aminotransferase (ALT) in 46 (0.4%). Anti-HCV was detected in 78 (0.7%) with a peak prevalence of 1.5% among subjects 40 and 45 years old. Being anti-HCV positive was associated with being unmarried, unemployed and having low education. Anti-HCV prevalence was higher among subjects with alcohol-related problems compared to those without (4.4% versus 0.6%, P &#114 < &#114 0.001). It was also higher among smokers compared to non-smokers (2.0% versus 0.2%, P &#114 < &#114 0.001). In 33 liver biopsies, bridging fibrosis was seen in 8 (24%) and cirrhosis in 1 (3%). The route of transmission was injecting drug use in 67%, transfusion in 6% and unknown in 27%. Conclusion: In this population-based survey the prevalence of chronic hepatitis C was 0.5% and ALT was raised in 80% of those with chronic infection.     

The prevalence and clinical spectrum of primary biliary cirrhosis in a defined population

We studied 33 patients with primary biliary cirrhosis representative of a well-defined population (240,000) during the decade 1973-82. Mean annual incidence was 13.7 per 10(6) and point prevalence, 92 per 10(6) inhabitants in 1982. An accumulation of asymptomatic cases, constituting 45% of all patients, with a normal life expectancy accounted for this high prevalence. During the study period no disease progress was seen in asymptomatic patients, in contrast to a 50% mortality in the symptomatic group. Disease progress in the latter group was reflected by deterioration of N-demethylating capacity and increasing bilirubin levels. Although our data confirm an increasing prevalence of primary biliary cirrhosis, the mortality rate during the study period was almost identical to that in an earlier period, 1951-60.     

Hepatitis B and C virus infection and the risk of atherosclerosis in a general population

BACKGROUND: The development of atherosclerosis has an inflammatory component. Currently it is not clear, whether hepatitis B and C virus infections are associated with the risk of atherosclerosis. The aim of the present analysis was to investigate those relationships in a population sample. METHODS AND RESULTS: The study of health in Pomerania (SHIP) is a cross-sectional study of the adult population in the northeast of Germany. HBs antigen (HBsAg) and IgG antibodies against hepatitis B and C virus (anti-HBs and anti-HCV) were determined by enzyme linked immunosorbent assays. Fifteen subjects (0.4%) were positive for HBsAg, and 21 subjects (0.5%) were positive for anti-HCV. Among the persons who had no history of anti-hepatitis B vaccination, 213 individuals (5.0%) were found to be as positive for anti-HBs. These individuals and those with prevalent anti-HCV antibodies were regarded as cases (n = 233). The control group comprised of 4033 individuals. Multivariable analyses revealed that there was no independent association between anti-HBs and anti-HCV antibody seropositivity and atherosclerotic end-points such as prevalent myocardial infarction, stroke, carotid intima-media thickness (IMT), carotid plaques and stenoses. CONCLUSION: There is no association between serological markers for hepatitis B and C virus infection and the risk of atherosclerosis in this population sample.     

一般妇女人群中STD感染状况调查

目的：了解近年来新疆维吾尔自治区(新疆)一般妇女人群中性传播疾病(STD)感染状况。方法：2001年5月在奎屯市2个农场随机对110名普通农村妇女进行STD感染状况调查，取宫颈分泌物检测解脲支原体(UU)、人型支原体(MH)、沙眼衣原体(CT)、淋球菌(NG)等，并采血做梅毒快速血浆反应素试验(RPR)及检测艾滋病病毒(HIV)。结果：UU、CT、MH、NG的阳性率分别为30．0％、21．8％、5．5％、5．5％；29例(26．4％)有≥2种病原体感染合并存在。在宫颈炎或／和附件炎病人(59例)中，CT或／和UU阳性率为59．3％，极显著高于正常组；所有人HIV检测阴性，RPR l例阳性。结论：应加强在一般妇女人群中STD的筛查和治疗。     

COPD in the general population: prevalence, incidence and survival

Worldwide, COPD is a leading cause of chronic morbidity and mortality. Although its prevalence is already well documented, very few studies have measured its incidence. We therefore investigated the prevalence, incidence and lifetime risk of COPD in the general population. In a population-based study including subjects ≥ 40, with 12 months of history available in the Dutch IPCI database, we identified COPD cases by a two-step validation algorithm. Among 185,325 participants with 601,283 years of follow-up, 7308 subjects with COPD were identified, and 1713 had incident COPD. The overall IR of physician-diagnosed COPD was 2.92/1000PY (95%CI 2.78-3.06). The incidence of COPD was higher in men (3.54; 95%CI 3.33-3.77) than in women (2.34; 95%CI 2.17-2.52), and the overall baseline prevalence of COPD was 3.02% (95%CI 2.94-3.10). For people who had entered the study free of COPD at the age of 40, the risk of developing COPD within the next 40 years was 12.7% for men and 8.3% for women. In patients with very severe COPD, 26% died after 1 year of follow-up, whereas 2.8% died among the non-COPD subjects. In the general population in the Netherlands, three on 1000 subjects were diagnosed with COPD per year. The incidence increased rapidly with age and was higher in men than in women. One in eight men and one in 12 women, being COPD free at the age of 40, will develop COPD during their further life. Mortality rates differed substantially between COPD patients and non-COPD subjects of the same age, underlining the burden of this disease.     

Hazardous drinking: prevalence and associations in the Finnish general population

Background:  Hazardous drinking, defined as consuming alcohol on a risky level and not meeting the diagnostic criteria of alcohol use disorders (AUDs), has been suggested for a new complementary nondependence diagnosis. This study aimed to investigate the prevalence and associations of hazardous drinking in comparison to AUDs, moderate drinking, and abstinence.
Methods:  A national representative sample of Finns was examined in the Health 2000 Survey. For 4477 subjects aged 30 to 64 years (76%, 2341 females), both the quantity frequency data about alcohol consumption and Composite International Diagnostic Interview (CIDI) data concerning AUD diagnoses were available. The nationally recommended limits for hazardous dinking were used (males: 24 drinks, females: 16 drinks/wk). Logistic regression models were used to analyze associations.
Results:  The prevalence of hazardous drinking was 5.8%. Hazardous drinking was more prevalent among males than females (8.5% vs. 3.1%). It was most prevalent among the subjects aged 40 to 49 years (7.3%), divorced or separated (8.3%), unemployed (8.2%) and subjects living in the southern (Helsinki) region (7.5%). AUDs versus hazardous drinking were more likely to be in males versus females and in the unemployed versus employed. Subjects aged 40 and over had higher odds for hazardous drinking versus AUDs. The odds for hazardous versus moderate drinking were higher for males versus females (adjusted odds ratio = 3.24), for subjects aged over 40 years, unemployed versus employed and cohabiting, divorced/separated or unmarried subjects versus married subjects.
Conclusion:  The high prevalence of hazardous drinking makes it an important public health concern. Hazardous drinkers have different sociodemographic characteristics as compared to people in other alcohol use categories.     

The spectrum and prevalence of arrhythmia in different clinical pulmonary hypertension groups in Chinese population

BackgroundArrhythmia is not uncommon among pulmonary hypertension (PH) population, and may be associated with disease severity.HypothesisTo investigate different spectrums and prevalence of arrhythmias in different clinical PH groups in Chinese population.MethodsPatients diagnosed with PH between April 15, 2019, and August 2, 2021, were enrolled prospectively. The prevalence of different types of arrhythmias in PH patients were calculated. Logistic regression analyses were conducted to determine independent predictors for arrhythmia.ResultsOne thousand patients were enrolled. The prevalence of any arrhythmia, sinus node dysfunction, sinus tachycardia, atrial fibrillation, atrial flutter, other types of atrial tachycardia, atrioventricular block, and ventricular tachycardia is 44.4%, 12.2%, 15.2%, 8.1%, 4.1%, 10.2%, 7.1%, and 2.5%. Logistic regression analyses revealed that older age and larger right ventricle (odds ratio: 1.111 and 1.095, p < .05) were independently related with higher probability of supraventricular arrhythmia; Complicating with coronary artery disease, larger right ventricle, and increased left ventricular end‐diastolic diameter (odds ratio: 19.540, 1.106, and 1.085, p < .05) were independently correlated with sinus node dysfunction/atrioventricular block in patients with pulmonary arterial hypertension.ConclusionsNearly half of PH patients experienced at least one type of arrhythmia. The most common seen arrhythmias were supraventricular arrhythmia, sinus tachycardia, and sinus node dysfunction. Older age and larger right ventricle were independently related with higher probability of supraventricular arrhythmia; Complicating with coronary artery disease, larger right ventricle and increased left ventricular end‐diastolic diameter were independently correlated with higher probability of sinus node dysfunction/atrioventricular block in patients with pulmonary arterial hypertension.     

The prevalence and characteristics of fibromyalgia in the general population

Objective. To determine the prevalence and characteristics of fibromyalgia in the general population. Methods. A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail. Results. The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (>7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia. Conclusion. Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia–pain threshold and symptoms–are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.     

中国成年人代谢综合征的患病率

目的本研究旨在提供关于我国35～74岁一般成年人群代谢综合征(MS)及其主要组成成分患病率的最新资料。方法我们于2000-2001年在全国35～74岁的成年人群中代表性地选择了15540例个体进行横断面调查。根据国际糖尿病联盟2004年度推荐的有关中国人MS的标准诊断MS和进行组分分类。结果男女合计，年龄未标化的MS患病率为16．5％。年龄标化后的MS患病率，男女分别为10．0％和23．3％；年龄标化后的患病率，北方和南方地区分别为23．3％和11．5％，城市和农村地区分别为23．5％和14．7％。我国北方居民的MS患病率高于南方居民，城市居民高于农村居民。结论我国成年人中有相当比例的个体患有MS。这些结果提示我国亟需制定面向全国的预防、检测和治疗MS的卫生策略，以降低心血管疾病的社会负担。     

Hepatitis C virus (HCV) infection in a community in the Nile Delta: population description and HCV prevalence

This report describes a cross-sectional survey of the prevalence of antibodies to hepatitis C virus (anti-HCV) in a rural Egyptian community in the Nile Delta. One half of the village households were systematically selected and examined by questionnaire and testing sera for anti-HCV and HCV RNA. Blood samples were obtained from 3, 888 (75.4%) of 5,156 residents >/=5 years of age; an additional 111 samples were obtained from children younger than 5 years. Overall, 973 (24.3%) of 3,999 residents were anti-HCV-positive, and the age- and gender-adjusted seroprevalence was 23.7%. Anti-HCV prevalence increased sharply with age, from 9.3% in those 20 years of age and younger to >50% in those older than 35 years. Currently or previously married individuals were more likely to be seropositive than those never married, controlling for age (Mantel-Haenszel risk ratio = 1.8; 95% CI: 1.3, 2.6). Of the 905 anti-HCV-positive samples tested, 65% were also positive for HCV RNA. Active schistosomal infection was not associated with anti-HCV status; however, history of antischistosomal injection therapy (reported by 19% of anti-HCV positives) was a risk for anti-HCV (age-adjusted risk ratio = 1.3; 95% CI: 1.2, 1.5). This study, the largest community-based survey to date, supports earlier reports of high levels of anti-HCV among adults in rural areas of Egypt, although many of those who are seropositive will not have active liver disease. The large reservoir of HCV infection in the community provides an opportunity to investigate risk factors for transmission, the natural history of infection and effectiveness of preventive methodologies, and raises concern about the prospect of an increasing incidence of chronic liver disease in the coming decades.     

邵阳市区成人胆石症患病率及其危险因素流行病学调查

目的明确邵阳市区成人胆石症的患病率及其主要危险因素。方法通过多阶段随机抽样,对邵阳市3个城区26个社区18岁以上居民进行调查,内容涉及问卷调查、体格检查、生化检测及肝胆B超检查。结果5267名成人完成调查,占邵阳市区总人口的1.24%。其中男性2704名,女性2563名,年龄46.1±14.4岁。B超共检出胆石症388例,占7.4%,年龄≥70岁组最高,女性患病率为男性的1.14倍。胆石症组的年龄、收缩压、体重指数(BMI)、空腹血糖和低密度脂蛋白胆固醇(LDL-ch)、糖尿病、血脂异常和脂肪肝患病率等显著高于对照组。多元回归分析显示:体重指数、年龄、脂肪肝等三项指标与胆石症密切相关。结论邵阳市区成人胆石症患病率高,体重指数、年龄、脂肪肝与胆石症密切相关。     

Low prevalence of islet autoimmunity in adult diabetes and low predictive value of islet autoantibodies in the general adult population of northern Italy

Aims/hypothesis. To assess the prevalence of islet autoimmunity in adult-onset diabetes mellitus and the predictive value of islet autoantibodies in the general adult population of northern Italy. Methods. A sample of 2076 people aged 40 years or more participating in the population-based Cremona Study and classified in 1990 as having diabetes mellitus, impaired and normal glucose tolerance according to WHO criteria after an oral glucose tolerance test, were tested for antibodies to glutamic acid decarboxylase and IA-2. Results. Increased concentrations of glutamic acid decarboxylase antibodies were found in 4 (2.8 %) of 143 participants with known diabetes and none of 50 with previously unknown diabetes, 1 (0.65 %) of 153 with impaired and 18 (1.0 %) of 1718 with normal glucose tolerance. The increased prevalence of these antibodies in subjects with known diabetes was not statistically significant. Protein tyrosine phosphatase IA-2-antibodies were found in only four subjects, two of whom also had glutamic acid decarboxylase antibodies, all with normal glucose tolerance. After 8 years of follow-up, none of 21 non-diabetic subjects with either glutamic acid decarboxylase or IA-2-antibodies had developed diabetes and only a slight deterioration from normal to impaired fasting glucose was observed in 3 of 15 subjects with previous normal glucose tolerance. Conclusion/interpretation. This study has shown that in northern Italy the prevalence of adult autoimmune diabetes in the general adult population is 0.19 % (95 % CI 0.05–0.5); that autoimmune diabetes represents only a minority of all cases of adult diabetes; and that islet autoantibodies are not a high-risk factor for diabetes development in adults with normal glucose tolerance over 8 years of follow-up. [Diabetologia (1999) 42: 840–844] Received: 29 December 1998 and in revised form: 9 March 1999     

Metabolic syndrome in central Brazil: prevalence and correlates in the adult population

Background

The prevalence of metabolic syndrome (MetS) has increased in developing countries in recent decades. This syndrome, a clustering of metabolic abnormalities, has been correlated to various socioeconomic and behavioral variables. We investigated the prevalence and prevalence ratios (PR) of MetS and related factors in an adult population of the Federal District (FD) of Brazil, which is located in the central region of the country.

Methods

A cross-sectional, population-based study conducted in 2007, with 2130 adults (aged 18?years or older) in the FD of Brazil. Metabolic syndrome was defined according to the recently harmonized criteria. The prevalence of MetS and PR were estimated for each sex according to the diagnostic components and the overall contribution of the selected correlates.

Results

The overall prevalence of MetS was 32.0% (95%CI: 28.9?C35.2), with no gender difference. The single component with the greatest contribution to the diagnosis of MetS was hypertension in men (PR 5.10, 95%CI: 3.17?C8.22) and high waist circumference in women (PR 5.02, 95%CI: 3.77?C6.69). The prevalence of MetS increased significantly and progressively with age and excess weight. In women, higher education was protective against MetS (PR 0.66, 95%CI: 0.49?C0.89) compared to 8 or less years of education. There was no association between the prevalence of MetS and behavioral variables studied.

Conclusions

This study provides comprehensive and alarming data about the prevalence of MetS among the adult population of Brazil??s FD. The results suggest that reducing education inequalities may be an important public policy goal to improve health outcomes, especially among women.     

Hepatitis C: Basic and clinical studies

The HCV, a single stranded RNA virus belonging to the family of flavivirus, has been identified as the probable cause of the majority of cases of transfusion-associated NANB hepatitis and community-acquired NANB hepatitis in Japan. The hepatitis virus is present in a least 2% of the blood donor population and is extremely common in high risk groups, such as hemophiliacs and hemodialysis patients. The contribution of HCV infection to sporadic, acute and chronic hepatitis, liver cirrhosis and primary liver cancer has been established. Furthermore anti-HCV in 20% of alcoholic patients with liver injury suggest that HCV may be etiologically associated with liver disease previously attributed to other causes. Therapy of acute and chronic liver disease associated with HCV infection is likely to be undertaken with recombinant IFN alpha in the future to prevent the progression of the disease from acute hepatitis to chronic hepatitis, and from chronic hepatitis to liver cirrhosis or primary liver cancer. However the prevention of HCV infection will be the goal, in addition to screening of donor blood and exclusion to a large degree of positive units likely to decrease the incidence of post-transfusion hepatitis.     

Aortic valvular regurgitation: prevalence and clinical characteristics in a predominantly obese adult population not taking anorexigens

BACKGROUND: We recently reported the prevalence of aortic regurgitation (AR) by Doppler echocardiography (echo) in obese subjects to be higher than in some previous reports. OBJECTIVE: To describe the prevalence of AR in an obese population not taking anorexigens as a function of demographic characteristics, cardiovascular risk factors, and other potential predictors. METHODS: In 539 adult subjects, cardiovascular status was evaluated by medical history, physical examination, and Doppler echocardiograms performed according to a standardized imaging protocol. Echocardiographic readers were blinded as to each subject's medical and medication histories. Associations of AR with demographic and comorbid factors were examined. RESULTS: Subjects had a mean (+/- SD) body mass index (BMI) of 35 +/- 7 kg/m2, and were predominantly white (87.6%), females (74%), with a mean age of 47 +/- 12 years. AR by Food and Drug Administration criteria (> or =mild) was present in 4.1% of the subjects. Covariates significantly associated with AR were increasing age (P < 0.001), presence of a history of hypertension (P = 0.001), left ventricular (LV) internal dimensions (P < 0.005), and tricuspid and mitral regurgitation grade (P < 0.001). CONCLUSIONS: Clinical and Doppler echo evaluation of a large, predominantly obese, adult population revealed that AR was more prevalent than in some previous reports and was highly correlated with increased age, presence of a history of hypertension, LV internal dimensions, tricuspid and mitral regurgitation.