Chronic viral hepatitis and risk of lymphoid malignancies: A retrospective twelve-year population-based cohort study in Côte d’Or,France

BackgroundThe association between hepatitis C infection and lymphoid malignancies is still a matter of debate. The hypothesis of a relationship between hepatitis B and lymphoid neoplasms is more recent and has been far less thoroughly explored.AimThe aim of this study was to evaluate the association between hepatitis C and B infections and B cell non-Hodgkin and Hodgkin lymphomas.MethodsWe took advantage of the co-existence in the French administrative area of Côte d’Or of two specialized registries – one for viral hepatitis and one for haematological diseases – to conduct a population-based, cohort study covering a 12-year period. The databases were anonymized and then linked using a probabilistic model.ResultsThere were 8234 person-years at risk in the hepatitis C cohort and 2784 in the hepatitis B cohort. We found 6 cases of non-Hodgkin lymphoma in the hepatitis C cohort, resulting in an overall adjusted standardized incidence ratio of 3.42 (CI: 1.25–7.45). Three of these 6 cases were diffuse-large-B-cell-lymphoma. Cirrhosis was associated with a higher risk of non-Hodgkin lymphoma in the hepatitis C cohort (relative risk = 8.4, p < 0.01, using a Poisson regression). We found one case of chronic lymphocytic leukaemia amongst the hepatitis B carriers.ConclusionHepatitis C carriers are at a higher risk of developing non-Hodgkin lymphoma than the general population. The role of cirrhosis and the association between hepatitis B and lymphoid malignancies deserve to be further assessed.     

Occult hepatitis B virus and the risk for chronic liver disease: A meta-analysis

BackgroundThe role of occult hepatitis B virus infection as a cause of liver disease is still debated although many studies found a higher prevalence of this condition in subjects than those without liver disease compared. A recent meta-analysis showed an increased risk of hepatocellular carcinoma for occult hepatitis B virus infection.AimsWe carried out a meta-analysis of observational studies to summarize the existing evidence and assess quantitatively the association between occult hepatitis B virus infection and chronic liver disease.MethodsWe searched the available literature on this issue published up to May 2012 using PubMed and EMBASE. All articles that provided enough information to estimate the chronic liver disease risk associated with occult hepatitis B virus infection were selected. Fourteen studies were retrieved.ResultsA total of 1503 subjects with (cases) and 2052 without chronic liver disease (controls) were included. The summary odds ratio for chronic liver disease from all studies was 8.9 (95% confidence interval: 4.1–19.5). The meta-analysis restricted to 7 studies with more precise effect estimate (wt% > 8%) provided a lower odds ratio estimate (odds ratio = 3.9; 95% confidence interval: 1.7–9.0).ConclusionsThese findings suggest a relevant association between occult hepatitis B virus infection and chronic liver disease, confirming the hypothesis that hepatitis B virus may play a pathogenic role even in the “occult” status.     

Hepatitis B virus particles preferably induce Kupffer cells to produce TGF-β1 over pro-inflammatory cytokines

BackgroundKupffer cells and related cytokines are thought to play a critical role in liver fibrosis; however, the role played by Kupffer cells in hepatitis B virus-related fibrogenesis is unknown.MethodsPrimary rat Kupffer cells were cultured with different titres of hepatitis B virus particles and the concentrations of transforming growth factor (TGF)-β1, interleukin (IL)-1, IL-6 and tumour necrosis factor (TNF)-α in the culture supernatant were measured every 24 h for 7 days. The mRNA and protein levels of these cytokines in Kupffer cells were also analysed using quantitative real-time polymerase chain reaction and western blotting, respectively.ResultsKupffer cells maintained normal morphology and function throughout the 7-day exposure to hepatitis B virus. The concentration of TGF-β1 secreted by hepatitis B virus-stimulated Kupffer cells (6 log IU/ml hepatitis B virus) increased 5.38- and 7.75-fold by Days 3 and 7, respectively (p < 0.01). Western blotting showed that TGF-β1 expression in Kupffer cells exposed to high titres of hepatitis B virus increased 1.80- and 2.42-fold by Days 3 and 7, respectively (p < 0.01). In contrast, Kupffer cell expression and secretion of pro-inflammatory cytokines (IL-6, IL-1 and TNF-α) was unchanged throughout the experiment.ConclusionHepatitis B virus preferentially stimulates Kupffer cells to produce the pro-fibrogenic/anti-inflammatory cytokine TGF-β1 rather than the pro-inflammatory cytokines IL-6, IL-1 and TNF-α. This may partly explain why overt liver fibrosis still presents in cases of chronic hepatitis B virus infection with minimal (or no) necro-inflammation.     

Inverse correlation between plasma oxysterol and LDL-cholesterol levels in hepatitis C virus-infected patients

BackgroundHepatitis C virus infection is characterised by enhanced oxidative stress, which can be measured quantitatively by plasma oxysterol concentration. These molecules may affect lipid metabolism through the activation of Liver X Receptors. Hepatitis C virus exploits host lipid metabolism to facilitate its replication and diffusion. In our study we aimed to evaluate and highlight the potential pathogenetic role of oxysterols, 7-ketocholesterol and 7-β-hydroxycholesterol, in hepatitis C virus-related lipid dysmetabolism.MethodsThe study was performed in 42 patients with chronic hepatitis C (93% genotype 1b) and 38 non-alcoholic fatty liver disease patients. Plasma oxysterols 7-ketocholesterol and 7-β-hydroxycholesterol were determined by isotope dilution gas chromatography/mass spectrometry.ResultsGas chromatography/mass spectrometry revealed higher 7-ketocholesterol (71.2 ± 77.3 vs 30.4 ± 14.5; p < 0.005) and 7-β-hydroxycholesterol (23.7 ± 20.6 vs 11.5 ± 4.9; p < 0.001) plasma levels in hepatitis C virus patients. Furthermore, multivariate regression analysis highlighted an inverse independent correlation between high oxysterol levels and low low-density lipoprotein cholesterol (p = 0.01 for 7-β-hydroxycholesterol; p = 0.02 for 7-ketocholesterol) in the hepatitis C virus group; in contrast, the non-alcoholic fatty liver disease group showed a direct correlation between oxysterol levels and low-density lipoprotein-cholesterol (p < 0.001 for 7-β-hydroxycholesterol; p = 0.002 for 7-ketocholesterol).ConclusionThese different correlations reveal profound differences in lipid dysmetabolism between chronic hepatitis C and non-alcoholic fatty liver disease patients.     

Atherosclerosis risk in HIV-infected patients: the influence of hepatitis C virus co-infection

BackgroundThe influence of hepatitis C virus (HCV) infection on atherosclerosis risk in HIV-infected patients has not been adequately evaluated in real-life situations.Objectives and methodsWe compared indexes of early atherosclerosis evaluated by echo-Doppler ultrasound (presence of plaque in carotid or femoral arteries) in 18 HCV–HIV co-infected patients versus 22 HIV mono-infected patients.ResultsPrevalence of subclinical carotid plaque was significantly higher in HCV–HIV co-infected patients (p = 0.04), despite of the fact LDL-cholesterol and blood pressure (BP) were lower in the co-infected patients (p = 0.003). HCV chronic infection (OR = 10; IC: 1.5–72; p = 0.02) was an independent risk factor.ConclusionThis cross sectional study suggests that HCV infection might be an independent cardiovascular risk factor in HCV–HIV co-infected patients. HCV infection might be considered as not only a liver infection but also as a metabolic disease in HIV patients, justifying regular cardiovascular surveillance.     

Hepatitis B remains a major health priority in Western Balkans: Results of a 4-year prospective Greek–Albanian collaborative study

Objective of the studyTo report on the results of two projects on chronic hepatitis B in Western Balkans lead by Ioannina, Northwest Greece and Tirana, Albania.MethodsIn two prospective projects, HEPAGA I and HEPAGA II which lasted 4 years. In HEPAGA I, serum samples from 410 Albanians were tested for HBV. In HEPAGA II, health care consumption was recorded in hospitalized patients with chronic hepatitis B.ResultsHEPAGA I showed that 11.89% of the Albanians was HBsAg(+) and only 21.19% had HBV immunoprotection. HEPAGA II study included 101 patients. There was a significant difference in hospitalization costs per patient between centers. The Greek patients were significantly older (p = 0.027) and there was a significant correlation between age > 50 years and hospitalization costs (p = 0.035). In Greece, hospitalization costs, number of patients admitted and number of hospitalization days per patient were in a remarkable position compared to other causes of hospitalization.ConclusionsThe HEPAGA I study showed a decrease in the prevalence of chronic HBV infection in Albania compared to that of the previous decade. The HEPAGA II study demonstrated that health care consumption due to HBV infection is still an important determinant of the overall health consumption in Western Balkans.     

The impact of a vaccination campaign against hepatitis B on the further decrease of hepatitis B virus infection in a southern Italian town over 14 years

BackgroundHepatitis B virus infection has decreased in Italy.The aims of this study were to identify changes, if any, in the epidemiological pattern of HBV infection in a southern Italian town first surveyed in 1996 and to assess the effectiveness of vaccination campaign against hepatitis B.MethodsIn 2010, subjects were selected from the census by a systematic 1:4 random sampling procedure. Hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B core antigen (anti-HBc) were detected by ELISA. Associations (odds ratios) linking exposure to hepatitis B virus infection to potential risk factors were estimated by univariate and multivariate analyses.ResultsOf the 1100 eligible subjects, 1020 (92.0%) agreed to participate. The prevalences of HBsAg (0.6%) and anti-HBc (15.2%) were significantly lower than in 1996 (0.8% and 21.5%) (p < 0.01). No subject below 30 years of age (those that had been targeted for compulsory immunization) had been exposed to HBV infection. At multiple logistic regression analysis, age > 45 years (OR = 9.8; 95% CI = 5.1–18.7) and past use of glass syringes (OR = 1.9; 95% CI = 1.2–3.1) independently predicted the likelihood of anti-HBc positivity.ConclusionsThese results, albeit obtained in a small town and thus not generalizable, confirm the continuous decreasing trend of HBV infection and demonstrate the effectiveness of the Italian hepatitis B vaccination program.     

Type 2 diabetes mellitus and chronic hepatitis C: Which is worse? Results of a long-term retrospective cohort study

BackgroundThe long-term outcome in patients with chronic hepatitis C and type 2 diabetes mellitus treated with interferon and ribavirin is unclear. We compared incidence of liver-related events and mortality rates between hepatitis C virus-positive patients with or without diabetes mellitus, and the incidence of diabetes-related events between diabetic patients with and without hepatitis C.MethodsRetrospective study of 309 patients with chronic hepatitis C. Incidence of liver-related events, diabetes-related events and mortality rates were assessed over a mean follow-up of 11.02 ± 4.9 years.Results50 (16%) chronic hepatitis C patients had diabetes mellitus. Diabetics showed a higher number of diabetes- and liver-related events than non-diabetics (10% vs 1.5%, p = 0.006; 18% vs 5.7%, p = 0.007, respectively) with a mortality of 14% vs 1.5% (p = 0.0003). Baseline cirrhosis (p = 0.002) and non-sustained virological response (p = 0.01) were independent risk factors for liver events; diabetes mellitus (p = 0.01) and hypertension (p = 0.0017) were independent factors for diabetes-related events.ConclusionsIn patients with chronic hepatitis C, comorbidity with diabetes mellitus was associated with a higher mortality rate and incidence of liver/diabetes-related events. Independent risk factors for liver-related events were the non-response to antiviral therapy and cirrhosis at baseline.     

Erectile dysfunction in patients with chronic hepatitis C virus infection

Background and study aimsHepatitis C virus (HCV) infection is a major public health problem worldwide and in Egypt. Several studies have suggested that chronic HCV infection may be associated with erectile dysfunction (ED) in men. The aim of our study was to detect the prevalence of ED among male patients with chronic HCV infection.Patients and methodsThe study included 150 male patients with chronic HCV infection (124 patients with chronic hepatitis and 26 patients with HCV-associated liver cirrhosis). The Child–Pugh score was used to assess the severity of cirrhosis. An Arabic validated version of the five-item International Index of Erectile Function (IIEF-5) was used to detect the presence and severity of ED.ResultsThe patients’ age ranged from 20 to 80 years with mean age ± standard deviation (SD; 50 ± 17.19) years. The prevalence of ED among patients with chronic HCV infection was found to be 29.3%. The prevalence was significantly higher in cirrhotic as compared to chronic hepatitis patients (p < 0.001) and the average ED score was significantly lower in patients with liver cirrhosis than in those with chronic hepatitis. There was a highly significant relation between the severity of ED and the severity of liver disease. There was a significant negative correlation between serum bilirubin and ED score and a significant positive correlation between serum albumin and ED score in patients with liver cirrhosis.ConclusionAbout 30% of patients with chronic HCV infection were found to have ED; so, given the high prevalence of HCV infection in Egypt, chronic HCV infection may be considered in the differential diagnosis of ED. There was a highly significant relation between the severity of ED and the severity of liver disease and the majority of patients with liver cirrhosis proved to be suffering from ED, which may be related to the associated hypoalbuminaemia.     

Virologic and histologic characterisation of dual hepatitis B and C co-infection in Egyptian patients

Background and study aimsData about dual hepatitis C (HCV) and B (HBV) co-infection are still scarce, especially in endemic areas such as Egypt. Therefore, we aimed to characterise the virologic and histologic pattern of dual B/C co-infection in a tertiary care centre in Egypt.Patients and methodsAfter obtaining approval from the review board, a retrospective design to evaluate the data registry between January 2009 and December 2012 of patients with dual HCV and HBV seropositivity (BC-group) at the Viral Hepatitis Unit in Ministry of Health and Assiut University Hospital, Egypt was conducted. Data for hepatitis B e antigen (HBe-Ag) and anti-HB core status, anti-hepatitis delta virus (anti-HDV), HBV-DNA and HCV-RNA assays and liver biopsy (METAVIR scoring) results were collected. Two other matched groups of mono-HCV (C-group) and HBV (B-group) were selected as controls. All patients were naive for antiviral therapy.ResultsA total of 3300 patients were enrolled. Dual infection was observed in 25 (0.7%) patients (all males, mean = 35.2 ± 10.2 years). Four patients (16%) were HBe-Ag-positive. Six (24%) patients were HBV-DNA-negative and all were positive for HCV RNA. Between groups, raised alanine aminotransferase (ALT) was found in 76%, 41.7% and 49.2% of the BC, B and C groups, respectively (p = 0.023). HBV DNA >2000 IU ml^?1 was more in the B-group than in the BC-group (63.9% vs. 36%; p = 0.042) and HCV RNA >800,000 IU ml^?1 was more in the BC-group than in the C-group (28% vs. 12.3%; p = 0.009). Histologically, there is no statistical significant difference between the three groups.ConclusionDual hepatitis B/C infection is not uncommon and their virologic and histologic profile is modest. Further evaluation with regard to treatment and long-term follow-up is warranted.     

Co-infections,comorbidities, and alcohol or other substances abuses in chronic hepatitis C-related hospitalisations in Spain

BackgroundThe Strategic Plan for Tackling Hepatitis C launched in 2015 in Spain has led to an important nationwide decrease in hepatitis C related hospitalisation rates. However, patients’ infection progression during decades could increase their health status complexity and challenge patient's prognosis after hepatitis C eradication.MethodsWe carried out an observational retrospective study evaluating the prevalence of the main co-infections, comorbidities (risk factors and extrahepatic manifestations), and alcohol or other substances abuses in chronic hepatitis C related hospitalised patients in Spain. Data were obtained from the National Hospitalisation Registry discharges from January 1st of 2012 to December 31st of 2019.ResultsBetween 2012 and 2019 there were 356,197 chronic hepatitis C-related hospitalisations. In-hospital deaths occurred in 11,558 (4.6%) non-advanced liver disease and in 10,873 (10.4%) advanced liver disease-related hospitalisations.Compared to 2012–2015, in 2016–2019 the proportion of hospitalisations related to non-advanced liver disease increased from 69.4% to 72.4%, while the advanced disease-related hospitalisations decreased from 30.6% to 27.6% (P < .001). In spite of the decrease in severe cases among hospitalisations, all comorbidities evaluated, and alcohol abuse increased in 2016–2019 compared to 2012–2015, while co-infections and other substances abuses decreased in the same period.In the latest period (2016–2019): 28,679 (18.3%) of the hospitalised patients had a HIV, 6928 (4.4%) a hepatitis B, and 972 (.6%) a tuberculosis co-infection. Most frequent comorbidities were diabetes (N = 33,622; 21.5%); moderate to severe renal disease (N = 28,042; 17.9%), chronic obstructive pulmonary disease and asthma (N = 25,559; 16.3%), and malignant neoplasms (excluding hepatocellular carcinoma) (N = 19,873; 12.7%). Alcohol or substances abuse was reported in 48,506 (31.0%) hospitalisations: 30,782 (19.7%) with alcohol; 29,388 (18.8%) with other substances; and 11,664 (7.5%) with both, alcohol and other substances, abuses.ConclusionsDespite the reduction in advanced liver disease hepatitis C-related hospitalisations due to prioritisation of treatment to the more severe cases, high and increasing prevalence of comorbidities and risks factors among hepatitis C-related hospitalisations have been found.     

Serological and molecular study of Hepatitis E virus in pediatric patients in Mexico

Introduction and objectivesCases of viral hepatitis reported in Mexico are typically identified as hepatitis A, B and C. However, unspecified cases are reported annually. Hepatitis E virus (HEV) is an emergent agent that causes a self-limiting infection that can evolve to chronic in immunosuppressed individuals. In Mexico, HEV genotype 2 is considered endemic, though it's the prevalence is not well known. Therefore, the present study was designed to determine the prevalence of HEV among patients at the “Hospital Infantil de Mexico Federico Gomez”.Materials and methodsThe study included 99 patients, anti-HEV antibody (IgG and IgM) were detected by indirect ELISA and viral genome was identified using RT-PCR technique. Two PCR products of positive cases were sequenced.ResultsELISA results were positive in 3% and 6%, for IgG and IgM respectively, 54.5% prevalence was found by PCR. Low lymphocyte count (p < 0.05) and malnutrition (p < 0.005) were significant factors for high PCR prevalence and could increase the possibility of infection. Two samples were sequenced and confirmed the presence of HEV genotype 3.ConclusionsThis report reveals the incidence of HEV in pediatric patients in Mexico. Moreover, the identification of HEV genotype 3 in human samples suggests a potential zoonotic risk that requires further research.     

Seroprevalence of hepatitis E virus in chronic hepatitis C in Brazil

Background and aims

Hepatitis E virus infection in patients with underlying chronic liver disease is associated with liver decompensation and increased lethality. The seroprevalence of hepatitis E virus in patients with chronic hepatitis C in Brazil is unknown. This study aims to estimate the seroprevalence of hepatitis E virus in patients with chronic hepatitis C and to describe associated risk factors.

Leprosy and hepatitis B coinfection in southern Brazil

To investigate the association of leprosy with hepatitis B virus (HBV) infection, as yet unknown for South Brazil, we assessed hepatitis B virus coinfection in 199 South Brazilian leprosy patients (119 lepromatous, 15 tuberculoid, 30 borderline, 12 undetermined and 23 unspecified) and in 681 matched blood donors by screening for the hepatitis B virus markers HBSAg and anti-HBc, using ELISA. Positive samples were retested and anti-HBc+ only samples were tested for the hepatitis B surface antibody (anti-HBs). There was a strong association between leprosy and hepatitis B virus infection (OR = 9.8, 95% CI = 6.4–14.7; p = 0.004·E⁻³⁰), as well as an association between HBV infection and lepromatous leprosy, compared to other forms (OR = 2.4, 95% CI = 1.2–4.8; p = 0.017). We also found that confinement due to leprosy was associated with hepatitis B virus infection (OR = 3.9, 95% CI = 2.1–7.4; p = 0.015·E⁻³). Leprosy patients are susceptible to develop hepatitis B virus infection, especially lepromatous. Institutionalized patients, who probably present a stronger Th2 response, have higher risk of being exposed to hepatitis B virus. This clearly emphasizes the need for special care to leprosy patients in preventing hepatitis B virus coinfection in South Brazil.     

Strong correlation by ultrasonography of hepatomegaly and the presence of co-infection in HIV/HCV cirrhotic patients

ObjectivesProgression of hepatic fibrosis is accelerated in patients co-infected with human immunodeficiency virus and hepatitis C virus compared to hepatitis C virus mono-infected patients. This study aimed to compare ultrasound features and selected clinical and biochemical variables between patients with human immunodeficiency virus/hepatitis C virus co-infection (n = 16) versus hepatitis C virus mono-infection (n = 16).MethodsEach patient underwent abdominal ultrasound, and a specific evaluation was performed in order to detect findings consistent with chronic liver disease. Characterization of spleen size, liver structural pattern, diameter of the portal, spleen, and mesenteric veins was based on classical ultrasound parameters. Propensity score was used for control of selection bias and performed using binary logistic regression to generate a score for each patient. The Fisher and Mann–Whitney tests were used to evaluate categorical variables and continuous variables, respectively.ResultsOn univariate analysis right hepatic lobe size was larger in human immunodeficiency virus/hepatitis C virus patients (157.06 ± 17.56 mm) compared to hepatitis C virus mono-infected patients (134.94 ± 16.95 mm) (p = 0.0011). The left hepatic lobe was also significantly larger in human immunodeficiency virus/hepatitis C virus patients (115.88 ± 22.69 mm) versus hepatitis C virus mono-infected patients (95.06 ± 24.18 mm) (p = 0.0177). Also, there was a strong correlation between hepatomegaly and co-infection (p = 0.005).ConclusionHuman immunodeficiency virus infection was the primary variable influencing liver enlargement in this population. Hepatomegaly on ultrasound was more common among cirrhotic human immunodeficiency virus/hepatitis C virus co-infected patients than among cirrhotic hepatitis C virus mono-infected patients. This aspect is very important in the management of human immunodeficiency virus/hepatitis C virus co-infected patients, because screening for hepatocellular carcinoma is necessary in this population.     

Decline of viral hepatitis prevalence among asymptomatic Egyptian blood donors: A glimmer of hope

BackgroundViral hepatitis is an important etiological agent of chronic hepatitis and liver disease and is a major cause of morbidity and mortality especially in Egypt since it has the highest prevalence of hepatitis C virus (HCV) infection. We aimed to assess if there is any change in the annual seroprevalence of both HCV and hepatitis B virus (HBV) infection in Egypt in the current era.MethodsOur study included 55,922 potentially healthy asymptomatic blood donors; 52,280 males and 3642 females with mean age of 30.98 ± 8.6 years. All of them were volunteers for the first time and 70% were from rural areas. We applied our own questionnaire that included past medical history, surgical history, and history of blood donation. We screened their sera for the presence or absence of anti-HCV antibodies with the 3rd generation enzyme-linked immunosorbent assay (ELISA) and the presence or absence of hepatitis B surface antigen (HBsAg) with ELISA.ResultsThe cumulative seroprevalence of HCV and HBV infection was 11.95% and 1.3% respectively. The annual seroprevalence of both viruses showed a declining pattern throughout the study period from 17.7% to 7.4% regarding HCV and HBV infection from 2.3% to 0.9%. The decline trends for both viral infections were observed for both genders.ConclusionThis study carries a glimmer of hope because of a decline in seroprevalence of viral hepatitis in Egypt. However stringent implementation of infection control programs in Egypt is mandatory to face this furious health problem.     

Lymphocytic duodenosis: aetiology and long-term response to specific treatment

BackgroundThe clinical significance of lymphocytic duodenosis remains unclear.AimTo prospectively assess the aetiology of lymphocytic duodenosis and the patterns of clinical presentation.MethodsNinety consecutive patients with lymphocytic duodenosis and clinical symptoms of the coeliac disease spectrum were prospectively included. All subjects underwent serological testing and HLA genotyping for coeliac disease, assessment of Helicobacter pylori infection, and parasite stool examination. Intake of non-steroidal anti-inflammatory drugs was also recorded. The final aetiology of lymphocytic duodenosis was evaluated on the basis of the long-term response to specific therapy.ResultsMore than one initial potential aetiology was observed in 44% of patients. The final diagnosis was gluten-sensitive enteropathy alone or associated with Helicobacter pylori infection in 43.3%, Helicobacter pylori infection (without gluten-sensitive enteropathy) in 24.4%, non-steroidal anti-inflammatory drugs intake in 5.5%, autoimmune disease in 3.3%, and parasitic infection in 2.2%. Among first degree relatives and patients with chronic diarrhoea, the most common final diagnosis was gluten-sensitive enteropathy. In contrast, in the group presenting with chronic dyspepsia the most common diagnosis was Helicobacter pylori infection (‘Diarrhoea’ vs ‘Dyspepsia’ groups, p = 0.008).ConclusionsLymphocytic duodenosis is often associated with more than one potential initial aetiology. Clinical presentation may be useful to decide the initial therapeutic approach with these patients.     

Relationship between hepatic haemodynamics assessed by Doppler ultrasound and liver stiffness

AimWe tested the relationship between hepatic haemodynamics assessed by Doppler ultrasonography and liver stiffness assessed by Transient Elastography in hepatitis C related chronic liver disease.MethodsThree liver Doppler ultrasound parameters (hepatic artery resistance index, splenic artery resistance index and waveform pattern in hepatic veins) and liver stiffness measured by Transient Elastography were analysed in one hundred consecutive patients affected by hepatitis C related chronic liver disease.ResultsHepatic and splenic arteries resistance indexes correlate significantly (p < 0.0001 for both) with liver stiffness. A hepatic artery resistance index cut-off value of 0.64 provided sensitivity and specificity respectively of 84.4% and 69.1% for predicting liver stiffness ≤or >13 kPa, whereas a splenic artery resistance index cut-off value of 0.56 provided sensitivity and specificity respectively of 81.3% and 48.5%. The coincidental finding of both resistance indexes above the respective cut-off values showed a good accuracy in identifying patients with liver stiffness values >13 kPa (accuracy = 78%, +LR = 2.90, −LR = 0.31).A significant difference in liver stiffness values was evident between patients with triphasic and bi- or monophasic waveform pattern (p = 0.005).ConclusionsHepatic and splenic arteries resistance indexes and the hepatic veins waveform pattern assessed by Doppler ultrasound may provide information similar to that of Transient Elastography in hepatitis C related chronic liver disease.     

Serum copper as a marker of inflammation in prediction of short term outcome in high risk patients with chronic heart failure

BackgroundOxidative process and inflammation are regarded as important factors in the pathogenesis of chronic heart failure. Our study was aimed at investigating the prognostic value of serum copper levels in high risk subjects with chronic heart failure.MethodsSerum copper levels and other prognostic indicators were determined in the group of 60 patients with chronic heart failure due to ischemic heart disease: 30 consecutive subjects with acute decompensation of chronic heart failure (acute group A) and 30 patients with chronic stable heart failure (group B). Patients were followed prospectively 12 months. Primary end-point was the mean time to death and/or heart failure hospital admission.ResultsThe mean time to death was in the group A 279.4 ± 18.9 days and 351.7 ± 13.6 days in the group B (p < 0.0001). Cox proportional hazard model revealed that the time to death for all subjects (n = 60) was affected by cardiothoracic ratio (p < 0.001). The time to combined end-point death or hospital admission was affected by serum copper concentration (p < 0.0001).ConclusionSerum copper levels predicted short term outcome in high risk patients with chronic heart failure.     

Seroprevalence of hepatitis B surface antigen and its correlation with risk factors among new recruits in Turkey

ObjectivesThe objective of this cross-sectional study was to determine seroprevalence of hepatitis B surface antigen and related risk factors among new recruits in a military unit in Turkey.MethodsEight thousand five hundred eighty-nine newly-recruited soldiers were enrolled in the study. Blood samples were drawn from them between January 2006 and December 2006 and ELISA technique was applied to the samples. In addition, questions on the risk factors of hepatitis B exposure were asked to the participants in the survey.ResultsThe results demonstrated that HBsAg seroprevalence was 2.8%. Further survey results indicated that seropositivity increased depending on certain risk factors. In multiple regression analysis, significant correlations were determined between HBsAg positivity and certain risk factors such as living in the Southeast Anatolia region (p < 0.01), having a history of living with a hepatitis B carrier (p < 0.001), and presence of a hepatitis B carrier in the neighborhood or at work (p < 0.05).ConclusionsThe HBsAg seropositivity found in this study supports the fact that Turkey remains in the medium endemicity zone, and that horizontal transmission is predominant.