Mortality due to hepatocellular carcinoma associated with hepatitis B and C viruses in the state of São Paulo, Brazil / Mortalidade por carcinoma hepatocelular associado às hepatites virais B e C no estado de São Paulo, Brasil

ABSTRACT: Objective: This study aimed to describe and analyze the temporal and spatial distribution of deaths due to hepatocellular carcinoma (HCC) associated with hepatitis B (HBV) and C viruses (HCV) in the state of São Paulo. Methods: This is an ecological study of HCC deaths associated with HBV and HCV in the state of São Paulo, from 2009 to 2017, with data from the Mortality Information System (SIM). The temporal trend was analyzed by linear regression with Prais-Winsten estimation. Deaths were described according to sociodemographic characteristics by means of absolute and relative frequencies and were spatially distributed according to the regional health department. Results: It is found that 26.3% of deaths due to HCC were associated with HBV or HCV. A higher proportion of deaths due to HCC associated with HCV was observed (22.2%) when compared to HBV (3.9%). The mortality rate due to HCC associated with HBV showed a downward trend, and the mortality rate due to HCC associated with HCV showed a steady trend. Deaths of males, white individuals, those who aged from 50 to 59 years, and those who had 8-11 years of schooling predominated. Spatial analysis revealed a heterogeneous distribution of deaths in the state of São Paulo. Conclusions: The downward trend in mortality rates due to HCC associated with HBV shows an important advance in the disease control. However, the mortality rate due to HCC associated with HCV has remained stable throughout the study period. The spatial distribution of deaths may contribute to raise hypotheses for deeper knowledge of these diseases in the regions.

RESUMO: Objetivos: Este estudo tem como objetivo descrever e analisar a distribuição temporal e espacial dos óbitos por carcinoma hepatocelular associados às hepatites virais B e C no estado de São Paulo. Métodos: Estudo ecológico dos óbitos por carcinoma hepatocelular associados a hepatites virais B e hepatites virais C no estado de São Paulo, de 2009 a 2017, com dados do Sistema de Informação sobre Mortalidade. A tendência temporal foi analisada por regressão linear, com método de Prais-Winsten. Os óbitos foram descritos segundo as características sociodemográficas, por meio de frequências absolutas e relativas, e foram espacialmente distribuídos segundo departamento regional de saúde. Resultados: Dos óbitos por carcinoma hepatocelular, 26,3% foram associados a hepatites virais B ou hepatites virais C. Observou-se maior proporção de óbitos por carcinoma hepatocelular associado a hepatites virais C (22,2%) quando comparada àquela associada a hepatites virais B (3,9%). A taxa de mortalidade por carcinoma hepatocelular associado a hepatites virais B apresentou tendência de queda, no entanto a taxa de mortalidade por carcinoma hepatocelular associado a hepatites virais C apresentou tendência estacionária. Predominaram óbitos de pacientes do sexo masculino, de cor branca, de 50-59 anos e com oito a 11 anos de estudo. A análise espacial revelou distribuição heterogênea dos óbitos no estado de São Paulo. Conclusão: A tendência de queda nas taxas de mortalidade por carcinoma hepatocelular associado a hepatites virais B revela um importante avanço no controle do agravo. Entretanto, a taxa de mortalidade por carcinoma hepatocelular associado a hepatites virais C vem-se mantendo estável ao longo do período estudado. A distribuição espacial dos óbitos pode contribuir para levantar hipóteses com vistas ao conhecimento mais aprofundado desses agravos nas regiões.

Prevalencia de marcadores infecciosos y factores asociados en donantes de un banco de sangre peruano / Prevalence of infection markers and associated factors in donors of a peruvian blood bank

RESUMEN Se buscó determinar la prevalencia de marcadores infecciosos en donantes de un banco de sangre en Perú y valorar si las variables sociodemográficas del donante se asocian con la presencia de estos marcadores. Se realizó un estudio transversal analítico en 5942 donantes de un banco de sangre durante el 2018. Se determinó la positividad a inmunodeficiencia humana (VIH), hepatitis B (VHB), hepatitis C (VHC) y HTLV I-II; además de sífilis y enfermedad de Chagas. La prevalencia de VIH fue 0,81%, VHB 6,19%, VHC 0,12%, HTLV I-II 0,66%, enfermedad de Chagas 2,76% y sífilis 1,73%. Diversos factores sociodemográficos se asociaron con la positividad de marcadores infecciosos. El tipo de donación predominante fue no voluntaria (96%) y el 53% presentó historia de donación previa. Las prevalencias de marcadores infecciosos de VIH, VHB, enfermedad de Chagas y sífilis en los donantes de sangre fueron altas comparadas con otros países de la región.

ABSTRACT We aimed to determine the prevalence of infection markers in donors of a Peruvian blood bank and to assess whether donor sociodemographic variables are associated with the presence of these markers. An analytical cross-sectional study was carried out in 5942 donors of a blood bank, whose data was collected during 2018. Positivity to human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and HTLV I-II was determined, in addition to syphilis and Chagas disease. The prevalence of HIV was 0.81%; for HBV it was 6.19%; for HCV, 0.12%; for HTLV I-II, 0.66%; for Chagas disease, 2.76% and for syphilis it was 1.73%. Several sociodemographic factors were associated with infection markers positivity. The predominant donation type was non-voluntary (96%) and 53% had history of previous donation. The prevalence of infection markers for HIV, HBV, Chagas disease and syphilis in blood donors was high compared to other countries in the region.

Prevalence of HIV, Hepatitis B and C Virus Co-infections among Iranian High-Risk Groups: A Systematic Review and Meta- Analysis

@#Co-infection with hepatitis B and C among HIV infected patients are prevalent among high-risk populations. This meta-analysis aimed to estimate the prevalence of HIV, HCV and HBV co-infections among high-risk populations in Iran. We systematically searched the national and international electronic databases until 2016. The primary outcome was the prevalence of HIV, HBV, HCV and HIV co-infections in different high-risk populations in Iran. All English and Persian studies conducted on Iranian high-risk groups were included in the study. The review was reported based on PRISMA guidelines and data were analysed at 95% confidence level using random effect models.Overall, 916 relevant papers were recognised and 14 articles were included in the metaanalysis. The pooled estimates of HBV/HCV, HCV/HIV, HBV/HIV and HBV/HCV/HIV were 1.3% (95%CI: 0.5–2.1), 16.3% (95%CI: 1.1–31.6), 0.5% (95%CI: 0–1.4) and 0.5% (95%CI: 0.2–0.8), respectively. Based on subgroup analysis, there was a higher proportion of all co-infections from the years 2010–2016 as compared to that of the years 2003–2009. Our results highlighted that HCV/HIV co-infection in Iranian high-risk groups including injection drug users (IDUs) and prisoners is common. In addition, the increasing trend of coinfections should be considered alarming for policymakers.

Efficacy and safety of Gantaishu Capsules for viral B hepatitis:a systematic review and Meta-analysis / 中国中药杂志

To evaluate the efficacy and safety of Gantaishu Capsules in the treatment of viral B hepatitis. The randomized controlled trials( RCT) retrieved from Cochrane Library,PubMed,Sino Med,CNKI,Wan Fang and VIP were enrolled. The methodology quality of the included studies was evaluated,and a Meta-analysis was performed using Rev Man 5. 3 software. A total of six randomized controlled trials were included. Meta-analysis results showed that the similarities in the negative conversion rate of HBe Ag( RR = 2. 09,95%CI[0. 90,4. 85],P = 0. 09,I2= 0%),the HBV-DNA negative rate( RR = 1. 49,95% CI[0. 56,3. 95],P = 0. 43,I2= 0%) and the changes in ALT levels before and after treatment( RR =-6. 28,95%CI[-72. 83,60. 27],P = 0. 85,I2= 99%),with no statistical difference. In terms of quality of life,Gantaishu Capsules can significantly alleviate the symptoms of hepatitis B patients,with less adverse reactions. Gantaishu Capsules and Dongbao Gantai Tablets were similar in antiviral effect. In this term,Gantaishu Capsules was superior to Dangfei Liganning Capsules. It can significantly alleviate the symptoms of chronic hepatitis B patients,with a good clinical safety.Therefore,it can be applied in the case of syndrome differentiation and treatment. In view of the low quality of the included studies,more high-quality clinical trials were required to confirm its efficacy.

Actualización del protocolo de vigilancia y manejo de exposición ocupacional a sangre y fluidos corporales. Hospital Nacional. 2017 / Protocol for surveillance and management of occupational exposure to blood and body fluids. National Hospital. 2017

Este protocolo de Vigilancia y manejo de casos de exposición ocupacional a sangre y fluidos corporales (EOSFC) tiene la finalidad de interrumpir la transmisión de VIH, sífilis y virus hepatitis B y C entre otros agentes infecciosos, y contribuir a evitar la ocurrencia de más casos de exposición ocupacional, ofreciendo prevención secundaria al personal del Hospital Nacional de Itauguá, con exposición ocupacional y optimizando el manejo clínico de los casos. Consta de una primera parte correspondiente al marco teórico y una segunda parte correspondiente a las acciones a realizar cuando se presenten casos de EOSFC y la conducta a seguir para la contención del personal afectado, adherencia al tratamiento si estuviere indicado y disminución de ocurrencia de más casos. Está ordenado en6 contenidos: medidas inmediatas y notificación; antecedentes de la exposición actual; clasificación de riesgo; estudios de laboratorio; profilaxis post exposición y seguimiento de los casos.

In 2016, it was proposed that the related to Occupational Exposure to blood and body fluids (OEBBF) of the National Hospital, to depend on the Occupational Health Service of the same. This protocol of Surveillance and Case Management of EOSFC has the purpose of interrupting the transmission of HIV, HBV, HCV and Syphilis among other infectious agents, and helping to prevent the occurrence of more cases of Occupational Exposure, offering secondary prevention to Hospital staff Nacional de Itauguá, with occupational exposure and optimizing the clinical management of cases. It consists of a first part corresponding to the theoretical framework and a second part corresponding to the actions to be taken when cases of EOSFC are presented, and the behavior to be followed for the containment of the personnel affected, adherence to the treatment if indicated and decrease in the occurrence of more cases, contained in 6 steps: Immediate Measures and Notification; Background of the current Exhibition; Classification of risk; Laboratory studies; Post-exposure prophylaxis and follow-up of cases.

Liver transplantation from donor liver of organ donation after citizen's death: a single center experience / 器官移植

Objective To evaluate the application value of donor liver from organ donation after citizen's death (organ donation) in clinical liver transplantation. Methods Clinical data of 75 pairs of donors and recipients undergoing liver transplantation from organ donation in the First People's Hospital of Foshan from October 2011 to December 2016 were retrospectively analyzed. The conditions of the donors were strictly evaluated. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Results The 1-year and 3-year accumulated survival rates of 75 liver transplantation recipients were 88% and 78%. Four recipients died from the recurrence and metastasis of liver cancer, 1 case from graft-versus-host disease, 1 case from severe pulmonary infection, 1 case from recurrence of virus B hepatitis (hepatitis B) and liver failure, 1 case from postoperative multiple organ failure and 1 case from massive hemorrhage of the upper digestive tract. Thirteen recipients suffered from biliary tract stenosis. One case was mitigated spontaneously and 1 recipient was healed after percutaneous transhepatic biliary drainage (PTBD). Eleven cases were treated with endoscopic retrograde cholangiopancreatography (ERCP). Among them, 5 cases were healed,2 recipients were switched to choledochojejunostomy and 4 cases were still monitored in clinical practice. Conclusions Liver transplantation from organ donation yields high clinical efficacy. Strict evaluation of donor conditions, standard perioperative management of the recipients, maintenance immunosuppressive therapy without adrenocortical hormone,timely and effective treatment of complications, regular postoperative follow-up are pivotal measures to guarantee the success of liver transplantation from organ donation and long-term survival of the recipients.

Effects of Liver Function in Patients with Liver Cirrhosis and Virus B Hepatitis on Drug Half-life and An-algesic Effect of Target Controlled Infusion of Remifentanil / 中国药房

OBJECTIVE:To explore the safety and effects of liver function in patients with liver cirrhosis following virus B hepatitis(called“hepatitis B”for short)on drug half-life and analgesic effect of target controlled infusion of remifentanil. METH-ODS:100 patients with liver cirrhosis following hepatitis B underwent liver and gallbladder surgery under selective general anesthe-sia were collected from our hospital and divided into group A(mild abnormal liver function)and group B(severe abnormal liver function,3 cases withdrew from the test and 47 cases completed the test),with 50 cases in each group,according to Child-Pugh grading of liver function. Both group were given phenobarbital sodium 0.1 g+scopolamine 0.3 mg intramuscularly 0.5 h before oper-ation;midazolam 0.04 mg/kg+propofol 1.5 mg/kg+atracurium 0.6 mg/kg intravenously;target controlled infusion of Remifentanil hydrochloride for injection during operation with 0.125-0.250 μg/(kg·min). The distribution half-life and the elimination half-life of remifentanil were determined, and temperature pain perception threshold (tPDT) and electrical pain perception threshold (ePDT) were measured immediately after the operation;the occurrence of ADR was observed. RESULTS:The distribution and elimination half-life of remifentanil were (4.52 ± 1.25)min and(24.64 ± 1.30)min in group A and (4.68 ± 1.31)min and(25.45 ± 2.08)min in group B respectively,there was no statistical significance between 2 groups(P>0.05). tPDT and ePDT of group A were(8.88± 1.66)mA and(1.54±0.09)mA respectively,and those of group B were(9.16±1.58)mA and(1.34±0.15)mA,there was no sta-tistical significance between 2 groups (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:The abnormal liver function of patients with liver cirrhosis following hepatitis B have no significant effect on drug half-life and analgesic effect of remi-fentanil with good safety.

Correlation of Traditional Chinese Medical Syndrome Elements with Plasma Connective Tissue Growth Factor and Platelet-derived Growth Factor in Early Liver Cirrhosis Induced by Type B Hepatitis / 广州中医药大学学报

Objective To explore the correlation of traditional Chinese medical syndrome elements with plasma connective tissue growth factor ( CTGF) and platelet-derived growth factor ( PDGF) in early liver cirrhosis induced by type B hepatitis. Methods The distribution of traditional Chinese medical syndrome elements in early liver cirrhosis induced by type B hepatitis was analyzed, plasma contents of CTGF and PDGF were detected by enzyme-linked immunosorbent assay ( ELISA) , and the correlation of syndrome elements with CTGF and PDGF was discriminated. Results ( 1) The distribution of traditional Chinese medical syndrome elements in early liver cirrhosis induced by type B hepatitis showed as follows: the syndrome elements involved the viscera of liver and spleen, and the pathogenesis was characterized as dampness, heat, qi stagnation, and yin deficiency. ( 2) CTGF was closely related with spleen, gallbladder and dampness, with OR value being 1.598, 1.567, 2.797, respectively. PDGF was closely related with heat, with OR value being 1.134. Conclusion Early liver cirrhosis induced by type B hepatitis mainly affects the viscera of liver and spleen, the pathogenesis is characterized by dampness, heat, qi stagnation, and yin deficiency. The patients with higher CTGF are apt to show the pathological changes of spleen, gallbladder, dampness, and have the syndrome el-ements of spleen, gallbladder, dampness. The patients with higher PDGF are apt to show the pathological changes of heat, and have the syndrome element of heat.

The Ethical Countermeasures of the Mental Health of Patients with Chronic type B Hepatitis / 中国医学伦理学

With a long duration of the CHB, patients who have economic pressures and physical problems will get changes in their psychological status, which are involved in the development of the disease. Moreover, poor thera-py compliance and insight of their disease, negative mood of anxiety and depression also have effects the prognosis of disease. Therefore, mental factors play a vital important role in the development and prognosis of CHB patients, health education and mental intervention are the most effective way to avoid the psychological disorder of patients.

Prevalence of occult hepatitis B virus infection among blood donors in Ulaanbaatar city, 2013 / Монголын Анагаах Ухаан

remains the most frequent transfusion-transmitted viral infection; thus, the term occulthepatitis B virus infection (OBI) was introduced. OBI is simply defined as serologically undetectable hepatitis Bsurface antigen (HBsAg-ve), despite the presence of circulating HBV DNA with or without the presence of HBVantibodies.GoalTo determine the prevalence of occult hepatitis B among blood donors and evaluate the presence of HBV DNAin HBsAg negative plasma samples.Materials and MethodsIt includes 16700 samples which donated in NCTM in Ulaanbaatar in 2013. We used to “triplex” PCR assay thatincluded the detect of hepatitis B virus HBV-DNA in addition HCV-RNA and HIV1/2-RNA for whom with absenceof serological markers of infection. The studies used molecular biology methods were performed with the help ofequipment (ROCHE COBAS S 201) and technology based on Real Time PCR (pool size: 6 donation) Then wechoose HBsAg negative, DNA positive samples and determined, anti-HBc and anti-HBs by serological methods,of ELISA Wantai HBc and HBs 3.0 tests.ResultsThe 14948 samples were detected serological negative in the total of 16700 samples. PCR test results show 35(0.23%) positive by HBV-DNA 29 (82.9%) of the 35 DNA positive blood donors were alone anti-HBc positive and3 (8.6 %) were anti-HBs, anti-HBc positive. 7(17.1%) were seronegative. Of the 35 OBI cases, 28 (80%) weredetected the first time they were screened for HBV DNA while 7 (20%) gave one more HBV PCR-nonreactiveresults before detection. Callback studies we determined 2 cases were pre-HBsAg window period.Conclusion:The prevalence of HBV DNA positive in HBsAg negative blood donors is found 0.2%. HBV NAT needs eitherextreme sensitivity or to be performed on individual donations to eliminate HBV DNA-containing units.

Analysis of pegylated interferon alpha-2a efficacy in the treatment of chronic hepatitis C / 中国基层医药

Objective To investigate the clinical efficacy and safety of the pegylated interferon alpha-2a (PEG-IFN-a-2a)in treatment of chronic hepatitis C.Methods 170 cases of patients with chronic hepatitis C were included in the study,by using digital table method they were randomly divided into two groups,the observation group of 85 cases were treated with PEG-IFN-alpha-2a therapy,and 85 cases in the control group using ordinary interferon alpha-2b therapy.Curative effect and safety of two groups of patients were compared.Results The obser-vation group treated for 12 weeks,24 weeks and 24 weeks of alanine aminotransferase (ALT)and improvement rate were respectively 70.59%,80%,92.94%,which were higher than that of the control group (52.94%,62.35% and 70.58%)(χ2 =5.42,6.71,4.83,all P<0.05).The observation group for 12 weeks,24 weeks and 24 weeks of HCV-RNA negative rate were 64.71%,75.29%and 91.76%,obviously were higher than the control group of50.59%, 61.18% and 70.59% (χ2 =4.28,7.68,6.31,all P<0.05).Adverse reaction rates were not statistically signifi-cant.Conclusion The pegylated interferon alpha-2a (PEG-IFN-a-2a)in treatment of chronic hepatitis C has a significant curative effect of PEG-IFN-alpha-2a therapy in chronic hepatitis C,which is better than the ordinary interferon alpha-2b,and is worthy of extensive promotion and application.

Hepatitis autoinmune en un paciente con hepatitis B crónica, a propósito de un caso / Topic Review: Autoimmune hepatitis in a patient with chronic hepatitis B. A case report

La hepatitis es una enfermedad viral que azota a gran parte de la población mundial y cuya etiología es multifactorial, por lo que se ha clasificado a fin de hacer más conveniente su estudio de la A a la E, separándolas según sus características. Existe además la hepatitis autoinmune (HAI), entidad de etiología no conocida que gana mayor prevalencia e incidencia cada año. Se cuenta con pocos reportes en la literatura que relacionen la presentación de una hepatitis viral más una hepatitis autoinmune en un mismo paciente. Sin embargo, algunos estudios han comprobado que dicha relación es una posibilidad; lo que dificulta su orientación diagnóstica, terapéutica, tratamiento y pronóstico. Se presenta un caso de hepatitis B crónica en la que se superpuso una hepatitis autoinmune, a fin de realizar una revisión del tema y sus dificultades diagnósticas.

Hepatitis is a viral disease that affects a large portion of the world's population, which has a multifactorial etiology, thus to facilitate its study has been classified from A to E according with the characteristic. Additionally to viral hepatitis also occurs the autoimmune hepatitis, a disease of unknown etiology of which prevalence and incidence are increasing every year. There is few reports in the literature that describe the possibility of finding viral hepatitis and autoimmune hepatitis in one patient at the same time. Nevertheless some studies have indicated that there is possible correlation between them, situation that make difficult its diagnosis, therapeutic approach, treatment and prognosis. A case of chronic B hepatitis with overlapped autoimmune hepatitis is reported aiming to, get a topic review and diagnostic difficulties.

Elevada circulación del genotipo F del virus de la hepatitis B en población infectada urbana no migratoria y migratoria de Venezuela / High circulation of genotype F hepatitis B non-migratory and migratory urban population infected virus Venezuela

Introducción: Se ha demostrado ampliamente que el genotipo F del virus de la hepatitis B (VHB) es dominante en nuestra población Amerindia. Recientemente, nosotros identificamos que en los pacientes infectados por VHB habitantes no migratorios de áreas urbanas venezolanas prevalece también el genotipo F. Objetivo: Determinar los genotipos del VHB en portadores crónicos urbanos migratorios y compararlos con el grupo no migratorio. Material y Métodos: Se investigaron 136 portadores crónicos del VHB, 110 no inmigrantes y 26 inmigrantes de origen asiático. Se evaluaron antígeno eHB y anti-eHB y los genotipos del VHB, este último mediante PCR. Resultados: En los 110 pacientes urbanos venezolanos persistió la elevada frecuencia del genotipo F (95%) con 3 casos coinfectados, 2 por genotipos A+F y 1 caso con genotipos E+F. Interesantemente, 2 casos demostraron genotipo D del VHB. Hepatitis crónica B (HCB) antígeno-e positivo fue diagnosticada en 83 pacientes (80,6%) mientras 20 casos (19,4%) presentaron HCB antígeno-e negativo. En los pacientes asiáticos infectados con un solo genotipo se identificó el C en 11 casos, el B en 4 pacientes, el F en 3 y, en 1 caso, genotipo D. Se demostró coinfección entre estos diferentes genotipos, incluyendo un caso coinfectado con genotipo E. El genotipo F se encontró coinfectando a 4 pacientes, 2 de ellos con genotipo C. Doce casos presentaron HCB antígeno e positivo y 14 pacientes HCB antígeno e negativo. De los pacientes infectados con genotipo C, 7 de ellos (54%), incluyendo los 2 coinfectados con genotipo F, presentaron HCB antígeno-e negativo. Conclusión: Es notoria la elevada circulación del genotipo F del VHB en nuestras áreas urbanas...

Introduction: It has been widely demonstrated that the genotype F of hepatitis B virus (HBV) is dominant in our Amerindian population. Recently, we identified that genotype F is prevalent in HBV non-migratory infected patients living in urban areas. Objective: To determine the genotypes of HBV in migratory chronic carriers compared to non-migratory population. Material and Methods: We investigated 136 chronic HBV carriers, 110 non-immigrants and 26 immigrants of Asian origin. We assessed hepatitis B e-antigen and antibody and HBV genotypes, the latter using PCR. Results: High prevalence (95%) of genotype F persisted among 110 Venezuelan urban patients, with 3 co-infected patients, 2 with genotypes A+F and 1 case with E+F. Interestingly, 2 cases showed HBV genotype D. Chronic hepatitis B (CHB) e-antigen positive was diagnosed in 83 patients (80.6%) while 20 cases (19.4%) showed CHB e-antigen negative. In Asian patients infected with one sole genotype, C was identified in 11 cases, B in 4 patients, F in 3, and in 1 case, genotype D. Co-infection was demonstrated among these different genotypes, including one case co-infected with genotype E. Genotype F was found in 4 co-infected patients, 2 with genotype C. Twelve cases had CHB e-antigen positive and 14 CHB e-antigen negative. From patients infected with genotype C, 7 of them (54%), including 2 co-infected with genotype F, demonstrated CHB e-antigen negative. Conclusion: It is remarkable the high circulation of HBV genotype F in our urban areas. However, given the distinct outcome described in CHB genotype F and the identification of other genotypes rather than F in urban areas, suggests that inclusion of HBV genotypes in Venezuela, should be considered standard in the management of CHB regardless the patient’s geographical origin.

Curative effect observation on the treatment of chronic type B hepatitis with Gankang Granule / 国际中医中药杂志

Objective To observe the clinical effects of treating chronic type B hepatitis with Gankang Granule combined with poly I-C and immune ribonucleic acid. Methods A total of 100 cases of chronic type B hepatitis were randomly recruited into a control group and a treatment group, 50 cases in each group. The control group was treated with poly I-C and immune ribonucleic acid, while the treatment group was treated with Gankang Granule on the basis of the control group. Results Symptoms in both groups were improved. 23 eases in the treatment group showed negative value of HBeAg,contrasting to 13 cases in the control group. 38 cases in the treatment group turned to be negative value of HBV- DNA, higher than the number of 23 cases in the control group. The treatment group demonstrated a significantly better therapeutic results than the control group (χ2 value was 6.267 and 6.345 respectively, both P＜0.05). Conclusion Gankang Granule combined with poly I-C and immune ribonucleic acid can obviously improve hepatic functions and symptoms of chronic type B hepatitis,shorten the course of disease, and increase the rate of negative value of HBeAg and HBV- DNA.

Hepatitis B inactiva. Decisiones en la práctica clínica / Inactive hepatitis B. Decisions in the clinical practice

La mayoría de portadores crónicos del HBsAg son portadores inactivos de la hepatitis B. A pesar de que en términos generales tiene buen pronóstico a largo plazo, posee un riesgo incrementado de cirrosis hepática y hepatocarcinoma respecto a la población general. Además, es un grupo con alto riesgo de complicaciones, incluso letales, en caso de recibir medicamentos hepatotóxicos o inmunosupresores, lo cual requiere una serie de medidas diagnósticas y terapéuticas oportunas por parte del médico tratante. En este artículo presentamos una revisión de la hepatitis B inactiva, haciendo énfasis en el abordaje que debe realizarse en los escenarios clínicos que con mayor frecuencia ocurren en este grupo de pacientes.

Most chronic carriers of HBsAg are inactive carriers. Although in general have a good prognosis in the long term, have an increased risk of liver cirrhosis and hepatocellular carcinoma with respect to the general population. It is also a group at high risk of complications, even lethal, if given hepatotoxic or immunosuppressive drugs, which requires a series of diagnostic and therapeutic measures necessary for the treating physician. In this article we present a review of inactive hepatitis B, emphasizing the approach to be implemented in clinical scenarios that occur most frequently in this patient group.

Virus B e interferón / Virus B and interferon

La aparición de nuevas drogas y formas de diagnóstico, han transformado la hepatitis crónica B de una enfermedad fatal a una manejable y aún curable. Se distinguen dos tipos de enfermedad crónica por virus B, la que se desarrolla con antígeno e positivo y la que cursa con antígeno e negativo. La enfermedad crónica puede presentarse con ALT normal, ALT en continua elevación, fluctuaciones de ALT sin llegar a ser normales o elevaciones intermitentes. El éxito de la terapia antiviral para el virus B incluye, suprimir la replicación viral al nivel más bajo posible, lograr mejoría bioquímica e histológica y prevenir el desarrollo de complicaciones. Existen dos estrategias de tratamiento para el virus B, una de duración limitada (interferones) y otra de largo plazo (análogos nucleós(t)idos). Existen factores que influencian favorablemente la respuesta al tratamiento con interferón: niveles bajos de HBV DNA, niveles altos de ALT, niveles bajos de HBeAg y genotipos A y B. En el manejo de la enfermedad crónica tanto por virus B e ( + ) y e ( - ) se han utilizado interferón αlfa y actualmente el interferón pegilado α-2a. El interferón pegylado también ha mostrado ser superior al interferón simple en cuanto a normalización de ALT, pérdida del HBe y pérdida sostenida del HBV DNA. El interferón pegylado también ha mostrado ser superior a la terapia combinada o a la lamivudina sola en cuanto a rangos de respuesta y seroconversión en e (+) y e (-). En los pacientes e (-) sigue existiendo controversia por ameritar tratamiento a largo plazo el uso de interferón o iniciar con análogos nucleósidos.

The appearance of new drugs and new forms of diagnosing has transformed chronic hepatitis B from being a lethal disease to becoming a treatable and even curable disease. There are two kinds of chronic hepatitis B, one that develops with antigen e positive and the other one with antigen e negative. This chronic disease can appear with normal ALT, ALT continuous elevation, and ALT fluctuations without becoming normal or intermittent elevations. The success of the antiviral therapy for HBVincludes, suppressing the replicative state to the lowest level possible, getting biochemical and histological amelioration; and preventing the development of complications. There are two strategies for HBV treatment, one with limited duration (interferon) and the other long term treatment (nucleotide analogue). There are factors that influence satisfactorily, the response to the treatment with interferon: low levels of HBV DNA, high levels of ALT, long levels of HBeAg and A & B genotypes. Alpha interferon and more recently Pegylated α-2a have been used for the management of HBVe (+) and HBVe (-). The Pegylated interferon has shown to be more effective than conventional interferon, in terms of ALT normalization, HBe loss, and sustainable loss of HBV DNA. The Pegylated interferon has also shown to be superior to the combined therapy or only to lamivudine, in terms of range response and seroconversion in e (+) and e (-). There is still controversy when treating patients with e (-) who need long term usage of interferon or those who need to start nucleoside analogue.

Acute pancreatitis associated with lamivudine therapy for chronic B hepatitis

Hyperamylasemia is a common complication during lamivudine use. We report a case of a pancreatitis following lamivudine therapy. A careful monitoring of amylase levels during treatment with lamivudine is discussed, mainly in the first weeks, considering the cost of this exam and further complication.

Clinical significance of serum interleukin-15 in the patients of severe type B hepatitis / 中国综合临床

Objective To observe the level changes of interleukin-15 (IL-15) and its role and clinical sig-nificance in severe type B hepatitis(HB). Methods IL-15 levels of 47 cases of severe HB and 20 cases of healthy subjects were detected by ELISA,meanwhile the alanine aminotransferase (ALT),total bilirubin (TBIL) and pro-thrombase activity (PTA) were measured as well. The correlation between IL-15 and ALT,TBIL and PTA were ana-lyzed. Results IL-15 in severe HB eases were higher than in control group [(18.9±7.5 ) ng/L vs. (5.9±2.0) ng/L,P <0.01] ,which was higher in death group than in survival group[(24.1±7.5) ng/L vs. (15.7±5.4) ng/L, P<0.01]. IL-15 level was decreasing with the improvement of general condition and liver function recovery. In addition, IL-15 in severe HB was positively correlated with TBIL (r=0.570,P<0.01) and negatively correlated with PTA(r=-0.529,P<0.01) but was not significantly correlated with ALT(r=0.099,P>0.05). Conclusion IL-15 may take part in the pathogenesis of severe HB ,which is consistent with disease condition and is closely re-lated to the improvement of disease. The detection of IL-15 may exert a predicting role in the prognosis of severe HB.

Influência dos genótipos no tratamento da hepatite B: [revisão] / Influence on its genotypes of the treatment for type B hepatitis: [review]

A hepatite B pode ser classificada em oito diferentes genótipos (A-H). Esses genótipos diferem na sua distribuição geográfica mundial. No Brasil, os genótipos mais freqüentemente encontrados são o A, D e F. Algumas alterações na estrutura genética desses genótipos podem resultar em diferentes níveis de patogenicidade, sendo relacionadas com maior ou menor risco de desenvolvimento de hepatocarcinoma ou cirrose no fígado. Além das diferenças citadas, a heterogeneidade dos genótipos da hepatite B parece estar relacionada com diferenças na evolução clínica da infecção e na resposta ao tratamento antiviral. Alguns genótipos demonstraram responder melhor ao tratamento com interferon ou nucleotídeos análogos do que outros. O objetivo desta revisão foi demonstrar a importância do tratamento da hepatite B baseado nos seus diferentes genótipos. Foram revisados artigos da literatura, selecionando aqueles que abordavam questões relacionadas aos genótipos da hepatite B e sua relação com o tratamento desta infecção. Nos artigos revisados, o tratamento da hepatite B baseada em genótipos apresentou diferenças significativas. Os genótipos A e B parecem ter uma melhor resposta ao tratamento antiviral com interferon alfa e/ou lamivudina; porém, mais estudos são necessários para a consistência dessa afirmação. No entanto, através dos presentes dados, já é possível demonstrar forte associação entre genótipos e resposta antiviral. Deste modo, adaptar o tratamento aos genótipos pode promover uma melhor resposta do interferon e dos nucleotídeos na terapêutica da infecção pelo vírus da hepatite B.

Type B hepatitis can be classified according to eight different genotypes (A-H). These genotypes are different in terms of worldwide geographical distribution. In Brazil the most frequent genotypes are A, D and F. Some changes in the genetic structure of these genotypes can cause different levels of pathogenesis, being related to lower or higher risk of developing hepatocellular carcinoma or liver cirrhosis. In addition to the above mentioned differences, heterogeneity of hepatitis B genotypes seems to be related to the differences in clinical evolution of the infection and response to antiviral treatment. Some genotypes proved to have a better response to the treatment using interferon or similar nucleotides than others. This review aimed at showing the importance of treatment of type B hepatitis based on its different genotypes. Different articles from the specific medical literature were reviewed and those including genotypes for type B hepatitis and their association with the treatment of this infection were selected. In the reviewed articles genotypebased treatment of hepatitis B showed significant differences. Genotypes A and B seem to have a better response to the antiviral treatment with alpha interferon and/or lamivudine; however, more studies are necessary to confirm this assertion. Nevertheless, using the present data it is already possible to prove a strong connection between genotypes and antiviral response. Therefore, adjusting treatment to genotypes can cause a better therapeutic response from interferon and nucleotides in type B hepatitis therapy.

Observation of the Therapeutic Effects of Compound Glycyrrhizin with Oxymatrine on Chronic Type B Hepatitis / 中国药房

OBJECTIVE:To observe the therapeutic effect of compound glycyrrhizin with oxymatrine on chronic Type B hepatitis.METHODS:66patients with chronic Type B hepatitis were randomly divided into2groups.The treatment group(36cases)were treated with compound glycyrrhizin with oxymatrine and the control group(30cases)were treated with di?ammonium glycyrrhizinate.The changes of clinical symptoms,signs,hepatic function parameters and liver fibrosis parameters of the two groups were observed after treatment for8weeks.RESULTS:Significant differences were found between the treatment group and the control group in improvements of clinical symptoms,signs,hepatic function parameters and hepatic fibrosis parameters(P