Prevención de las hepatitis virales crónicas como contenido de la superación del Equipo Básico de Salud

Introducción: Entre las causas más frecuentes de mortalidad se encuentran las enfermedades infecciosas, en particular en el tercer mundo. Y entre estas, están las hepatitis virales crónicas, las cuales aumentan su incidencia en Cuba. Objetivo: Exponer elementos de un sistema de superación dirigido al desarrollo de los conocimientos en los miembros del Equipo Básico de Salud del Policlínico Docente José Martí de la provincia de Camagüey, Cuba, sobre la prevención de las hepatitis virales crónicas en la Atención Primaria de Salud. Método: Se desarrolló una investigación participativa cuanticualitativa de carácter explicativo causal, mediante la ejecución del proyecto de investigación no asociado a programa Sistema de estrategias para la prevención de las hepatitis virales crónicas, desde la consulta provincial, ejecutado entre 2017 y 2022. El universo involucró 137 profesionales para una muestra de 68. Resultados: Los profesionales adquirieron nuevas experiencias, reconocieron la necesidad de capacitación, así como la comprensión de su vínculo con los pacientes que padecen estas enfermedades para advertir el riesgo que corren al no acudir a los servicios de salud para ser diagnosticados y tener un seguimiento con los servicios de la Atención Primaria de Salud. Predominó el índice alto como calificación de las preguntas del instrumento de salida para todos los participantes. Conclusiones: El sistema favorece el desarrollo de los conocimientos sobre la prevención de las hepatitis virales crónicas del Equipo Básico de Salud objeto de estudio. Las acciones potencian la participación de los actores de la comunidad y sus sesiones de intercambio se distinguen por su carácter activo, dinámico y funcional, en pos de una mejor práctica asistencial, preventiva de las hepatitis virales crónicas en el nivel primario.

Introduction: Among the most frequent causes of mortality are infectious diseases, particularly in the third world. And among these are chronic viral hepatitis, which increases its incidence in Cuba. Objective: To present elements of an improvement system aimed at developing knowledge in the members of the Basic Health Team of the José Martí Teaching Polyclinic in the province of Camagüey, Cuba, on the prevention of chronic viral hepatitis in Primary Health Care. Method: A quantitative participatory research of a causal explanatory nature was developed, through the execution of the research project not associated with the System of Strategies for the Prevention of Chronic Viral Hepatitis program, from the provincial consultation, executed between 2017 and 2022. The universe involved 137 professionals for a sample of 68. Results: Professionals acquired new experiences, recognized the need for training, as well as understanding their relationship with patients who suffer from these diseases to warn of the risk they run by not going to health services, to be diagnosed and have follow-up with Primary Health Care services. The high index predominated as the rating of the output instrument questions for all participants. Conclusions: The system favors the development of knowledge on the prevention of chronic viral hepatitis of the Basic Health Team under study. The actions enhance the participation of community actors and their exchange sessions are distinguished by their active, dynamic and functional nature, in pursuit of better care practice, preventive of chronic viral hepatitis at the primary level.

Introdução: Entre as causas mais frequentes de mortalidade estão as doenças infecciosas, principalmente no terceiro mundo. E entre estas estão as hepatites virais crónicas, que aumentam a sua incidência em Cuba. Objetivo: Apresentar elementos de um sistema de melhoria que visa desenvolver conhecimentos nos membros da Equipe Básica de Saúde da Policlínica Escolar José Martí, na província de Camagüey, Cuba, sobre a prevenção das hepatites virais crônicas na Atenção Primária à Saúde. Método: Desenvolveu-se uma pesquisa quantitativa participativa de natureza causal explicativa, através da execução do projeto de pesquisa não vinculado ao programa Sistema de Estratégias de Prevenção das Hepatites Virais Crônicas, a partir da consulta provincial, executada entre 2017 e 2022. O universo envolveu 137 profissionais para uma amostra de 68. Resultados: Os profissionais adquiriram novas experiências, reconheceram a necessidade de capacitação, bem como compreenderam sua relação com os pacientes que sofrem dessas doenças para alertar sobre o risco que correm ao não procurarem os serviços de saúde. ser diagnosticado e ter acompanhamento nos serviços de Atenção Primária à Saúde. O índice alto predominou na classificação das questões do instrumento de saída para todos os participantes. Conclusões: O sistema favorece o desenvolvimento do conhecimento sobre a prevenção das hepatites virais crônicas da Equipe Básica de Saúde em estudo. As ações potenciam a participação dos atores comunitários e as suas sessões de intercâmbio distinguem-se pelo seu caráter ativo, dinâmico e funcional, na procura de melhores práticas assistenciais, preventivas das hepatites virais crónicas no nível primário.

Prevención de las hepatitis virales crónicas como contenido de la formación del especialista de Medicina General Integral

La superación profesional constituye un proceso permanente de la educación superior que garantiza la actualización y preparación de sus graduados para un ejercicio adecuado de sus desempeños en la práctica: en particular, en el ámbito de las ciencias médicas favorece la atención a las situaciones de salud que se presentan en la comunidad. El objetivo del presente trabajo está encaminado a exponer los fundamentos teóricos que sustentan el estudio del proceso de formación del residente de Medicina General Integral y la concreción del trabajo preventivo desde la comunidad. Se trata de un acercamiento inicial al proceso de formación de los especialistas de la Atención Primaria de Salud y la prevención de las hepatitis virales crónicas y como continuidad de las acciones de un proyecto de investigación, se acomete el abordaje actual en el período comprendido entre septiembre de 2022 a octubre de 2024, bajo el auspicio del Centro de Estudios de Ciencias de la Educación Enrique José Varona, de la Universidad Ignacio Agramonte Loynaz y el Centro de Desarrollo de las Ciencias Sociales y Humanísticas en Salud, de la Universidad de Ciencias Médicas, ambas instituciones pertenecientes a la provincia de Camagüey.

Professional improvement constitutes a permanent process of higher education that guarantees the updating and preparation of its graduates for an adequate exercise of their performances in practice: in particular, in the field of medical sciences, it favors attention to health situations that appear in the community. The objective of this work is aimed at exposing the theoretical foundations that support the study of the training process of the Comprehensive General Medicine resident and the concretion of preventive work from the community. This is an initial approach to the training process of Primary Health Care specialists and the prevention of chronic viral hepatitis and as a continuation of the actions of a research project, the current approach is undertaken in the period between September from 2022 to October 2024, under the auspices of the Enrique José Varona Center for the Study of Education Sciences, of the Ignacio Agramonte Loynaz University and the Center for the Development of Social and Humanistic Sciences in Health, of the University of Medical Sciences, both institutions belonging to the province of Camagüey.

Dépistage de la stéatose hépatique par le Fibroscan/CAP chez les sujets noirs africains porteurs d'une Hépatite Virale B chronique en Côte d'Ivoire / Fibroscan/CAP screening for hepatic steatosis in black African subjects with chronic Viral Hepatitis B in Ivory Coast

Context and objectives As the global epidemic of obesity and metabolic syndrome progresses, the coexistence of fatty liver disease in patients with chronic viral hepatitis B (VHB) becomes significant. The objective of this work was to determine the frequency of hepatic steatosis assessed by Fibroscan/CAP (Controlled Attenuation Parameter) in patients with chronic VHB in Côte d'Ivoire. Methods. The study included 83 patients with chronic VHB. These were black patients who had performed a Fibroscan/CAP during the recruitment period and were willing to participate in the study. Patients with significant alcohol consumption, a secondary cause of hepatic steatosis, another liver disease regardless of the etiology associated with VHB were not included. Results. The frequency of hepatic steatosis in chronic HBV carriers assessed by CAP in our study population was 48.19 %, including 24.10 % of severe steatosis. Obesity was statistically correlated with the presence of steatosis in our patients. Patients who had steatosis on ultrasound were 5 times more likely to have steatosis on CAP. Significant fibrosis was insignificantly associated with steatosis. Conclusion. The frequency of fatty liver disease detected by fibroscan/CAP is high in patients with chronic VHB.

Contexte et objectifs Avec la progression de l'épidémie mondiale d'obésité et du syndrome métabolique, la coexistence d'une stéatose hépatique chez les patients porteurs d'une hépatite virale B chronique devient non négligeable. L'objectif de ce travail était de déterminer la fréquence de la stéatose hépatique chez les patients porteurs d'une hépatite virale B (HVB) chronique. Méthodes. Il s'agissait d'une série des cas de HVB de race noire, ayant réalisé un Fibroscan/CAP pendant la période du recrutement et consentants à participer à l'étude. Les patients ayant une consommation d'alcool significative, une cause secondaire de stéatose hépatique, une autre hépatopathie quelle que soit l'étiologie associée à l'hépatite B n'ont pas été inclus. Résultats. Quatre-vingt-trois patients porteurs d'une HVB ont été inclus. La fréquence de la stéatose hépatique chez les porteurs du VHB chronique était de 48,19 % dont 24,10 % de stéatose sévère. L'obésité était statistiquement corrélée à la présence d'une stéatose chez nos patients. Les patients qui avaient une stéatose à l'échographie étaient 5 fois plus à risque d'avoir une stéatose au CAP. La fibrose significative était associée de façon non significative à la stéatose. Conclusion : Près de la moitié des patients porteurs d'une hépatite virale B chronique présente une stéatose hépatique.

Aspects socio-économiques de la prise en charge des hépatites virales chroniques en Côte-d'Ivoire / Socio-economic aspects of the management of chronic viral hepatitis in Côte-d'Ivoire

Contexte et objectifs. Les hépatites virales chroniques constituent un problème de santé publique en Côte-d'Ivoire. Très peu de malades accèdent au traitement en raison des coûts élevés du bilan et du traitement. L'objectif de la présente étude était d'évaluer les coûts du bilan et du traitement des hépatites virales chroniques. Méthodes. Il s'agissait d'une étude observationnelle transversale analytique réalisée, du 1er mars 2019 au 31 juillet 2019, en consultation d'hépato-gastroentérologie du CHU de Yopougon. Les variables étudiées étaient les paramètres sociodémographiques et économiques. Résultats. Au total, 136 patients (hommes 53, 6 %, âge moyen de 42 ans ± 12,2) ont été inclus. Plus de la moitié des patients (63,3 %) avaient un revenu mensuel n'excédant pas 490.39 USD. Le coût du bilan initial était de 223.13 USD et de 351.14 USD respectivement, pour l'hépatite virale B et C. Le ténofovir et l'interféron pégylé étaient gratuits. Le traitement par sofosbuvir + velpastavir coûtait 593.37 USD. Le bilan de suivi annuel était estimé à 237.02 USD pour l'hépatite virale B, 225.58 USD pour l'hépatite virale C. Conclusion. Le bilan et le traitement des hépatites virales chroniques ont un coût prohibitif pour les patients malgré la couverture maladie universelle.

Context and objectives. Chronic viral hepatitis is a public health problem in Côte-d'Ivoire. A significant number of patients have little access to treatment due to the high costs of assessment and treatment. The objective of our study was to evaluate the costs of assessments and treatment of chronic viral hepatitis. Methods. This was an analytical cross-sectional observational study from March 1, 2019 to July 31, 2019 in the HepatoGastroenterology Consultation Service at the Yopougon University Hospital. The variables studied were socio-demographic and economic parameters. Results. 136 patients (men 53.6 %, average age 42 ± 12.2 years) were included. More than half of the patients (63.3 %) had a monthly income not exceeding 490.39 USD. The cost of the initial assessment was 223.13 USD and 351.14 USD for viral hepatitis B and C, respectively. Tenofovir and pegylated interferon were free of charge. Treatment with sofosbuvir + velpastavir cost 593.37 USD. The annual follow-up assessment was estimated at 237.02 USD for viral hepatitis B and 225.58 USD for viral hepatitis C. Conclusion. The assessment and treatment of chronic viral hepatitis have a cost that remains high for patients despite the universal health coverage.

Algunas consideraciones sobre las hepatitis virales crónicas como problema de salud / Some considerations on the chronic viral hepatitis as a health problem

Introducción: Hoy día, las enfermedades infecciosas constituyen una de las causas de muerte más frecuentes, de ahí que la actual epidemia de hepatitis es un problema de salud a escala mundial. Las hepatitis B y C se propagan por medio del contacto con la sangre, el semen u otro líquido corporal de una persona infectada. Objetivo: Actualizar algunos elementos sobre las hepatitis virales crónicas como un problema de salud. Desarrollo: Se analizan aspectos de las hepatitis virales crónicas relacionados con las estadísticas globales, regionales y locales; también se abordan los indicadores de impacto, la epidemiología, las características de los virus y las formas de trasmisión. Conclusiones: Esta problemática se ha convertido en un grave problema de salud en todo el orbe y Cuba no está exenta de esta situación. El principal eslabón para prevenir y reducir el número de pacientes y la trasmisión de estas enfermedades es la atención primaria, donde el trabajo educativo y preventivo que se desarrolla en la comunidad es fundamental.

Introduction: Nowadays, infectious diseases constitute one of the most frequent causes of death, with the result that current hepatitis epidemic is a health problem worldwide. The hepatitis B and C are spread by means of the blood contact, semen or another body fluid of an infected person. Objective: To update some elements on the chronic viral hepatitis as a health problem. Development: Some aspects of the chronic viral hepatitis related to the global, regional and local statistics are analysed; the impact indicators, epidemiology, characteristics of the virus and the ways of transmission are also approached. Conclusions: This question has become a serious health problem worldwide and Cuba is not exempt of this situation. The main link to prevent and reduce the number of patients and the transmission of these diseases is the primary health care, where the educational and preventive work that is developed in the community is fundamental.

Expression and significance of serum chemokine CXCL-13, interleukin-1beta and interleukin-6 in patients with chronic hepatitis B / 中华实验和临床病毒学杂志

Objective@#To investigate the correlation between serum chemokine CXCL13 (CXCL-13), interleukin-1beta (IL-1beta), interleukin-6 (IL-6) levels and liver function damage and hepatitis B virus replication in patients with chronic hepatitis B (CHB).@*Methods@#Eighty patients with CHB who were treated in Jiyuan People′s Hospital of Henan Province from January 2016 to December 2018 were selected as the study subjects. According to the severity of the disease, the patients were divided into mild group (34 cases), moderate group (26 cases) and severe group (20 cases). Eighty healthy people in the same period were selected as control group, and the serum levels of CXCL-13, IL-1β and IL-6 were detected and compared. Spearman correlation analysis was used to analyze the relation between CXCL-13, IL-1β, IL-6 and ALT, AST, HBV-DNA.@*Results@#The levels of ALT, AST, serum CXCL-13, IL-1β and IL-6 in patients with CHB were significantly higher than those in control group (P=0.000 for all comparisons); the levels of ALT, AST, HBV DNA and serum CXCL-13, IL-1β and IL-6 in patients with CHB were significantly higher than those in control group (P=0.000 for all the comparisons). Serum CXCL-13, IL-1β, IL-6 were positively correlated with ALT and AST (P=0.000, P=0.006, P=0.003, P=0.000, P=0.000, P=0.001), CXCL-13 level was positively correlated with HBV DNA (P=0.014), IL-1β and IL-6 were not correlated with HBV DNA. There were positive correlations among CXCL-13, IL-1β and IL-6 (P=0.012, P=0.019, P=0.008).@*Conclusions@#Serum CXCL-13 and IL-1β, IL-6 were closely related to the degree of liver function damage and disease progression in CHB patients. The level of CXCL-13 is positively correlated with the amount of hepatitis B virus. Therefore, close monitoring of serum CXCL-13, IL-1β and IL-6 in CHB patients is of clinical reference value for judging the patient′s condition.

Assessment of Association Cytochrome Р450 Gene Polymorphism with Pathogenesis and Course of HСV in Uzbek Population.

Aims: The assessment of polymorphisms CYP2C9*2 (430С>Т; rs1799853) and CYP2E1*1B (–C9896G, rs2070676) role of the genes of cytochrome Р450 in pathogenesis of the chronic viral hepatitis C (HCV) in Uzbek population became the main aim. Place and Duration of Study: The molecular and genetic study of biomaterial was accomplished under Department of Molecular Medicine and Cellular Technologies of SRIH&BT (Scientific Research Institute of Hematology and Blood Transfusion), MoH RUz in the period of 2013-2016. Methodology and Study Design: Genotyping assay of polymorphism of the genes under study was accomplished by the standard polymerase chain reaction (PCR). Peripheral blood of 107 patients with diagnosis chronic viral hepatitis C included in the main group and 81 relatively healthy donors (test group) was used for the molecular and genetic study of CYP2Е1*1В and CYP2C9*2 polymorphisms. Results: Comparative analysis revealed differences in the distribution of allele frequencies of polymorphisms 430C > T CYP2C9 gene and gene C9896G CYP2E1 * 1B in groups of patients with chronic HCV group and population control. In the main group of patients with chronic HCV mutant allele "T » CYP2C9 gene met significantly more frequently in comparison with the control group population. Thus, the highest frequency of the mutant allele of the "T", as compared with the control group was observed in patients with moderate HCV activity. This is the lowest frequency of this genotype was observed in the subgroup of patients with liver cirrhosis. Our studies have shown that the accumulation of the mutant allele «G» CYP2E1 * 1B gene was also the case in almost all sub-groups of patients with chronic HCV. The frequency of heterozygous genotype CYP2E1*1B polymorphism in the population control group was 13.6%. It should be noted that the highest frequency component of genotype C/G was detected in the group of patients with chronic HCV with high activity. The data obtained indicate an association genotype C/G with the activation process of inflammation and fibrotic changes. Conclusion: The results showed a high frequency of mutant allele "T" polymorphism 430C > T CYP2C9 with HCV, which allows us to consider the CYP2C9 gene as a factor of a favorable outcome of chronic hepatitis C. The association between the expression of CYP2E1 * 1B and progression of the disease with activation fibrosis-formation in individuals of Uzbek population is an important factor in the development of personalized therapy.

LIVER BIOPSY: IMPORTANCE OF SPECIMEN SIZE IN THE DIAGNOSIS AND STAGING OF CHRONIC VIRAL HEPATITIS

Liver biopsy is the gold standard method for the grading and staging of chronic viral hepatitis, but optimal biopsy specimen size remains controversial. The aim of this study was to evaluate the quality of liver specimen (number of portal tracts) and to evaluate the impact of the number of portal tracts in the staging of chronic hepatitis. Material and Methods: 468 liver biopsies from consecutive patients with hepatitis C virus and hepatitis B virus infection from 2009 to 2010 were evaluated. Results: The length of fragment was less than 10 mm in 43 cases (9.3%), between 10 and 14 mm in 114 (24.3%), and ≥ 15 mm in 311 (64.4%); of these, in 39 (8.3%) cases were ≥ 20 mm. The mean representation of portal tracts was 17.6 ± 2.1 (5-40); in specimens ≥ 15 mm the mean portal tract was 13.5 ± 4.7 and in cases ≤ 15 mm was 11.4 ± 5.0 (p = 0.002). Cases with less than 11 portal tracts were associated with F3, and cases with 11 or more portal tracts with F2 (p = 0.001). Conclusion: this study demonstrated the good quality of liver biopsy and a relationship between the macroscopic size of the fragment and the number of portal tracts.

Quantitative Analysis on Staging of Chronic Viral Hepatitis B and Hepatic Fibrosis by Real-time Shear Wave Elastography / 昆明医科大学学报

Objective To explore the application value of real-time shear wave elastography (SWE) technique in diagnosing and staging of chronic viral hepatitis B and hepatic fibrosis and to establish Young's modulus reference range for diagnosing and staging of hepatic fibrosis.Methods Forty-eight patients with chronic hepatitis B and fifty-eight healthy adults were enrolled and their Young's modulus values of S5 and S6 segments of liver were measured.Histopathologic examination was performed on 48 patients with chronic hepatitis B.Comparative analysis was conducted between the pathological findings and Young's modulus values,by means of which Young's modulus reference range for diagnosis and staging of hepatic fibrosis was obtained.Results There was significant difference in Young's modulus values of S5 and S6 segments of liver between chronic hepatitis B group and the normal control group (P＜0.05).Young's modulus values of S5 and S6 segments of liver in chronic hepatitis B group were (11.7 ± 2.9) kPa and (12.1 ± 3.2) kPa respectively,which were significantly higher than those in the normal control group,(5.7 ± 1.1) kPa and (5.8 ± 1.3) kPa respectively.Significant differences of Young's modulus values were detected in every staging of hepatic fibrosis (P＜0.05).S5 segment of liver Young's modulus values in S0-S4 stages were (5.8 ± 2.2) kPa,(7.3 ± 1.9) kPa,(10.3 ± 2.8) kPa,(10.3 ± 2.8) kPa,and (25.3 ± 3.6) kPa,respectively.S6 segment of liver Young's modulus values in S0-S4 stages were (5.7 ± 2.3) kPa,(9.2±2.1) kPa,(10.5±2.1) kPa,(14.7±4.5) kPa,and (26.1 ±2.1) kPa,respectively.Young's modulus value of the liver rose with the increase of S stage.Conclusion SWE technique can establish the Young's modulus reference range for hepatic fibrosis stage.Besides,it features high sensitivity,specificity and accuracy.

A clinical analysis of patients with hepatitis B virus related acute-on-chronic liver failure treated by combination of traditional Chinese and western medicine / 中国中西医结合急救杂志

Objective To observe the clinical curative effect of combination of traditional Chinese and western medicine for treatment of patients with hepatitis B virus (HBV) related acute-on-chronic (subacute) liver failure (ACLF). Methods A prospective randomized controlled trial was conducted; 66 cases of HBV-ACLF patients were randomly divided into two groups: a test group (44 cases) and a control group (22 cases). Conventional western medicine treatment was given to both groups; the patients in test group additionally received the traditional Chinese medicine (TCM) in accord to the principles of differentiation of syndromes in TCM, in cases with damp-heat and blood stasis syndrome with yellow appearance, Liangxue Jiedu Huayu decoction (Paeoniae Radix Rubra 60 - 150 g, Artemisiae Scopariae Herba 30 - 90 g, Gardeniae Fructus 9 - 12 g, Hedyotis diffusa Willd 20 - 30 g, Salviae Miltiorrhizae Radix et Rhizoma 30 g, Atractylodis Macrocephalae Rhizoma 30 g, Rubiae Radix et Rhizoma 30 - 45 g, Siegesbeckiae Herba 30 - 45 g, Bletillae Rhizoma 15 g ) was given, in cases with Qi deficiency and blood stasis with yellow appearance, Yiqi Jiedu Huayu decoction (Astragali Radix Preparata Cum Melle 30 g, Pseudostellariae Radix 15 g, Artemisiae Scopariae Herba 30 - 60 g, Polygoni Cuspidati Rhizoma et Radix 15 - 30 g, Salviae Miltiorrhizae Radix et Rhizoma 30 g, Aconiti Lateralis Radix Preparata 10 - 15 g, Atractylodis Macrocephalae Rhizoma 30 g, Rubiae Radix et Rhizoma 30 - 45 g, Siegesbeckiae Herba 30 - 45 g, Gigeriae Galli Endothelium Corneum 20 g) was given, the dosage in both groups being 1 dose daily, one dose was prepared to a water decoction 250 - 300 mL which was divided into two parts, one part taken twice a day; the control group received only western medicine treatment. After 2 weeks of treatment, the clinical comprehensive curative effect, the syndrome score efficacy, and the changes of main indexes of liver function,cholinesterase (ChE), albumin (Alb), prothrombin activity (PTA) were observed in the two groups.Results The clinical total efficacy in the test group was significantly higher than that in the control group [75.0% (33/44) vs. 45.5% (10/22),P 0.05). After treatment, the alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and direct bilirubin (DBil) were all lower than those before treatment in both groups, while the ChE, Alb and PTA were higher than those before treatment, and the degree of changes was more significant in the test group [test group: ALT (U/L): 63.28±99.28 vs. 574.58±571.08, AST (U/L): 86.84±92.88 vs. 438.20±482.74, TBil (μmol/L): 161.90±178.34 vs. 269.46±95.10, DBil (μmol/L): 115.32±126.51 vs. 209.12±79.78, ChE (U/L): 4 239.14±1 505.00 vs. 3 341.49±1 609.40, Alb (g/L): 32.65±4.77 vs. 29.73±3.31, PTA: (69.69±44.92)% vs. (32.84±7.47)%; control group: ALT (U/L): 93.28±93.86 vs. 365.24±376.98, AST (U/L): 126.26±121.35 vs. 287.17±301.04, TBil (μmol/L): 226.80±187.38 vs. 281.02±103.73, DBil (μmol/L): 172.50±147.32 vs. 227.96±87.20, ChE (U/L): 4 484.66±1 886.53 vs. 3 918.77±1 417.77, Alb (g/L): 33.17±4.76 vs. 30.47±3.03, PTA: (63.80±36.80)% vs. (33.96±6.32)%,P < 0.05 orP < 0.01].Conclusion The combination of TCM and western medicine for treatment of HBV-ACLF can improve liver function, and the prognosis is superior to using western medicine treatment alone.

How Many Valid Measurements Are Necessary to Assess Liver Fibrosis Using FibroScan(R) in Patients with Chronic Viral Hepatitis? An Analysis of Subjects with at Least 10 Valid Measurements

PURPOSE: Using FibroScan(R) to obtain a reliable liver stiffness measurement (LSM) may require more than 10 valid measurements (VMs), according to the manufacturer's recommendations. However, this requirement lacks scientific evidence in support thereof. We investigated the minimal number of VMs required to assess liver fibrosis without significant loss of accuracy in patients with chronic hepatitis B (CHB) and C (CHC) and predictors of discordance between LSM and liver biopsy (LB). MATERIALS AND METHODS: Between January 2005 and December 2009, we prospectively enrolled 182 patients with CHB and 68 patients with CHC who were to undergo LB and LSM before starting antiviral treatment. Only LSMs with at least 10 VMs were considered reliable. The Batts and Ludwig scoring system was used for histologic assessment. RESULTS: The mean age and body mass index were 46.0 years and 23.4 kg/m2 in patients with CHB and 49.7 years and 23.1 kg/m2 in those with CHC, respectively. The median elasticity scores from the first 3, first 5, and all VMs taken significantly predicted fibrosis stages > or =F2 and F4 (all p0.05 by DeLong's method). Alanine aminotransferase (ALT) was the only predictor of discordance in fibrosis stage as estimated by the median elasticity score from the first 3 VMs and by LB in patients with CHB, whereas no significant predictor was identified in those with CHC. CONCLUSION: After comparison of patients who had more than 10 valid measurements for LSM, three VMs may be enough to assess liver fibrosis using LSM without significant loss of accuracy in patients with CHC and patients with CHB. However, ALT should be considered when interpreting LSM for patients with CHB.

Vitiligo Universalis Associated with Chronic Hepatitis B / 대한피부과학회지

Vitiligo universalis is an uncommon variant that is rarely seen. Interestingly, vitiligo universalis often accompanies systemic diseases such as endocrinopathies. A 43-year-old man presented with whole body depigmentation and poliosis affecting most of his scalp and body hair. He had undergone a liver transplant 2 years ago due to liver cirrhosis from a chronic hepatitis B infection and has been treated for diabetes mellitus for several years. Histopathology showed no melanocytes and an absence of epidermal pigmentation on the skin. We herein report a rare case of vitiligo universalis associated with chronic viral hepatitis B.

MicroRNAs and chronic liver disease: Recent progress / 第二军医大学学报

Recent studies have indicated that miRNA is an important element that regulates gene expression at the post transcriptional level. MiRNAs play important roles in development and progression of chronic disorders of many organs. This. review summarizes the recent researches on the association of miRNA with chronic liver diseases.

Lamivudine Alone or in Combination with Bicyclol to Treat Chronic Viral Hepatitis B:A Clinical Study / 中华医院感染学杂志

OBJECTIVE To survey the therapeutic effect of lamivudine alone or in combination with bicyclol on chronical viral hepatitis B.METHODS Ninety patients with chronic viral hepatitis B were divided into 3 groups: A,B and C.Patients of group A(n=30) were given each 100mg lamivudine po qd,and 25 mg(bicyclol) po,tid,and the course of treatment lasted 72 weeks.Patients of group B(n=30) were subjected to(lamivudine) treatment alone at the same dosage as that of patients in group A.Patients of group C(n=30) were treated with(conventional) hepatinica and symptomatic therapeutic measures,serving as controls.Changes in serum HBV DNA and liver functions and YMDD mutant were dynamically monitored.RESULTS At the end of the 24,48 and 72 weeks of treatment,the rates of sera to turn negative for HBV DNA were 90.0%,(86.7%,) and(83.3%),(respectively),in patients of group A,and 86.7%,83.3%,and 76.7%,respectively,in patients of group B.The rates of sera to turn negative for HBV DNA,in patients of groups A and B were significantly higher than those in patients of group C(P0.05);at the end of 72 weeks,the rates of YMDD mutant were 16.7% in group A and 36.7% in group B,the rates in group A were significantly higher than in group B((P

Economic Benefit of Interferon in Treatment of Chronic Hepatitis B Virus Infection / 中国药房

OBJECTIVE:To evaluate the economic burden of chronic hepatitis B(CHB)and its complications,and to e-valuate the benefits of treatment with interferon-?.METHODS:The components of the economic burden of disease included direct medical costs and non-medical costs as well as indirect economic loss per patient-year in patients with chronic hepatitis B virus infections,including chronic hepatitis B,compensated and decompensated cirrhosis,and hepatocellular carcinoma.Net cost savings due to treatment of CHB with interferon-?were estimated using clinical data from2therapeutic schemes used in hospital.RESULTS:For the patients at different stages of hepatopathy,the direct medical cost and economic burden per year were different:9000yuan,11362yuan(CHB);13865yuan,19412yuan(compensated cirehosis);25678yuan,36979yuan(decompensated cirrhosis);26501yuan,40264yuan(liver cancer),Compared with conrentional therapy against CHB,the direct medical cost and total cost were reduced following4months treatment of interferon-?after5-year follow-up.The reduced amounts were831yuan,2038yuan per person,respectively.The surrival rate rised by2.8%.CONCLUSION:CHB infections create a heavy economic burden on the society,as well as patients and their families.We have seen the potential cost-savings due to treatment with interferon-?.

The study on quality of life and related factors among patients with chronic hepatitis B in Wuhan area / 中华全科医师杂志

0.05).Conclusion Coverage of medical insurance and effective antiviral therapy for the patients with CHB could affect their QOL.

Secondary Fish-Odor Syndrome Can be Acquired by Nitric Oxide-mediated Impairment of Flavin-containing Monooxygenase in Hepatitis B Virus-Infected Patients

Primary fish-odor syndrome (FOS) is a genetic disorder caused by defective flavin-containing monooxygenase 3 gene (FMO3) with deficient N-oxidation of trimethylamine (TMA), causing trimethylaminuria (TMAU). By contrast, secondary FOS can be acquired by decreased FMO activities in patients with chronic liver diseases, but the underlying mechanisms are unknown. In the present study, we examined plasma NOx concentrations and viral DNA contents as well as in vivo FMO activities and their correlations in chronic viral hepatitis (CVH) patients. Plasma concentration of NOx was significantly increased by 2.1 fold (56.2+/-26.5 vs. 26.6+/-5.4micrometer, p< 0.01), and it was positively correlated with plasma hepatitis B virus (HBV) DNA contents (r2=0.2838, p=0.0107). Furthermore, the elevated plasma NOx values were inversely and significantly correlated with in vivo FMO activities detected by ranitidine-challenged test (8.3% vs. 20.0%, r2=0.2109, p=0.0315). TMA N-oxidation activities determined in CVH patients without challenge test were also significantly low (73.6% vs. 95.7%, p< 0.05). In conclusion, these results suggested that secondary FOS could be acquired by the endogenously elevated NO in patients with CVH.

Relationship of Magnetic Resonance Diffusion-Weighted Imaging to Histology in Chronic Viral Hepatitis / 中国普外基础与临床杂志

Objective To investigate the relationship of magnetic resonance diffusion-weighted imaging (DWI) to histology in the patients of chronic viral hepatitis. Methods Thirty-five patients of chronic viral hepatitis who received liver biopsy and 10 healthy volunteers were included in this study. All of them underwent DWI on a 3.0T MRI device. Apparent diffusion coefficient (ADC) of the liver were measured respectively when b value were set as 100, 400, 600 and 800 s/mm~2. Biopsy specimens were scored for fibrosis and necroinflammation according to the Knodell histology activity index (HAI). Results When b value was set as 800 s/mm~2, statistical difference was showed between the fibrosis group and the non-fibrosis group, statistical difference was also shown among the different degrees of necroinflammation and fibrosis. Conclusion DWI is a valuable method for grading and staging of chronic viral hepatitis.

Predictive Factors and Clinical Outcome of Viral Breakthrough during Lamivudine Treatment for Chronic Hepatitis B Infection / 대한간학회지

BACKGROUND/AIMS: Long-term treatment with lamivudine causes breakthrough, but the clinical course after lamivudine breakthrough is not well known. The aims of this study were to evaluate the clinical course in lamivudine after breakthrough, and to identify predictive factors of breakthrough. METHODS: 124 patients with chronic hepatitis B infection, who represented viral breakthrough during lamivudine therapy, were included. The mean duration of lamivudine therapy and additional lamivudine therapy after breakthrough was 30.5 months and 12.5 months, respectively. RESULTS: The cumulative breakthrough rates at 12, 18, 24 and 36 months were 8, 24, 36 and 52%, respectively. After viral breakthrough, only 4 patients maintained normal ALT levels. 120 patients showed ALT elevation. The number of patients with ALT levels greater than 5 times, and greater than 10 times, the upper normal limit were 67 (56%) and 29 (24%), respectively. While still on lamivudine therapy after breakthrough, 98 patients presented ALT elevation. Only 22 had normalized ALT levels. Hepatic decompensation developed in 2 patients. HBeAg seroconversion after breakthrough occurred in 10 patients. The changing pattern of quantitative HBeAg levels during lamivudine therapy was the only predictive factor associated with viral breakthrough. The mean time of turning points in decrescendo-crescendo patterns of HBeAg levels during lamivudine therapy was earlier than viral breakthrough (9 months vs. 17 months). CONCLUSIONS: These results suggested that deterioration of hepatic function can usually be observed after breakthrough. The serial monitoring of serum quantitative HBeAg levels may allow an early recognition of viral breakthrough.

Efficacy of Lamivudine Re-treatment and Relapse Patterns after Initial Lamivudine Treatment for Chronic Hepatitis B Infection / 대한간학회지

BACKGROUND/AIMS: The post-treatment relapse patterns and efficacy of lamivudine re-treatment for relapsed patients have not been clarified. The aims of this study were to evaluate the relapse patterns after discontinuing therapy and the effects of lamivudine re-treatment for relapsed patients after HBeAg seroconversion. METHODS: Therapy was discontinued after HBeAg seroconversion in 121 patients. Sixty-six patients were relapsed and included in this study. The duration of lamivudine re-treatment therapy was from 6-35 (mean: 16) months. Post-retreatment monitoring continued for 1-40 (mean: 8.9) months. RESULTS: Among the relapsed 66 patients, 50 (75.8%) had HBeAg reappearance while 16 (24.2%) remained HBeAg negative and anti-HBe positive. The cumulative relapse rates at 3, 6, 12 and 24 months were 27%, 47%, 60% and 66%, respectively. Forty-two relapsers received lamivudine re-treatment. Among them, 33 were HBeAg positive and 9 were HBeAg negative and anti-HBe positive, Response was achieved in 31 of the 42 patients (73.8%). The cumulative response rates at 6, 9 and 12 months were 62%, 69% and 72%, respectively. Six patients (14.3%) developed viral breakthrough. All patients were HBeAg positive chronic hepatitis B. The duration of lamivudine re-treatment was the only predictable factor for response of lamivudine re-treatment. Therapy was discontinued after response in 21 patients. Eleven patients were relapsed, including 6 who were HBeAg positive and 5 who were HBeAg negative. Predictive factors for post-retreatment relapse were age and the duration of additional lamivudine therapy after response. CONCLUSIONS: The response rate of lamivudine re-treatment was significantly higher than in initial lamivudine treatments. The breakthrough and relapse rates, however, were similar in both initial and retreated lamivudine therapy.