Syphilitic hepatitis.

Syphilis is a sexually transmitted multisystemic disease known as "the great imitator" due to its variable presentations. Despite being preventable and curable, it still constitutes a major health problem. Hepatic manifestation of syphilis is usually mild cholestatic liver injury but in very rare cases can become fulminant. Moreover, syphilitic hepatitis, known for several decades, is considered rare but is probably under-diagnosed. Given the significant morbidity associated with a missed diagnosis, syphilitic hepatitis should be taken into account as an element of differential diagnosis in patients with unexplained elevation of liver enzymes.

Shear-wave elastography for evaluation of hepatic stiffness in chronic viral hepatitis B and C.

Aim of the study: To analyse the consistency between 2D shear-wave elastography (2D-SWE) stiffness and fibrosis in liver biopsy in patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. The secondary aim of the study was to analyse the consistency between liver stiffness in 2D-SWE and transient elastography (TE) measurements in patients with chronic hepatitis B and C. Material and methods: The study compared the results of hepatic stiffness assessment with 2D-SWE to available past liver biopsy reports in 153 patients with chronic HBV (n = 51) and HCV (n = 102) infection. In 43 patients with both hepatitides HBV (n = 8) and HCV (n = 35) we performed FibroScan on the same day as 2D-SWE. The appropriate statistical tests were applied for the analysis. Results: Stiffness values analysed in the whole studied population showed a significant positive correlation with a stage of liver fibrosis in biopsy (r = 0.555, p < 0.001). If 2D-SWE was carried out within 24 months since liver biopsy the consistency of the results was 96%, and if the period between procedures exceeded 24 months the consistency was 81%. In 43 patients with both 2D-SWE and TE the coherence (r = 0.872, p < 0.001) and consistency (95%) between these two methods were high. Conclusions: Liver stiffness measured with 2D-SWE showed good consistency with stage of liver fibrosis in liver biopsies, particularly in HCV infected patients, and if the period between procedures did not exceed 24 months.

Best therapy for the easiest to treat hepatitis C virus genotype 1b-infected patients.

BACKGROUND: The revolution in treatment of patients with chronic hepatitis C virus (HCV) infection dates back to the introduction of direct-acting antivirals (DAAs). The increase in efficacy was most pronounced in patients infected with genotype (GT) 1b, as this was the most poorly responsive population to treatment during the interferon era. AIM: To identify the most effective interferon-free therapy for GT1b-infected patients and to determine positive and negative predictors of virological response. METHODS: This real-world retrospective analysis included patients chronically infected with GT1b HCV whose data were obtained from the multicenter observational EpiTer-2 database. Treatment effectiveness was evaluated for each therapeutic regimen as the percentage of sustained virological responses (SVR). Assessment of the safety was based on the evaluation of the course of therapy, the occurrence of adverse events including serious ones, deaths during treatment and in the post 12-wk follow-up period. RESULTS: The studied population consisted of 11385 patients with a mean age of 53 ± 14.8 years and a female predominance (53.4%). The majority of them were treatment-naïve (74.6%) and patients with cirrhosis accounted for 24.3%. Of the DAA regimens used, 76.9% were GT-specific with ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin being the most used option (32.4%). A total of 10903 patients responded to treatment resulting in a 98.1% in the per-protocol analysis after excluding 273 patients without SVR data. The effectiveness of all regimens exceeded 90% and the highest SVR of 98.9% was achieved in patients treated with a combination of glecaprevir/pibrentasvir. Logistic regression analyses showed that the virologic response was independently associated with female sex [odds ratio (OR) = 1.67], absence of decompensated cirrhosis at baseline (OR = 2.42) and higher baseline platelets (OR = 1.004 per 1000/µL increase), while the presence of human immunodeficiency virus (HIV) coinfection significantly decreased the odds of response (OR = 0.39). About 95%-100% of patients completed therapy irrespective of the drug regimen. At least one adverse effect occurred in 10.9%-36.3% and most of them were mild. No treatment related deaths have been reported. CONCLUSION: We documented very high effectiveness and a good safety profile across all DAA regimens. Positive predictors of SVR were female sex, absence of decompensated cirrhosis at baseline and higher platelet count while HIV coinfection reduced the effectiveness.

Severe Breakthrough COVID-19 Cases during Six Months of Delta Variant (B.1.617.2) Domination in Poland.

The emergence of a highly transmissible and a more pathogenic B.1.617.2 (delta) variant of SARS-CoV-2 has brought concern over COVID-19 vaccine efficacy and the increased risk of severe breakthrough infections. The objective of this study was to assess the frequency and the clinical characteristics of severe breakthrough COVID-19 cases recorded in 10 Polish healthcare units between 1 June and 31 December 2021, a period during which a rapid surge in the share of B.1.617.2 infections was seen, while a significant number of populations were already fully vaccinated. Overall, 723 individuals who completed the initial vaccination regime (fully vaccinated group) and an additional 18 who received a booster dose were identified­together, they represented 20.8% of all the COVID-19 patients hospitalized during the same period in the same healthcare institutions (0.5% in the case of a group that received a booster dose). Although laboratory and clinical parameters did not differ between both groups, patients who received a booster tended to have lower CRP, IL-6, PCT, and d-dimer levels and they required oxygen therapy less frequently. The most common early COVID-19 symptoms in the studied group were fatigue, cough, fever (>38 °C), and dyspnea. Individuals with no detectable anti-spike IgG antibodies constituted 13%; the odds of being a humoral non-responder to the vaccine were increased in patients aged >70 years. Fully vaccinated patients hospitalized after more than 180 days from the last vaccine dose were significantly older and they were predominantly represented by individuals over 70 years and with comorbidities, particularly cardiovascular disease. Contrary to mRNA vaccines, most patients vaccinated with adenoviral vector vaccines were infected within six months. A total of 102 fatal cases (14% of all deaths among vaccinated individuals; 0.7% in the case of a group that received a booster dose) were recorded, representing 17.6% of all the COVID-19 fatalities recorded in June−December 2021 in the considered healthcare units. The odds of death were significantly increased in men, individuals aged >70 years, patients with comorbidities, and those identified as humoral non-responders to vaccination; in fully vaccinated patients the odds were also increased when the second vaccine dose was given >180 days before the first COVID-19 symptoms. The mortality rate in immunocompromised subjects was 19%. The results indicate that compared to vaccinated individuals, severe COVID-19 and deaths in the unvaccinated group were significantly more prevalent during the B.1.617.2-dominated wave in Poland; and, it highlight the protective role of a booster dose, particularly for more vulnerable individuals.

Serum sialic acids levels according to the severity of liver cirrhosis.

BACKGROUND: The sialylation of serum proteins and lipids changes in liver diseases of different etiologies and could change the total sialic acid (TSA), lipid-bound SA (LSA), and free SA (FSA) levels in the sera. However, little is known of the relationship of serum SAs concentrations and the severity of liver disease. Therefore, the aim of this study was to investigate the SAs concentrations (TSA, LSA, and FSA) in liver cirrhosis in relation with the severity of liver disease. METHODS: Tested group consisted of 91 consecutive patients suffering from liver cirrhosis. For each patient, the Child-Pugh score was calculated. TSA and LSA were determined by the enzymatic method on microplate reader, and FSA using the thiobarbituric method. RESULTS: Among the SA forms, only the serum FSA level in liver cirrhosis appears to be different according to the severity of liver damage evaluated by the Child-Pugh score. It was the highest in score C, and was higher than that in scores B and A. The elevated levels of FSA significantly positively correlated with the Child-Pugh score. CONCLUSION: In conclusion, the sialylation of serum proteins and lipids changes in liver cirrhosis, but only the serum concentrations of FSA are stage-related and reflect the severity of liver disease.

The effect of the severity of liver cirrhosis on the level of lipids and lipoproteins.

The effect of severity of liver cirrhosis, an alcoholic and non-alcoholic genesis, on the results of serum lipids and lipoproteins was evaluated. Serum cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-Ch), and low-density lipoprotein cholesterol (LDL-Ch) were measured in the sera of 59 patients suffering from alcoholic cirrhosis and 34 patients with non-alcoholic cirrhosis. The level of serum triglycerides depends on the severity of liver damage in alcoholic liver cirrhosis, being the highest in Child-Pugh score B. The severity of liver damage significantly affects the HDL-Ch and LDL-Ch levels in cirrhosis of non-alcoholic origin, reaching the highest value for LDL-Ch and the lowest for HDL-Ch in score C. It should not be generalized that the levels of lipids and lipoproteins in liver cirrhosis progressively diminished with the deterioration of liver function. The serum HDL-Ch and LDL-Ch may be considered as markers of severity of liver damage in non-alcoholic cirrhosis, but the triglycerides only in disease of alcoholic origin.

[The diagnostic value of non-invasive biochemical biomarkers in alcohol abuse]. / Wartosc diagnostyczna biochemicznych nieinwazyjnych biomarkerów w naduzywaniu alkoholu.

UNLABELLED: The diagnosis of alcoholic liver disease, steatosis, fibrosis and alcoholic steatohepatitis, can be evaluated by means of non-invasive biochemical biomarkers: SteatoTest, FibroTest and AshTest. The aim of the study was to evaluate the diagnostic usefulness of these tests for the detection of steatosis, fibrosis and alcoholic steatohepatitis in alcohol abusing patients. MATERIAL AND METHODS: The experimental group comprised 137 alcohol-dependent subjects. The control group was consisted of 50 healthy social drinkers. Ten biochemical assays were determined according to methods recommended by the provider of the tests - BioPredictive company. The scores were computed by the company according to the bilateral agreement. RESULTS: The diagnostic sensitivity and specificity were as follows: 61.9% and 93.9% for SteatoTest, 61.3% and 93.9% for FibroTest and 9.6% and 93.9% forAsh Test. The diagnostic power of Steato Test (A UC = 0.806) and FibroTest (AUC = 0.795) were significantly higher than the diagnostic power of AshTest (AUC = 0.626) but did not differ from each other. The probability of a positive test results of Steato Test and FibroTest is 10-times more likely in alcoholics than in healthy individuals. CONCLUSION: SteatoTest and FibroTest can be useful diagnostic tool for the detection of liver steatosis and fibrosis in alcohol-dependent patients but cannot differentiate of these clinical conditions.