Euroasian Journal of Hepato-Gastroenterology

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2011 | July-December | Volume 1 | Issue 2

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MINI REVIEW

Pradip Bhaumik, Ajit Ranjan Choudhury, Priyabrata Sinha

Combating Hepatitis B: The Tripura Model

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:39 - 41]

   DOI: 10.5005/jp-journals-10018-1009  |  Open Access |  How to cite  | 

Abstract

Although hepatitis B is a major public health problem globally, mass vaccination against this virus is yet to be implemented in many countries of the world, including in India, which happens to be one of the most populous nations in the globe. Hepatitis Foundation of Tripura has become a role model in combating this virus in the small north-eastern Indian state of Tripura. With infrastructural help from the Tripura Government, the foundation has done a commendable job of vaccinating 0.25 million out of 3.65 million population of the state, setting an unique example of public partnership in sustaining hepatitis B virus.

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MINI REVIEW

Salimur Rahman

Hepatitis B: From Blumberg to Bangladesh

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:2] [Pages No:42 - 43]

   DOI: 10.5005/jp-journals-10018-1010  |  Open Access |  How to cite  | 

Abstract

Bangladesh has made significant progress in all aspects, if hepatitis B management in the recent years. On one hand, we have local generics of most approved antivirals against hepatitis B, including pegylated interferon, which has brought down treatment cost significantly. On the other extreme, significant progress has also been made in the research arena and good quality papers on hepatitis B from Bangladesh are now being published regularly in impact factor journals. Several clinical trials have already been completed, while others are ongoing, which is testimony to the very promising side of hepatology in Bangladesh as a whole.

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MINI REVIEW

Abhijit Chowdhury

Hepatitis B Virus-related Liver Disease Burden in South Asia

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:44 - 46]

   DOI: 10.5005/jp-journals-10018-1011  |  Open Access |  How to cite  | 

Abstract

Hepatitis B is major health concern globally, specially in the Asia-Pacific region. The virus results in countless premature mortalities and greater number of morbidities. While the scientific community is more focused toward HBV-related liver disease burden, the toll of this virus on our economies remain largely undermine. Proper planning and active participation of the government machinery and decision makers are vital to the best utilization of resources of our resource-constrained countries for the implementing best possible measures against hepatitis B.

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MINI REVIEW

Mamun Al-Mahtab

Immunotherapy for Chronic Hepatitis B: Will This Lead to Rome?

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:2] [Pages No:47 - 48]

   DOI: 10.5005/jp-journals-10018-1012  |  Open Access |  How to cite  | 

Abstract

The entity and concept of immune therapy against chronic infections and cancers is still elusive. Credible preclinical studies and clinical trials are scare in this field due to improper understating about cellular and molecular mechanism of these diseases. In addition, immune interventional strategies against these diseases have not been properly formulated. A sketch about immune pathogenesis of these diseases and interventional strategies has been formulated in this communication.

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MINI REVIEW

Desmond Wai

Update on Management of Viral Hepatitis B

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:4] [Pages No:49 - 52]

   DOI: 10.5005/jp-journals-10018-1013  |  Open Access |  How to cite  | 

Abstract

Management of hepatitis B has gone a long way since the introduction of lamivudine and interferon. Today, we have several much more potent oral antivirals for hepatitis B, which are associated with much less resistance. Pegylated interferon has the path for immune modulation and newer immune modulators are in the pipeline. Options of combination therapy are being evaluated, while treatment is being individualized. Although the best treatment for hepatitis B is yet to be identified, the prospects are brighter than ever before.

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REVIEW ARTICLE

Rajesh Kumar, Jasbir Singh

Genetic Diversity of HBV Genotypes/ Subgenotypes and Their Correlation with Disease Progression

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:15] [Pages No:53 - 67]

   DOI: 10.5005/jp-journals-10018-1014  |  Open Access |  How to cite  | 

Abstract

Hepatitis B virus (HBV) infection remains a global health problem and a public health threat in the present era. It is estimated that 2 billion people are infected with HBV and 350 million people suffer from chronic HBV infection in the world. India is a prosperous country in Asia and has peculiar geographical presence which is responsible for evasion of this land by traders and invaders in past and resulted in gene influx due to invasion and/or anthropological migrations in the past. Moreover, recent increase in trade, trafficking and use of illicit drugs has also considerably influenced the epidemiology of HBV in different parts of India. However, data on the genotypes/subgenotypes diversity of HBV in India is scanty. In this manuscript, the information available on the genetic diversity of HBV genotypes and subgenotypes in India and in world and their relationship with the disease progression has been reviewed.

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ORIGINAL ARTICLE

Shasanka Kumar Saha, Ranjit Kumar Banik, Mili Rani Saha, Munshi M Habibullah

Prevalence of Transfusion Transmitted Infection in Healthy Blood Donors in Sir Salimullah Medical College Dhaka, Bangladesh

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:68 - 70]

   DOI: 10.5005/jp-journals-10018-1015  |  Open Access |  How to cite  | 

Abstract

Background: Transfusion of blood and blood components, as a specialized modality of patient management, saves millions of lives worldwide each year and reduce morbidity. It is well-known that blood transfusion is associated with a large number of complications. Objective: The objective of the present study was to assess the status of transfusion transmitted infections (TTI) among the apparently healthy donors so as to increase the awareness of complications of blood transfusion and make the clinicians more vigilant with regard to judicious use of blood. Methods: A total of 21,966 units of donor’s blood were screened from January 2007 to December 2010 at blood bank of Sir Salimullah Medical College, Mitford Hospital, Dhaka. All the samples were screened for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), human immunodeficiency virus (HIV) 1 and 2, venereal disease research laboratory test (VDRL) and malaria. All healthy blood donors were 18 to 60 years old. Result: Prevalence of hepatitis B virus (HBV), HCV, HIV and syphilis were 2.19, 0.25, 0.06 and 0.15% respectively. No blood donor tested showed positivity for malarial parasite. With the implementation of strict donor selection criteria and use of sensitive screening test, it may be possible to reduce the incidence of TTI in the Bangladeshi population.

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ORIGINAL ARTICLE

Tarek A Besheer, Mahmoud M El-Bendary, Khaled R Zalata, Hossam E Zaghalol

Evaluation of Fibrosis Progression by Noninvasive Biochemical Markers in Egyptian Patients with Chronic Hepatitis B

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:6] [Pages No:71 - 76]

   DOI: 10.5005/jp-journals-10018-1016  |  Open Access |  How to cite  | 

Abstract

Background: To evaluate the usefulness of biochemical markers for prediction of fibrosis in chronic hepatitis B. Materials and methods: This study was carried out on 133 patients with chronic hepatitis B. The diagnostic accuracy of four noninvasive liver fibrosis markers; matrix metalloproteinase-2 (MMP-2), hyaluronic acid (HA), aspartate aminotransferase (AST) to platelet ratio index (APRI) and FIB-4 was evaluated. Results: The levels of HA and MMP-2 were increased along with the severity of fibrosis. The cutoff value for HA was 265 ng/ml for predicting liver cirrhosis, whereas cutoff value for MMP-2 was 860 ng/ml. The cutoff value for APRI for detecting severe fibrosis (F3 and F4) was ≥ 0.9. Finally, cutoff value for FIB-4 was ≥ 0.9 for assessment of severe fibrosis in chronic hepatitis B. Conclusion: HA, MMP-2, APRI and FIB-4 could be clinically useful as noninvasive markers for detection of severe fibrosis in chronic hepatitis B.

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ORIGINAL ARTICLE

Hu Shengping, Wang Mingliang, Wu Zhiyuan, Zhao Xuesong, Miao Fei

Gemstone Spectral Monochromatic CT Imaging: Detection and Classification of Focal Liver Lesions in Patients with Pancreatic Cancer

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:6] [Pages No:77 - 82]

   DOI: 10.5005/jp-journals-10018-1017  |  Open Access |  How to cite  | 

Abstract

Objective: To analyze the diagnostic performance of gemstone spectral monochromatic CT imaging in the detection and classification of focal liver lesions in patients with pancreatic cancer. Methods: We retrospectively studied 32 pancreatic cancer patients with 55 focal liver lesion images (19 cysts and 36 metastases) conducted by gemstone spectral CT. We obtained the focal liver lesions and the pancreatic iodine concentration from the iodine-based material decomposition images. This was further normalized to that of aorta. Receiver-operator characteristic curves to determine the diagnostic sensitivities and specificities of correctly diffentiating liver metastases from cysts were calculated. Imaging results were correlated with findings of intraoperative surgical (n = 13), imaging follow-up, ultrasound findings and percutaneous ethanol therapy (n = 19). Results: Gemstone spectral CT played a significant role in differentiating focal liver metastases from liver cysts. The parameters we drew could provide extra quantitative data. Conclusion: The gemstone spectral monochromatic CT scanner provides not only the processed polychromatic images, including arterial and portal phase images, but also extra quantitative data.

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ORIGINAL ARTICLE

Naznin Nahar, AJE Nahar Rahman, Saequa Habib

Histopathological Assessment of Liver Biopsy Specimen in the Context of HBV DNA and HBeAg in Patients with Chronic Hepatitis B

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:6] [Pages No:83 - 88]

   DOI: 10.5005/jp-journals-10018-1018  |  Open Access |  How to cite  | 

Abstract

Background: There is lack of consensus if hepatitis B virus (HBV) DNA can be regarded as a surrogate marker of liver damages in patients with chronic hepatitis B (CHB). Methods: A total of 77 patients with CHB were enrolled in this study. The sera of the patients were tested for HBV DNA and hepatitis B e antigen (HBeAg). The extent of hepatitis and hepatic fibrosis was assessed by liver biopsy. Results: Out of total of 77 patients with CHB, 29 were HBeAg-positive and 48 were HBeAg-negative. Twenty-seven of 29 HBeAg-positive patients and eight of 48 HBeAg-negative patients had high levels of HBV DNA (HBV DNA>105 copies/ml). The extent of hepatitis was minimal or mild in most HBeAg-positive CHB patients (27 of 29) irrespective of the levels of HBV DNA in the sera. Moderate levels of hepatitis were seen in two HBeAg-positive patients and five HBeAg-negative patients. Moderate levels of hepatic fibrosis were seen in four of eight HBeAg-negative patients with high HBV DNA. Conclusion: This study shows that HBV DNA and HBeAg do not reflect the extent of hepatitis or hepatic fibrosis in CHB patients of Bangladesh. Combination of different HBV-related markers with liver biopsy is required for proper diagnosis and management of CHB in Bangladesh.

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ORIGINAL ARTICLE

Kamlesh K Bhopale, Dhananjaya Nauduri, Kizhake V Soman, Gagan K Sood, Anthony Okorodudu, GAS Ansari, Bhupendra S Kaphalia

Differentially Altered Plasma Proteins in Patients diagnosed with Alcoholic and Nonalcoholic Fatty Liver Disease

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:11] [Pages No:89 - 99]

   DOI: 10.5005/jp-journals-10018-1019  |  Open Access |  How to cite  | 

Abstract

Alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) are major health problems. Although both diseases follow a similar course of disease progression from an early reversible fatty liver stage to severe necroinflammation with or without fibrosis and cirrhosis, the mechanisms of ALD and NAFLD are not well understood. This preliminary study was conducted to determine blood alcohol concentration (BAC) and altered proteins and fatty acid ethyl esters (FAEEs, nonoxidative metabolites of ethanol) in the plasma of patients diagnosed with ALD or NAFLD. Differentially altered proteins were identified by two-dimensional gel electrophoresis and mass spectrometry, FAEEs by gas chromatography and BAC by an enzymatic method. Precursors of complement C3, complement C6 and serum amyloid A-4 protein, and Ig gamma-3 chain C region were significantly decreased in ALD vs controls (group 1). Haptoglobin precursor was the only altered protein (increased) in NAFLD vs controls (group 2). However, significantly increased levels of precursors of complements C3, C4-B and C6 and decreased levels of immunoglobulin J chain and Leucine-rich alpha-2 glycoprotein precursor were observed in NAFLD vs ALD (group 3). These results indicate potential of precursors of complements C3 and C6 and haptoglobin for the differential diagnosis of ALD and NAFLD. Although high BAC and plasma FAEEs levels in the ALD group appear to be associated with chronic alcohol abuse, biological significance of endogenous biosynthesis of FAEEs yet to be established. Therefore, a detailed proteomic and lipidomic study need to be conducted in larger cohorts to understand the etiopathogenesis of ALD and NAFLD.

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CASE REPORT

Sunil Taneja, Anil Arora, Piyush Ranjan, Sanjay Khanna, Nandini Vasdev, SK Sama,

Spontaneous Rupture of Spleen in Immunoglobulin Light Chain Amyloidosis: A Case Report and Review of Literature

[Year:2011] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:100 - 102]

   DOI: 10.5005/jp-journals-10018-1020  |  Open Access |  How to cite  | 

Abstract

Rupture of spleen in absence of trauma is very rare and can occur in certain pathologic conditions. Amyloidosis involves spleen and splenomegaly has been reported in 4 to 13% of patients; however, splenic rupture has rarely been reported in amyloidosis. Here, we report a case of spontaneous splenic rupture in a patient with immunoglobulin light chain amyloidosis.

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