Background: The study was designed to assess the prevalence of asymptomatic gallstone disease in North-East part of Bangladesh. Materials and methods: Randomly selected asymptomatic persons, unknown to have gallstone disease, from both rural and urban areas were enrolled. They were subjected to abdominal ultrasonography and findings were recorded in a data sheet. Results: Total 1,019 persons (316 males and 703 females) were examined. Age of them varied from 18 to 80 years with mean age of 37.22 years. Out of them, 61 (6%) persons were found to have gallstone. Among them, 14 were males and 47 were females. Both male and females of age below 40 years were more affected. Gallstone disease was found more commonly among housewives and middle class people. Among 61 patients with gallstone, seven were underweight (11.47%), 32 (52.45%) had normal weight and 22 (36.06%) were overweight, obese or extremely obese. But, this difference was not statistically significant (p = 0.894). Conclusion: Prevalence of asymptomatic gallstone disease was found in 6% apparently healthy subjects of North-East part of Bangladesh. It was more prevalent among housewives and middle class group of population. It is also common among the people of age group below 40 years.

Background: Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of liver disease characterized by excess of fat in liver which ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC) in the absence of excessive alcohol consumption. Materials and methods: The study was carried out in 216 with sonologically defined fatty liver. They underwent detailed history evaluation, clinical examination and anthropometric measurements, biochemical and serological tests. The cut-off values for central obesity were waist hip ratio (WHR) > 0.85 in women and > 0.9 in men. Results: The prevalence of NAFLD was highest in the age group of 31 to 60 years. It was more common in males than females. Twenty cases (11.7%) had discomfort at right upper abdomen. Hepatomegaly was found in 27 patients (13.2%), impaired glucose tolerance (IGT) in 29 (14.21%) and diabetes mellitus in 38 (18.63%) patients. Overweight or obesity was found in 110 (53.92%) cases and central obesity was seen in 129 (63.23%) patients. Hence, metabolic syndrome (according to International Diabetes Federation Criteria) was present in 62.25% cases of NAFLD. Alanine aminotransferase (ALT) more than upper limit of normal was found in 36.76% cases. Conclusion: Risk factors for NAFLD in Bangladesh are similar to reported from the rest of the world. Age more than 30 years, male sex, WHR > 0.9 in men and more than 0.85 in female, BMI more than 25, glucose intolerance are predictive factors for NAFLD.

Background: Hepatitis B virus (HBV) infection has many faces. Precore and core promoter mutants resemble inactive carrier status. The identification of hepatitis B core antigen (HBcAg) in hepatocytes may have variable clinical significance. The present study was undertaken to detect HBcAg in chronic hepatitis B (CHB) patients and to assess the efficacy of detection system by indirect immunofluorescence (IIF) and indirect immunoperoxidase (IIP). Materials and methods: The study was done in 70 chronic HBV-infected patients. Out of 70 patients, eight (11.4%) were hepatitis B e antigen (HBeAg) positive and 62 (88.57%) were HBeAg negative. Hepatitis B core antigen was detected by indirect immunofluorescence (IIF) and indirect immunoperoxidase (IIP) methods in liver tissue. Results: All HBeAg positive patients expressed HBcAg by both IIF and IIP methods. Out of 62 patients with HBeAg-negative CHB, HBcAg was detected by IIF in 55 (88.7%) patients and by IIP in 51 (82.26%) patients. A positive relation among viral load and HBcAg detection was also found. This was more evident in the case of HBeAg negative patients and showed a positive relation with HBV DNA levels. Conclusion: Hepatitis B core antigen can be detected using the IIF from formalin fixed paraffin block preparation and also by IIP method. This seems to reflect the magnitudes of HBV replication in CHB.

Virological monitoring is the best predictor for the management of chronic hepatitis B virus (HBV) infections. Consequently, it is important to use the most efficient, rapid and cost-effective testing systems for HBV DNA quantification. The present study compared the performance characteristics of a one-step HBV polymerase chain reaction (PCR) vs the two-step HBV PCR method for quantification of HBV DNA from clinical samples. A total of 100 samples consisting of 85 randomly selected samples from patients with chronic hepatitis B (CHB) and 15 samples from apparently healthy individuals were enrolled in this study. Of the 85 CHB clinical samples tested, HBV DNA was detected from 81% samples by one-step PCR method with median HBV DNA viral load (VL) of 7.50 × 103 IU/ml. In contrast, 72% samples were detected by the two-step PCR system with median HBV DNA of 3.71 × 103 IU/ml. The one-step method showed strong linear correlation with two-step PCR method (r = 0.89; p < 0.0001). Both methods showed good agreement at Bland-Altman plot, with a mean difference of 0.61 log10 IU/ml and limits of agreement of –1.82 to 3.03 log10 IU/ml. The intra-assay and interassay coefficients of variation (CV%) of plasma samples (4-7 log10 IU/ml) for the one-step PCR method ranged between 0.33 to 0.59 and 0.28 to 0.48 respectively, thus demonstrating a high level of concordance between the two methods. Moreover, elimination of the DNA extraction step in the one-step PCR kit allowed time-efficient and significant labor and cost savings for the quantification of HBV DNA in a resource limited setting.

This cross-sectional observational study was conducted to evaluate the implication of CA19-9 level in predicting the extent of hepatic fibrosis in patients with chronic hepatitis B (CHB). Fifty treatmentnaïve patients with CHB were divided into three groups: group I, patients with no fibrosis (F0; n = 3); group II, patients with mild fibrosis (F1; n = 25) and group III, patients with moderate fibrosis (F3; n = 22). There was no significant (p > 0.05) difference in levels of serum bilirubin, serum alanine aminotransferase, alkaline phosphatase, and alpha fetoprotein among groups I, II and III. Also, mean CA19-9 level did not differ among the three groups. It was observed that, for group II, AUC was 42.6%, sensitivity 52%, specificity 32%, considering cut-off value as 2.8 U/ml to predict F1 liver fibrosis. For group III, AUC was 57.7%, sensitivity 68%, specificity 50% considering cut-off value as 3.2 U/ml to predict F3 fibrosis. The levels of CA19-9 level do not seem to have significant predictive implication to assess hepatic fibrosis.

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. Multiple treatment modalities for HCC are available, depending on size and number of tumor. Liver transplantation offers the most reasonable option for curative treatment, because it simultaneously removes the burden of the diseased liver. The Milan criteria currently remain the benchmark for the selection of patients with HCC for transplantation. However, there is considerable and promising interest in expanding the eligibility criteria to include the University of California San Francisco criteria. Liver transplantation (LT) has progressed during the past decade. The introduction of living donor LT has provided a means of expanding organ transplant, but with some inherent concerns. Herein, we reviewed the diagnosis and management of HCC with emphasis on the current concepts of liver transplantation for the treatment of HCC.

Bangladesh is a South Asian country with a homogeneous population. However, some difference has been demonstrated in the distribution of liver disease in different parts of the country. Hepatitis E remains the principal cause of acute hepatitis in Bangladesh, while chronic liver disease in Bangladesh, including hepatocelullar carcinoma, is predominantly due to hepatitis B virus. Hepatitis B has been extensively studied and characterized in Bangladesh, and some major clinical trials with HBV-related antigens have also been conducted.

In Cambodia, the true burden of viral hepatitis has not been revealed, but many surveys were carried out focusing on specific population or on small scales. Different markers of viral hepatitis were found between 27 and 97% in children and almost 100% in adults. Viral hepatitis B in children was 3.5% in 2006 and dropped in 2011; and in adults, it ranged from 4.5 to 10.8%. Viral hepatitis C was between 0.87 and 14.7%. No data are available for hepatitis D in the country. Viral hepatitis E (anti-HEV IgG) went from 7.2 to 12.7%. The complications due to viral hepatitis including chronic liver diseases and hepatocellular carcinoma were reported in the health information system. Around 79% of the patients with high transaminase had at least one viral marker and about 45% of the adults with chronic hepatitis and liver cirrhosis were positive for Hepatitis B surface antigen (HBsAg). Hepatocellular carcinoma accounted for 19.1% of all reported cancer cases. Hepatitis B surface antigen was found in between 55 and 90% in adults with hepatocellular carcinoma and anti-HCV in one-fourth. The only intervention implemented in Cambodia is vaccination against viral hepatitis B (HepB vaccine).

Diverse Indian population provides an excellent opportunity to study the prevalence and feature of hepatitis virus for understanding viral evaluation and viral pathogenesis. India is in intermediate zone of pathogenesis of hepatitis B (2-5%), and India is having around 40 million hepatitis B virus (HBV) carriers. A wide variation in prevalence of hepatitis B is observed from region to region and community to community. The prevalence of HBV is higher among tribal population, than nontribal. Population prevalence of hepatitis C virus (HCV) infection in India is 1%. Prevalence study among blood donors may reflect population prevalence. Hemodialysis increases the possibility of blood borne viral infection. Higher prevalence of HBV among tribal population is of paramount importance from public health point of view and hepatitis B vaccination.

Mongolia which is located in Northern Asia between Russia and China is endowed with one of lowest population density in the world. Acute hepatitis due all types of hepatitis virus has been reported in Mongolia. Also, dual and triple hepatitis viruses, HBV, HDV and HCV are highly prevalent among patients with chronic liver disease living in Mongolia. Due to these facts, liver cancer is the leading cause of cancer mortality in Mongolia. The national immunization program including vaccination against hepatitis B was started in 1991 and screening of blood donations for HBsAg and anti-HCV was introduced in 1993 and 1997 respectively. The incidence of hepatitis viruses showing a downhill course in some parts of Mongolia, but comprehensive efforts are needed to control hepatitis viruses and containment of hepatitis related liver diseases and liver cancer in Mongolia.

Geographical and ethnic diversity in Nepal has led to interesting epidemiology of viral hepatitis and liver diseases. Before the epidemic of Biratnagar that occurred in April to June 2014, Kathmandu was the only known endemic region for hepatitis E virus infection (HEV), where at least four previous epidemics have been documented since 1973. Due to rapid urbanization with still low socioeconomic condition, other major cities are appreciated to be at increasing risk of outbreaks. Characteristics of HEV epidemics and genetic changes of HEV during last decade have been studied. While hepatitis A virus infection was only common during childhood till recent years, it is re-emerging as an important etiology of acute hepatitis in young adults. Nepal is classified as low endemic region for hepatitis B virus infection (HBV) with overall seroprevalence of 1.1%. But, some ethnic groups and geographical areas have high prevalence rates. Despite low endemicity, HBV accounts for majority of cases of hepatocellular carcinoma and liver cirrhosis in the country. Similarly, though hepatitis C virus (HCV) is present in only 0.4% of general population, high seroprevalence was found among intravenous drug abusers many of them with HIV coinfection. Apart from hepatitis viruses, alcohol use also contributes significantly to liver cirrhosis and chronic liver failure. A unique form of hepatic venous outflow obstruction called ‘hepatic vena cava syndrome’ has been identified as an important etiology of liver cirrhosis and hepatocellular carcinoma.

Pakistan is among ten most populous countries in world. All sorts of hepatitis are highly prevalent in Pakistan. Due to lack of proper mechanisms to handle sewerage, disinfection and lack of clean water supply across the country, hepatitis A and E are endemic in Pakistan. Moreover, Pakistan ranked in intermediate prevalence zone for hepatitis B and C. Also, prevailing socioeconomic conditions, political statuses and unstable healthcare delivery system are not suitable for tackling further progression of hepatitis viruses and its complications. The notable factors related to epidemiology of different hepatitis viruses have been described in this communication.

Vietnam has been a highly endemic country of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections with high hepatitis B surface antigen (HBsAg) rate (8.8-19.0%) and high anti-HCV rate (1.0-3.3%) among general population. High mortality rates of liver cancer were also estimated from 14.8 to 23.7 per 100,000. Recently, the coverage of universal HB vaccination for infants has not been high as expected while there have been no other national programs against HBV and HCV infections yet. The burden of HBV and HCV-related diseases is predicted to remain a significant health problem in next decade.

Extracorporeal shock wave lithotripsy (ESWL) is a standard treatment method used for the treatment of renal calculi and upper ureteral calculi. Acute pancreatitis is a serious condition which develops due to multiple etiologic factors and is characterized by autodigestion of the pancreas. A case of acute pancreatitis which developed following ESWL performed for right renal calculi treatment is presented here.

A 35-year-old man was admitted to hospital with severe anemia. Two years back, he had presented with bleeding esophageal varices and subsequently diagnosed as a case of chronic liver disease with portal hypertension. He was then treated with esophageal band ligation. He tested positive for hepatitis B surface antigen with HBV DNA levels of 4 × 106 copies/ml by PCR. His repeat endoscopy showed grade 1 esophageal varices with no evidence of recent or active bleeding. On further investigation, his bone marrow showed dimorphic erythroid hyperplasia with ring sideroblasts and diagnosis of sideroblastic anemia was made. Although rarely, it was suggested that as cirrhosis is a chronic process, it may cause nutritional deficiency, which in turn may lead to the development of anemia.

According to the World Health Organization, more than 2 billion people are estimated to be infected with tuberculosis (TB) and approximately 95% of tuberculosis cases occur in developing countries. Extrapulmonary forms of tuberculosis constitute approximately one-sixth of all cases and the prevalence of extrapulmonary tuberculosis (TB) seems to be rising, particularly due to increasing prevalence of acquired immunodeficiency syndrome (AIDS). In patients with extrapulmonary TB, abdomen is involved in 12% of patients. Gastrointestinal involvement is found in 66 to 75% of abdominal cases, with the terminal ileum and the ileocecal region being the most common sites of involvement. Here, we report a case of abdominal TB.

Acute hepatitis is a disorder that goes with liver cell necrosis and liver inflammation. Among the causes of acute hepatitis, the most common reasons are viral hepatitis. About 95% of the acute hepatitis generate because of hepatotropic viruses. Epstein-barr virus (EBV) and cytomegalovirus (CMV) are from the family of herpes viruses and rare causes of acute hepatitis. In this case report, acute hepatitis due to EBV and CMV coinfection will be described.

Cerebral injury may persist and brain death may occur following an emergency liver transplantation (LT) for fulminant hepatic failure (FHF) even if the graft functions well. We herein present two patients developing brain death following emergency LT for FHF.