Aim: Diabetes mellitus (DM) represents one of the major lifestyle-related pathological conditions; the incidence and prevalence of DM have reached an epidemic level around the world. Diabetes mellitus is usually associated with obesity, coronary diseases, and cerebral pathologies. However, more insights are required to evaluate a temporal relation between DM and hepatic functions. This study assesses whether and to what extent liver functions are modified in DM patients. Materials and methods: A total of 100 patients with type 2 DM and 100 normal healthy controls were enrolled in this study following proper scrutiny of inclusion and exclusion criteria. Different parameters of liver function tests were measured in patients in the two groups. Data were analyzed to assess the extent and magnitude of abnormal liver functions in DM. Results: The levels of bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, and prothrombin time were 0.737 ± 0.311 mg/dL, 39.00 ± 24.21 IU/L, 26.42 ± 10.40 IU/L, 4.10 ± 0.513 g/dL, and 16.46 ± 2.78 seconds in patients with DM and 0.506 ± 0.183 mg/dL, 28.26 ± 6.67 IU/L, 18.90 ± 4.75 IU/L, 4.12 ± 0.277 g/dL, and 14.23 ± 1.04 seconds in control subjects. Statistical analyses revealed that most of these parameters of liver function test were significantly different in DM patients compared to control subjects (p < 0.05). Serum alkaline phosphatase level was 89.61 ± 25.59 mg/dL in type 2 DM patients and 96.83 ± 16.34 mg/dL in control subjects (p > 0.05). The prevalence of abnormal values of serum bilirubin, ALT, AST, prothrombin time, and albumin were 5.17, 31.03, 5.17, 5.17, 43.10, and 10.34% respectively in type 2 DM patients and 0, 2, 0, 2, 3, and 0% respectively in control subjects, indicating high prevalence of DM patients with abnormal liver functions. Conclusion: Abnormal liver functions of different extents and magnitudes have been found in type 2 DM patients, and the impact of abnormal liver function should be considered during the management of DM patients and also to assess their long-term follow-up prognosis.

Aims: To see the prevalence of lactose intolerance (LI) and related symptoms following oral lactose challenge in healthy volunteers. Materials and methods: Symptoms of abdominal pain, nausea, borborygmi, flatulence, and diarrhea were noted for 24 hours and blood glucose was estimated at 0 hour and 30 minutes after 25 gm oral lactose load to healthy volunteers. Failure to rise blood glucose level ≥ 1.1 mmol/l at 30 minutes after lactose intake from fasting level was taken as lactose malabsorption (LM), i.e., LI. Results: A total of 166 volunteers (123 males, 43 females) with a mean age 34.78 ± 11.45 years participated in this study. Lactose intolerance was found among 85.54% (n = 142, M = 104, F = 38). The main symptoms of LI were diarrhea (n = 83, 58.4.0%), borborygmi (n = 81, 57.04%), abdominal pain (n = 35, 24.65%), and flatulence (n = 27, 19.0%). Conclusion: Lactose intolerance among healthy adults may be common in Bangladesh. Diarrhea and borborygmi were mostly associated symptoms of LI.

Introduction: Ascites is a common complication of chronic liver diseases and is related to the extent of portal hypertension. This study evaluated whether the serum ascites albumin gradient (SAAG) (the difference between the albumin level of serum and of ascitic fluid) is endowed with clinical implications. Materials and methods: This is a prospective study involving 50 patients with cirrhosis of liver with ascites. The SAAG was measured in all patients and its relation with portal hypertensive changes was analyzed. Results: Based on SAAG values, the patients were divided into three groups: Group 1 – SAAG value 1.1 to 1.49 gm/dL (n = 15); group 2 – SAAG value 1.5 to 1.99 gm/dL (n = 9); and group 3 – SAAG value 2.0 gm/dL (n = 26). In group 1, 14 patients had esophageal varices (93.3%) and 13 had gastropathy (86.6%). In group 2, all 9 patients had esophageal varices (100%), 7 (77.7%) had gastropathy, and 1 (11.1%) had gastric varices. In group 3, all 26 patients had esophageal varices (100%), 24 patients (92.3%) had gastropathy, and 1 patients (3.8%) had gastric varices. Conclusion: Serum ascites albumin gradient value is weakly related to the extent of portal hypertension in patients with liver cirrhosis and its implication seems to be limited in clinics.

Introduction: Cirrhosis of the liver is a common complication of chronic liver disease and is associated with portal hypertension and esophageal varices. In this study, we checked the implication of prothrombin time, if any, in the genesis of esophageal varices. Materials and methods: Sixty patients with cirrhosis of the liver were randomly assigned into two groups: Group I – 30 cirrhotic patients with esophageal varices, and group II – 30 cirrhotic patients without esophageal varices. The prothrombin time was checked for both groups. Results: A positive correlation was found between the prolonged plasma prothrombin time (> 4 seconds) and esophageal varices with a sensitivity of 56.67% and specificity of 73.33%. The Child–Pugh score showed a correlation; however, the size of varices did not exhibit any such relation. Conclusion: Prothrombin time may be cautiously used to assess portal hypertension in a field level and rural setting where endoscopy is not available or feasible.

Background and aims: Insulin resistance and cytokine production are key mechanisms leading to fatty change in the liver and may produce nonalcoholic steatohepatitis (NASH). Oxidative stress may also contribute to clinical progression from simple fatty liver (FL) to NASH. A therapy for insulin resistance and antioxidant has been applied to treat NASH, yet these treatments are not fully established. In the present study, we have evaluated whether an antioxidant agent, glutathione, prevents the development of NASH from FL. Materials and methods: Five patients with FL and 10 with NASH were enrolled in the study. Three hundred milligrams per day of glutathione was given orally to patients with nonalcoholic fatty liver disease (NAFLD) every day, and an oxidative stress marker and biochemical tests were analyzed before treatment and 1 and 3 months after starting the treatment. We measured serum levels of 8-hydroxy- 2-deoxyguanosine (8-OHdG) and gamma-glutamyltranspeptidase (GGT). Immunohistochemistry for glutathione was performed on formalin fixed liver specimens obtained from liver biopsies. Results: Before treatment, the NASH group had higher serum 8-OHdG and lower serum glutathione levels than the FL group. Immunohistochemistry revealed that a strong expression of glutathione was observed in zone 3 in both NASH and FL before treatment. Serum levels of alanine transaminase and 8-OHdG were significantly decreased after treatment in the NASH group. Gamma-glutamyltranspeptidase was decreased after treatment, although the decrease was statistically not significant. Discussion: The present pilot study demonstrated that antioxidant therapy with glutathione may reduce the pathological oxidative stress in the liver in NASH, preventing the progression from NAFLD to NASH.

Aims: We studied the functional stability of a primer pair and the standard curve based on a plasmid carrying full-length HBV genome, from a novel low-cost real-time quantitative polymerase chain reaction (qPCR) assay. The assay was developed at the Center for Genetic Engineering and Biotechnology (CIGB) in Havana, to quantify the serum hepatitis B virus (HBV) DNA from chronic HBV-infected (CHB) patients. Materials and methods: In-house generated oligonucleotides and plasmids were incubated at 37°C during 1 month and compared with the same materials incubated at –20, 4, and 25°C during the same time in qPCR experiments. Results: This work shows that the oligonucleotide pair and the plasmid for the quantitative standard curve are functionally stable in severe temperature conditions during 1 month. Polymerase chain reaction amplification with both materials after its incubation 30 days at 37°C produced similar cycle threshold (CT) values and similar degree of sample quantifications compared with the same materials preserved using the conventional storage conditions at –20°C. Conclusion: These results are indicative of the robustness of this low-cost qPCR system for HBV DNA quantification. These results also support that this qPCR assay can be used as a low-cost technology in clinical studies to monitor the viral load changes of serum HBV DNA of CHB patients, which could be used by poor people of third world countries, where there are frequent blackouts and temperature changes that can hinder the primer and plasmid stability.

The development of therapeutic vaccines against chronic hepatitis B requires the capacity of the formulation to subvert a tolerated immune response as well as the evaluation of histopathological damage resulting from the treatment. In the present study, the dynamicity of induced immune response to hepatitis B surface antigen (HBsAg) was evaluated in transgenic mice that constitutively express the HBsAg gene (HBsAg-tg mice). After immunization with a vaccine candidate containing both surface (HBsAg) and core (HBcAg) antigens of hepatitis B virus (HBV), the effect of vaccination on clearance of circulating HBsAg and the potential histological alterations were examined. Transgenic (tg) and non-transgenic (Ntg) mice were immunized by intranasal (IN) and subcutaneous (SC) routes simultaneously. A control group received phosphate-buffered saline (PBS) by IN route and aluminum by SC route. Positive responses, at both humoral and cellular levels, were obtained after five immunizations in HBsAg-tg mice. Such responses were delayed and of lower intensity in tg mice, compared to vaccinated Ntg mice. Serum IgG response was characterized by a similar IgG subclass pattern. Even when HBsAg-specific CD8+ T cell responses were clearly detectable by gamma-interferon ELISPOT assay, histopathological alterations were not detected in any organ, including the liver and kidneys. Our study demonstrated, that it is possible to subvert the immune tolerance against HBsAg in tg mice, opening a window for new studies to optimize the schedule, dose, and formulation to improve the immune response to the therapeutic vaccine candidate. These results can be considered a safety proof to support clinical developments for the formulation under study.

Introduction: Periampullary diverticula (PD) is caused by extraluminal pouching of duodenal mucosa. Using a very common endoscopic procedure to diagnose or treat gastrointestinal disorders, we encountered duodenal diverticulum. Materials and methods: This is a retrospective, single-center study. Three thousand and sixteen patients on whom endoscopic retrograde cholangiopancreatography (ERCP) was performed at Ankara University Medical School, Department of Gastroenterology, from June 2009 to June 2014 were included to the study. Results: Hundred and thirty patients (males 65, females 65) among the 3,016 had PD. Two hundred and sixty patients without diverticulum were randomly chosen from the 3,016 patients, as a control group [121 (47%) females, 139 (53%) males]. There was no statistical difference between the two groups. The mean age of the patients with PD was 69.9 years, while the mean age was 62.3 years for patients without PD (p < 0.001). Incidence for PD was 4.6%. The papilla of Vater was located in the inter-diverticular area (Type 1) in 9 patients (8.3%), at the edge of the diverticulum (Type 2) in 31 patients (28.4%), and at a distance of 2 to 3 cm from the papilla (Type 3) in 69 patients (63.3%). Discussion: Although numerically more common bile duct stones occurred in patients with PD compared to those without PD, there was no statistical difference between the two groups. The rate of pancreatobiliary carcinomas was higher in patients without diverticulum. Cannulation was successful in both groups at the rate of 97.6 and 92% respectively, but cannulation failed more often in patients without PD. Duodenal perforation occurred in one patient with PD. Bleeding after sphincterotomy occurred in two patients without PD.

Hepatitis C virus (HCV) is known to cause chronic hepatitis C, and its sequelae of cirrhosis and hepatocellular carcinoma. Hepatitis C genotype 3 (HCV-3) in particular is notorious for causing accelerated liver fibrosis, cardiovascular, and metabolic effects, thus increasing morbidity and mortality. It is the commonest variant in Asian countries like India and Pakistan. It is also one of the hardest-totreat genotypes, especially among treatment-experienced and cirrhotic patients. Due to limited health care affordability and accessibility in these areas, many patients remain untreated. Until recently, the established therapy for HCV had been a combination of pegylated interferon + ribavirin. However, it was only effective in about half of patients and had severe adverse effects; hence a more efficacious option needed to be found. Recent advances have led to the development of sofosbuvir, an NS5B inhibitor that is fast becoming the standard of care, in combination with other novel drugs. It was initially marketed at $1,000 per pill, a cost that was too high for most. Thus, it has not been utilized as a global therapy as yet. Formulation of effective interferon-free regimens is a huge milestone, and awareness needs to be raised regarding these new highly effective options in both the physician and the patient population. This article discusses the newest drugs and combinations that have been developed in the fight against HCV-3, as a treatment outline for HCV-3-dominant areas. It also highlights recent breakthroughs in cost reductions of these drugs and the effort to make them globally accessible.

Viral hepatitis poses huge burden to the health care delivery system as well as to the economy of Bangladesh. Hepatitis E virus is the leading cause of acute hepatitis in this country, however with the improvement of economic status and sanitation this seems to be on the decline. Hepatitis B virus remains the leading cause in all forms of chronic liver diseases in this country. This virus has been extensively studied in Bangladesh, including from epidemiology to pathogenosis. Clinical trials with innovative therapy conducted in Bangladesh have shown promise. Hepatitis C virus follows hepatitis B virus as the second commonest cause of chronic liver diseases here. However patients in Bangladesh have started benefitting from the local generic versions of the newly introduced direct acting anti-virals.

The prevalence of viral hepatitis represents Cambodia as 1 of the highest endemic countries in the world. But the prevalence of viral hepatitis B among 5-year-olds is on a decreasing trend due to the effect of nationwide vaccination against hepatitis B. There are key interventions to address viral hepatitis by the Cambodian Ministry of Health. There are so far no comprehensive national guidelines for the prevention, care, and treatment of viral hepatitis. In 2014, the coverage of hepatitis B vaccine at birth and HepB3 vaccine was very high, at 87 and 97% respectively. Other interventions include the screening of viral hepatitis B and C among blood donors; the enhancement of infection prevention and control at health facilities; the program for People Who Use Drugs (PWUDs) and People Who Inject Drugs (PWIDs); control and prevention of HIV/AIDS and sexually transmitted diseases (STDs); and improved sanitation, clean water, and food safety. The diagnosis of viral hepatitis B and C could be made only at the national and provincial referral hospitals and there are no specific antiviral therapies for people who are infected with hepatitis B and C.

Of all the industrialized countries of the world, Japan has the highest rate of hepatitis C. It also has 1 of the oldest and most varied histories of hepatitis C in the world among the industrialized modern nations. Hepatitis C and its complications are the leading cause of liver cancer in Japan. Japan has the highest rate of liver cancer among the industrialized countries. From 2004 to 2014, PegIFN/RBV treatment was the mainstream of hepatitis C treatment. In 2014, the first interferon-free therapy was approved in Japan. Subsequently, other interferon-free therapies have been approved. Hepatitis C virus disinfection in hepatitis C patients in Japan has become possible with a probability of 96% or more.

Malaysia is multiethnic, with a population of 31,127,247 comprising a mixture of Malays (50.1%), Chinese (22.6%), Indians (6.7%), Aborigines (11.8%), others (0.7%), and noncitizens (8.2%). Like other countries in the region, viral hepatitis is an important public health problem in Malaysia. The 3 most common causes for hepatitis in Malaysia are hepatitis A, B, and C. Hepatitis A has been a reportable disease in Malaysia since 1988. Due to the introduction of government control programs, the national incidence rate has dropped steadily. It is now estimated that 50% of Malaysians less than 30 years of age do not have antibodies to hepatitis A and are therefore susceptible to the disease, which can be prevented by reinforcing the hygiene status of the general population. Malaysia is a country of medium seroprevalence for the hepatitis B virus (HBV) surface antigen (HBsAg) in the general population (1.5–9.8%). The major route of transmission is from infected mother to fetus. There are an estimated 1 million people chronically infected with hepatitis B in Malaysia. Approximately 75% of all viral hepatitis cases are due to hepatitis B infection, with a male-to-female ratio of 2:1. Chronic hepatitis B (CHB) accounts for more than 80% of the hepatocellular carcinoma (HCC) cases seen in Malaysia and HCC is the 3rd most common malignant neoplasm and among the 10 leading causes of death. Most common genotypes are B and C. Incidence rates among Chinese, Malays, and Indians are 36, 26, and 15% respectively. The hepatitis B vaccination program for children was introduced in 1989, which successfully managed to reduce the seroprevalence of infection among Malaysians to 0.01% (graph 4, 2014). But the disease burden will still remain high for some time as the infected people are getting older and living longer. Hepatitis C virus (HCV) infection is a growing problem in Malaysia. An estimated 453,700 people were living with HCV infection in Malaysia in 2009 (2.5% of the population aged 15–64 years), of whom 59% acquired their infection through injection and the most common genotypes found are genotype 3 and 1. The HCV-related disease burden is already high and is forecast to rise steeply over the coming decades under current levels of antiviral treatment. Increased governmental resources to improve HCV screening and treatment rates and to reduce transmission are essential to address the high projected HCV disease burden in Malaysia.

Viral hepatitis is one of the major health concerns worldwide, particularly in Asian countries. Mongolia, which is located in northern Asia, between Russia and China, is confronting various infectious diseases, such as viral hepatitis and tuberculosis. As for healthy individuals in Mongolia, the reported prevalence of hepatitis B surface antigen (HBsAg) was 9 or 10% and the reported prevalence of anti-hepatitis C virus ranged from 11 to 25%. We reported a markedly high prevalence of hepatitis D virus RNA (83%) among apparently healthy individuals with HBsAg in Ulaanbaatar. Also due to lack of proper mechanisms to handle sewerage, disinfection, and lack of clean water supply across the country, hepatitis A is endemic in Mongolia. Moreover, Mongolia ranked in the high-prevalence zone for hepatitis B, D, and C.

Over the last four decades, the diagnosis and therapy of viral hepatitis has evolved substantially all over the world. Although Nepal is a developing nation, it has been keeping pace with these developments in terms of the implementation of diagnostic and therapeutic strategies. However, because of a lack of infrastructure and logistics, Nepal still depends on its neighboring countries for molecular diagnostics in viral hepatitis B and C. Though most of the recent antivirals for hepatitis B and directly acting antivirals for hepatitis C are available at a highly subsidized cost, affordability still remains an issue. A lack of comprehensive national program for hepatitis B and C has been a major barrier for access to health care in patients with chronic viral hepatitis. Similarly, hepatitis E still remains an important public health issue with major epidemics at periodic intervals. Recent developments in understanding hepatitis E virus have unveiled important aspects of the virus, particularly with regard to why these epidemics occur. In this manuscript we try to elaborate the evolution in understanding, diagnosing, and treating viral hepatitis in Nepal.

Korea has been one of the endemic areas of hepatitis B virus (HBV; exclusively genotype C) infection since ancient times. The epidemiology of HBV in Korea is easily expected to have changed over the last two decades owing to the high coverage rate of universal HBV vaccination. The main mode of hepatitis C virus (HCV) infection may have been effectively blocked since 1992 when compulsory blood screening for anti-HCV was implemented, and consequently, the prevalence of anti-HCV is also expected to have markedly decreased during the last two decades. This review will briefly describe what really happened during the last couple of decades in the epidemiology of HBV and HCV and in the incidence and mortality rates of liver cirrhosis (hepatic failure) and hepatocellular carcinoma in Korea.

Since Indonesia is a huge archipelago country, the prevalence of hepatitis virus infection highly varies among islands. In average the prevalence of clinical hepatitis in Indonesia was 0.6% in the year 2007. Of 82 clinical acute hepatitis patients treated in hospitals in several cities, acute hepatitis A accounted for 28.0%, acute hepatitis B 13.4%, and acute hepatitis C 1.2%; 35.4% patients were infected by unknown etiology. In 1980s, the prevalence of anti-HAV in the age group 10- to 14-years was almost 100% in smaller towns and 45 to 60% in big cities. About 30 years later, anti-HAV prevalence decreased to around 13% in the same smaller town. Outbreaks of hepatitis A were reported between 2006 and 2009 in several cities in Java island. The prevalence of HBsAg in the islands other than Java island (8.5%) was significantly higher than in Java island (4.9%). In 1,409 viremic subjects, 4 genotypes of HBV were found, i.e., genotype B (60%), followed by genotype C (33%), genotype D (7%), and genotype A (0.3%). In contrast, the prevalence of hepatitis C was much higher in Java island compared to other islands. In blood donors in Java island, the prevalence of anti-HCV and HCV RNA were 1.5 and 1.1% respectively, while in other islands, the prevalence were only 0.7 and 0.2% respectively. Hepatitis D was very rare in Indonesia, and so was hepatitis E. Outbreaks of hepatitis E were reported between 1989 and 1993 in West Kalimantan. Afterward, the incidence of hepatitis E was reported sporadically.

Viral hepatitis is a major cause of morbidity and mortality worldwide and a rising cause for concern in Asian countries. Weather it is blood borne or water/food borne hepatotropic virus, increasing burden is alarming for Asian countries. In this review we have evaluated the existing data to estimate the burden of viral hepatitis in populations of all age groups nationwide, along with an assessment of the risk factors and preventive and management strategies currently employed in Pakistan. The aim of our work is to consolidate and supplement the present knowledge regarding viral hepatitis in light of past and present trends and to provide future direction to the existing health policies.

Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver. Hepatitis B virus infection is one of the most important etilogical factors of HCC. In this case report, a patient with HCC previously infected and having ongoing immunity against hepatitis B virus will be discussed.

Brunner gland hamartoma (brunneroma) is a rare benign tumor of the duodenum. It is usually asymptomatic and detected incidentally by endoscopy or other imaging modality. The definitive diagnosis is based on histopathological findings. These may mimic tumors of other natures, such as gastrointestinal stromal tumors (GIST), carcinoids, lipomas, and leiomyomas. Here, we present a case of duodenal polyp presenting with abdominal pain and obstructive symptoms that caused duodenal intussusception. It was surgically removed and found to be a brunneroma on histopathology.

Diversity of clinical presentation of inborn errors of metabolism (IEM) gives a diagnostic challenge to the practicing physicians. In recent years there have been dramatic advances in the diagnosis and treatment of these fatal diseases, which shows improved prognosis of many of these conditions. The need for screening for IEM arises out of the fact that most cases take to irreversible effects as time progresses. Here, the main challenge is to recognize the early signs and symptoms that are also common to sick infants with other diseases. We describe a 32-day-old female infant who was finally diagnosed as a case of IEM (organic acidemia).The baby had a history of multiple neonatal intensive care unit admission. She died during her last hospital admission. The purpose of our case presentation is to provide clues to the true nature of the disease and to make physicians aware about the possibility of IEM.