Hepatitis Monthly
Year:2015 | Volume:15 | Issue:11|Papers Count:8

Background: Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis. Objectives: This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia.Patients and Methods: In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of < 5, 5 - 14, 15 - 29 and ³30 are categorized as control, mild, moderate and severe, respectively.Results: One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 ± 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO2 values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner.Conclusions: We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO2 levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.

Background: Hepatitis B infection is a global public health problem affecting various sectors in the society. Vaccination is the first line measure to prevent the disease.Objectives: To assess the persistence of anti-HBs marker among medical students after 18 - 22 of vaccination as an indicator for Hepatitis B virus vaccine efficacy.Patients and Methods: In this study, 249 Palestinian medical students vaccinated at birth, 1, and 6 months of age using Engerix™-B starting from 1992 were studied. About 58% (144.249) of the students were Palestinians holding Israeli citizenship, while 42% (105.249) were Palestinians from the West Bank. Students were tested serologically for anti-HBs, as a marker for vaccine-induced immunity.Results: Over 75% (188/248) of students had levels of anti-HBs greater than 10 mIU/mL indicating immunity and protection. Five cases had positive results for anti-HBc indicating exposure to HBV infection; however, none of these cases showed any sign of HBV-DNA indicating effective clearance of the virus by the vaccine. Around 57% of the study group had anti-HBs level of 100 - 1000 mIU/mL. No significant association was found between anti-HBs level and age, sex, locality and level of anti-HBc (P > 0.05). The students were aware of different aspects of hepatitis B infection regarding the virus, symptoms, prevention and mode of transmission.Conclusions: The Palestinian and Israeli official policies to give a booster dose for risk groups like medical students at anti-HBs level below 10 mIU/mL should continue to ensure absolute protection. The currently-used vaccine and its time program cleared virus from students believed to have been exposed to the virus during their lifetime.

Background: Viral hepatitis is a major health problem in Brazil and worldwide. The state of Santa Catarina has high endemic areas, and the disease burden is unknown.Objectives: To estimate and analyze the burden of hepatitis B in the state of Santa Catarina, in 2005 - 2010.Materials and Methods: A time-series analysis was conducted using notification data of incidence and mortality rates from hepatitis B. The Disability-Adjusted Life Years (DALY) and the components Years of Life Lost (YLL) and Years Lived with Disability (YLD) were calculated. The annual variation was estimated using segmented linear regression, identifying the points at which there were changes in the trend.Results: The state of Santa Catarina showed an increase of 11.9% (95% CI 0.9, 24.2) per year in YLL rates. A significant increase was observed for men and within the 70 - 79 age group. There was a significant decrease of -9.4% (95% CI -16.1, -2.2) in the YLD rates per year. The decline was significant for women and within the 15-34 age group. Regarding the DALY rates, the state of Santa Catarina showed a decline of -6.6% (95% CI: -11.0, -2.0) per year. Significant decreases occurred for females and within the 15 - 29 and 45 - 59 age groups. However, there was a significant increase within the 70 - 79 age range.Conclusions: The state of Santa Catarina has reduced the disease burden rates attributed to disability from hepatitis B, but there has been an increase in the burden of premature mortality from 2005 to 2010.

Background: Hepatitis C virus (HCV) is an important human pathogen affecting an estimated 120 – 170 million individuals in the world. Toll-Like receptors (TLRs) are pattern-recognition receptors that recognize pathogen-associated molecular patterns, and stimulate immune responses.Objectives: The aim of this study was to determine the mRNA expression level of TLR2 and TLR7 in HCV-infected patients in comparison with normal controls.Patients and Methods: Nineteen consecutive patients with HCV infection and nineteen sex and age-matched healthy controls were studied in a case-controlled research.Results: Our results showed that the expressions of TLR7 in HCV infected samples were significantly increased in comparison those of the controls (P = 0.02), while the expression of TLR2 was similar between the case and the control group (P = 0.8). There were no associations between the expression levels of TLR2 and TLR7 with HCV viral load and HCV genotypes. Also, there was no association between viral load and genotypes of the virus.Conclusions: Our findings showed that HCV infection could lead to increased expression level of TLR7 mRNA in peripheral blood cells of HCV infected samples. The viral load and genotypes of HCV did not affect the mRNA expression levels of TLR2 and TLR7.

Hepatitis C Virus Infection, a Global ConcernHepatitis C Virus (HCV), as the only member of genus Hepacivirus within the family of Flaviviridae, is the major worldwide health concern. Diagnosis of HCV infection is based on finding antibodies against the virus (HCV-antibodies) or HCV-RNA in the serum. It is known that some of the recently infected patients can recover from the acute infection.

Context: The objective of the current study was to evaluate the association between the I148M variant of patatin-like phospholipase domain-containing protein 3 (PNPLA3) and the presence of Chronic Hepatitis C (CHC) across different populations.Evidence Acquisition: This study was a meta-analysis of all relevant researches published in the literature from year 2000 to 2015. The odds ratios (ORs) of PNPLA3 allele distributions in CHC patients were analyzed and compared with healthy controls. The meta-analysis Revman 5.2 software was applied for investigating heterogeneity among individual studies and for summarizing all the studies. The meta-analysis was carried out according to the Cochrane Reviewers’ Handbook recommendations. A total of 120 clinical trials or reports were retrieved, yet only five trials met the study selection criteria.Results: Five hospital-based case-control studies were included in the final analysis. The overall frequency of PNPLA3 gene polymorphisms was 20.4% (205.1005) in CHC and 10.23% (53.518) in controls. The summary odds ratio for the association of gene polymorphisms of PNPLA3 with the risk for CHC was determined as 2.20 (95% CI: 1.56 -3.11) and was statistically significant (P < 0.05).Conclusions: The current meta-analysis showed an association between frequency of G genotype of PNPLA3 and the risk of development of CHC in various populations throughout the world.

Dear EditorWe have read with great interest the article entitled “Telaprevir experience from Turkey” by Komur et al. recently.First of all, we have applauded the efforts of the authors and the editors of journal for putting forward this controversial and wondered topic for us. Currently, the hepatitis C treatment is in a very dynamic situation, due to newly introduced potent drugs. Therefore, the most popular guidelines (AASLD, EASL and APASL) have constantly updated the treatment recommendations, based on the new evidences from the effects and side-effects of these drugs. Thereby, every comment on novel potent drugs is very important for the clinicians, who have insufficient experience with them. We firstly want to discuss the content of the article and present to our experience that selected patients are more difficult to treat as a group, with different and strange side-effects.

Background: Although so far several studies have determined the hepatitis E virus (HEV) prevalence in some parts of Iran, no data exists regarding the HEV seroprevalence in Bushehr province as the southernmost point in Iran yet.Objectives: The aim of this study was to evaluate the seroprevalence of anti-HEV IgG among the blood donors in Bushehr.Patients and Methods: A total of 628 blood donor samples were collected from September to October 2013, after obtaining informed written consents, and analyzed for the presence of anti-HEV IgG using commercial HEV enzyme-linked immunosorbent assay (ELISA) kit. All the samples were tested by two ELISA kits and evaluated for liver function test.Results: Overall, 105 (16.7%) blood samples were positive for HEV-specific-IgG antibodies, while 523 (83.8%) were negative. The presence of anti-HEV IgG was not associated with gender; however, it was correlated with age. It was indicated that the anti-HEV prevalence increases by age and there was a significant difference between the age groups regarding HEV seropositivity.Conclusions: High HEV seroprevalence (16.7%) was observed among the blood donors in Bushehr province. It appears that exposure to HEV increases with age; although, more people should be examined.