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Razavi-Shearer D, Gamkrelidze I, Pan C, Jia J, Berg T, Gray R, Lim YS, Chen CJ, Ocama P, Desalegn H, Abbas Z, Abdallah A, Aghemo A, Ahmadbekova S, Ahn SH, Aho I, Akarca U, Al Masri N, Alalwan A, Alavian S, Al-Busafi S, Aleman S, Alfaleh F, Alghamdi A, Al-Hamoudi W, Aljumah A, Al-Naamani K, Al-Rifai A, Alserkal Y, Altraif I, Amarsanaa J, Anderson M, Andersson M, Armstrong P, Asselah T, Athanasakis K, Baatarkhuu O, Ben-Ari Z, Bensalem A, Bessone F, Biondi M, Bizri AR, Blach S, Braga W, Brandão-Mello C, Brosgart C, Brown K, Brown, Jr R, Bruggmann P, Brunetto M, Buti M, Cabezas J, Casanovas T, Chae C, Chan HLY, Cheinquer H, Chen PJ, Cheng KJ, Cheon ME, Chien CH, Choudhuri G, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Coffin C, Contreras F, Coppola N, Cornberg M, Cowie B, Cramp M, Craxi A, Crespo J, Cui F, Cunningham C, Dalgard O, De Knegt R, De Ledinghen V, Dore G, Drazilova S, Duberg AS, Egeonu S, Elbadri M, El-Kassas M, El-Sayed M, Estes C, Etzion O, Farag E, Ferradini L, Ferreira P, Flisiak R, Forns X, Frankova S, Fung J, Gane E, Garcia V, García-Samaniego J, Gemilyan M, Genov J, Gheorghe L, Gholam P, Gish R, Goleij P, Gottfredsson M, Grebely J, Gschwantler M, Guingane NA, Hajarizadeh B, Hamid S, Hamoudi W, Harris A, Hasan I, Hatzakis A, Hellard M, Hercun J, Hernandez J, Hockicková I, Hsu YC, Hu CC, Husa P, Janicko M, Janjua N, Jarcuska P, Jaroszewicz J, Jelev D, Jeruma A, Johannessen A, Kåberg M, Kaita K, Kaliaskarova K, Kao JH, Kelly-Hanku A, Khamis F, Khan A, Kheir O, Khoudri I, Kondili L, Konysbekova A, Kristian P, Kwon J, Lagging M, Laleman W, Lampertico P, Lavanchy D, Lázaro P, Lazarus JV, Lee A, Lee MH, Liakina V, Lukšić B, Malekzadeh R, Malu A, Marinho R, Mendes-Correa MC, Merat S, Meshesha BR, Midgard H, Mohamed R, Mokhbat J, Mooneyhan E, Moreno C, Mortgat L, Müllhaupt B, Musabaev E, Muyldermans G, Naveira M, Negro F, Nersesov A, Nguyen VTT, Ning Q, Njouom R, Ntagirabiri R, Nurmatov Z, Oguche S, Omuemu C, Ong J, Opare-Sem O, Örmeci N, Orrego M, Osiowy C, Papatheodoridis G, Peck-Radosavljevic M, Pessoa M, Pham T, Phillips R, Pimenov N, Pincay-Rodríguez L, Plaseska-Karanfilska D, Pop C, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Rautiainen H, Razavi-Shearer K, Remak W, Ribeiro S, Ridruejo E, Ríos-Hincapié C, Robalino M, Roberts L, Roberts S, Rodríguez M, Roulot D, Rwegasha J, Ryder S, Sadirova S, Saeed U, Safadi R, Sagalova O, Said S, Salupere R, Sanai F, Sanchez-Avila JF, Saraswat V, Sargsyants N, Sarrazin C, Sarybayeva G, Schréter I, Seguin-Devaux C, Seto WK, Shah S, Sharara A, Sheikh M, Shouval D, Sievert W, Simojoki K, Simonova M, Sinn DH, Sonderup M, Sonneveld M, Spearman CW, Sperl J, Stauber R, Stedman C, Sypsa V, Tacke F, Tan SS, Tanaka J, Tergast T, Terrault N, Thompson A, Thompson P, Tolmane I, Tomasiewicz K, Tsang TY, Uzochukwu B, Van Welzen B, Vanwolleghem T, Vince A, Voeller A, Waheed Y, Waked I, Wallace J, Wang C, Weis N, Wong G, Wong V, Wu JC, Yaghi C, Yesmembetov K, Yip T, Yosry A, Yu ML, Yuen MF, Yurdaydin C, Zeuzem S, Zuckerman E, Razavi H. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol 2023; 8:879-907. [PMID: 37517414 DOI: 10.1016/s2468-1253(23)00197-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] [Imported: 09/20/2023]
Abstract
BACKGROUND The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. METHODS In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dynamic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. FINDINGS We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3·2% (95% uncertainty interval 2·7-4·0), corresponding to 257·5 million (216·6-316·4) individuals positive for HBsAg. Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0·7% (0·6-1·0), corresponding to 5·6 million (4·5-7·8) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission. INTERPRETATION As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals. FUNDING John C Martin Foundation, Gilead Sciences, and EndHep2030.
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Abbas Z, Abbas M. An Insight Into the Factors Affecting the Prevalence and Natural History of Hepatitis D. Cureus 2023; 15:e43362. [PMID: 37593072 PMCID: PMC10427805 DOI: 10.7759/cureus.43362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/19/2023] [Imported: 08/30/2023] Open
Abstract
Epidemiological studies and recent metanalyses addressing hepatitis D have reported a wide variation in the prevalence of the disease. Between 4.5% to 15% of all hepatitis B surface antigen (HBsAg) positive patients are thought to harbor the hepatitis D virus. The emergent variation in prevalence can be attributed to several factors. Unsurprisingly, published literature shows that the prevalence of the disease is higher in areas where aggregate viral hepatitis infections are endemic and amongst groups with high-risk practices facilitating the horizontal transfer. Meanwhile, the natural history of the disease is influenced by the genotype of the virus, the hepatitis D virus (HDV) RNA levels, HBV-HDV codominance, HBsAg titers, HBV genotype, nutritional status, HIV co-infection, and prior treatment. Together these factors contribute to the accelerated development of fibrosis and the increased risk of hepatocellular carcinoma. Superinfection with genotype 1 results in rapid progression to cirrhosis with lower rates of remission. Genotype 3 follows an aggressive course but shows a good response to interferon therapy. Other genotypes have better outcomes. The course of the disease leading to these outcomes can be tracked by HDV-specific models integrating clinical surrogate markers and epidemiological factors such as age, region, alanine aminotransferase (ALT), gamma-glutamyl transferase, albumin, platelets and cholinesterase, and liver stiffness.
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Tahiri M, Goh KL, Abbas Z, Epstein D, Min-Hu C, Mulder CJJ, Puri AS, Schultz M, LeMair A, Melberg J. Digestive Tract Tuberculosis Guideline. J Clin Gastroenterol 2023; 57:643-650. [PMID: 37428083 DOI: 10.1097/mcg.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/21/2022] [Indexed: 07/11/2023] [Imported: 09/02/2023]
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Altaf A, Abbas Z, Qadeer MA, Siyal M. Point of Care Testing for SARS-COV-2 Antibodies before doing Endoscopy. Pak J Med Sci 2023; 39:367-370. [PMID: 36950411 PMCID: PMC10025744 DOI: 10.12669/pjms.39.2.5659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/03/2022] [Accepted: 10/06/2022] [Indexed: 01/29/2023] [Imported: 09/02/2023] Open
Abstract
Objectives COVID-19 has taken the world by storm, creating much disparity among both healthcare and non-healthcare centres regarding the provision of services. The purpose of our study was to see the prevalence of the SARS-COV-2 exposure in the asymptomatic patients undergoing the endoscopic procedure, already triaged based on history and examination. Methods Total 207 patients were enrolled during a time period of five months during October 2020 to April 2021 at Dr. Ziauddin Hospital Clifton campus, Karachi. In this prospective observational study patients undergoing endoscopic procedures were included after taking informed consent. The patients who already tested positive for COVID-19 by PCR were excluded. Patients were tested for Covid serology by immunochromatographic rapid serology test (ICT). Standard Operating Procedures for dealing with endoscopy patients during the COVID era were followed in all patients irrespective of antibody status. Result Total number of patients included was 207; males were 121 (58.5%). The mean age was 48.5 ± 17.55 (range 13 to 92). Forty eight patients (23.2%) were positive for either antibody suggesting exposure to the COVID-19 virus. Out of these combined IgM and IgG positivity was seen in 24 (11.5%), IgM mono antibody positivity was seen in 7 (3.38%) and 17 (8.21%) of the study population tested positive for IgG only. 15 out of 46 (32.6%) patients with chronic liver disease in the cohort were seropositive for COVID antibodies. Conclusion About one-fourth of the patients undergoing the endoscopic procedure were tested positive for COVID antibodies of which a significant percentage had chronic liver disease. It stresses the need of observing standard precautions to prevent the spread of infection during these procedures, especially in the vulnerable population.
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Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome. Eur J Gastroenterol Hepatol 2023; 35:59-63. [PMID: 36468570 DOI: 10.1097/meg.0000000000002475] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 09/02/2023]
Abstract
OBJECTIVE Postinfectious irritable bowel syndrome (IBS) is a known entity. We evaluated the incidence of post-COVID-19 IBS in patients discharged from the hospital and analyzed its correlation with the clinical and laboratory parameters, and treatment during the hospital stay. METHODS Three hundred three COVID-19 hospitalized patients without prior history of IBS were prospectively followed after their discharge and were evaluated as per Rome-IV criteria for IBS. RESULTS One hundred seventy-eight patients were males (58.7%). The age range was 17-95 years (mean ± SD, 55.9 ± 15.8). A total of 194 (64%) had mild COVID-19, 74 (24.4%) had moderate COVID-19, whereas 35 (11.6%) had severe COVID-19 infection. Sixteen (5.3%) patients had concomitant GI symptoms during COVID-19 infection. IBS symptoms were found to be present in 32 (10.6%) patients, out of which 17 (53.13%) had diarrhea-predominant, 10 (31.25%) had constipation-predominant, and five (15.62%) had mixed-type IBS. Post-COVID-19 IBS was more common in the female sex (P < 0.001), concomitant GI symptoms with COVID-19 (P < 0.001), oxygen requirement (P = 0.015), deranged liver function tests at the time of admission (P = 0.002), high procalcitonin (P = 0.013), high C-reactive protein levels (P = 0.035); whereas negative correlation was found with remdesivir treatment (P = 0.047). After performing regression analysis, female sex (P < 0.001), oxygen requirement during hospital stay (P = 0.016), GI symptoms during COVID-19 infection (P < 0.001), and high procalcitonin levels (P = 0.017) were independently associated with post-COVID-19 IBS. CONCLUSION GI symptoms during active COVID-19 infection increase the chances of developing post-COVID-19 IBS. The risk of developing post-COVID-19 IBS increases in female patients, those requiring oxygen and having high procalcitonin levels during COVID-19 infection.
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Acute variceal bleeding portends poor outcomes in patients with acute-on-chronic liver failure: a propensity score matched study from the APASL ACLF Research Consortium (AARC). Hepatol Int 2022; 16:1234-1243. [PMID: 35851437 DOI: 10.1007/s12072-022-10372-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/28/2022] [Indexed: 11/04/2022] [Imported: 09/02/2023]
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Nayar M, Varghese C, Kanwar A, Siriwardena AK, Haque AR, Awan A, Balakrishnan A, Rawashdeh A, Ivanov B, Parmar C, Halloran CM, Caruana C, Borg CM, Gomez D, Damaskos D, Karavias D, Finch G, Ebied H, Pine JK, Skipworth JRA, Milburn J, Latif J, Apollos J, El Kafsi J, Windsor JA, Roberts K, Wang K, Ravi K, Coats MV, Hollyman M, Phillips M, Okocha M, Wilson MS, Ameer NA, Kumar N, Shah N, Lapolla P, Magee C, Al-Sarireh B, Lunevicius R, Benhmida R, Singhal R, Balachandra S, Demirli Atıcı S, Jaunoo S, Dwerryhouse S, Boyce T, Charalampakis V, Kanakala V, Abbas Z, Tewari N, Pandanaboyana S. SARS-CoV-2 infection is associated with an increased risk of idiopathic acute pancreatitis but not pancreatic exocrine insufficiency or diabetes: long-term results of the COVIDPAN study. Gut 2022; 71:1444-1447. [PMID: 34764192 DOI: 10.1136/gutjnl-2021-326218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] [Imported: 09/02/2023]
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Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol 2022; 7:396-415. [PMID: 35180382 DOI: 10.1016/s2468-1253(21)00472-6] [Citation(s) in RCA: 211] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 02/07/2023] [Imported: 09/02/2023]
Abstract
BACKGROUND Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends. METHODS This analysis includes a literature review, Delphi process, and mathematical modelling to estimate HCV prevalence (viraemic infection, defined as HCV RNA-positive cases) and the cascade of care among people of all ages (age ≥0 years from birth) for the period between Jan 1, 2015, and Dec 31, 2030. Epidemiological data were collected from published sources and grey literature (including government reports and personal communications) and were validated among country and territory experts. A Markov model was used to forecast disease burden and cascade of care from 1950 to 2050 for countries and territories with data. Model outcomes were extracted from 2015 to 2030 to calculate population-weighted regional averages, which were used for countries or territories without data. Regional and global estimates of HCV prevalence, cascade of care, and disease burden were calculated based on 235 countries and territories. FINDINGS Models were built for 110 countries or territories: 83 were approved by local experts and 27 were based on published data alone. Using data from these models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global prevalence of viraemic HCV infection of 0·7% (95% UI 0·7-0·9), corresponding to 56·8 million (95% UI 55·2-67·8) infections, on Jan 1, 2020. This number represents a decrease of 6·8 million viraemic infections from a 2015 (beginning of year) prevalence estimate of 63·6 million (61·8-75·8) infections (0·9% [0·8-1·0] prevalence). By the end of 2020, an estimated 12·9 million (12·5-15·4) people were living with a diagnosed viraemic infection. In 2020, an estimated 641 000 (623 000-765 000) patients initiated treatment. INTERPRETATION At the beginning of 2020, there were an estimated 56·8 million viraemic HCV infections globally. Although this number represents a decrease from 2015, our forecasts suggest we are not currently on track to achieve global elimination targets by 2030. As countries recover from COVID-19, these findings can help refocus efforts aimed at HCV elimination. FUNDING John C Martin Foundation, Gilead Sciences, AbbVie, ZeShan Foundation, and The Hepatitis Fund.
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Abeer Altaf, Zaigham Abbas, Bushra Shahid, Muhammad Ali Qadeer, Shoukat Ali Samejo, Siyal M. Patients visiting gastroenterology clinics avoid giving honest history for COVID-19 related symptoms in the pre-clinic triage. J PAK MED ASSOC 2022; 72:1572-1576. [PMID: 36280921 DOI: 10.47391/jpma.4362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] [Imported: 09/02/2023]
Abstract
Objective: To assess the discrepancy in terms of history related to coronavirus disease-2019 and symptoms given in the pre-clinic triage and to the doctor attending the patient in a gastroenterology clinic.
Method: The observational study was conducted from September 2020 to January 2021 at the Gastroenterology outpatient department of Dr Ziauddin Hospital’s Clifton unit in Karachi, and comprised all patients visiting the facility regardless of age and gender. Data was collected using a questionnaire that was first filled up by the receptionist outside the clinic and was then administered again once the patient entered the clinic. Discrepancy on the answers was then checked and associations were determined with clinical assessment. Data was analysed using SPSS 20.
Results: Of the 300 patients, 184(61.3%) were males and 116(38.6%) were females. The overall mean age was 55 ± 16.98 (range: 18-92 years). Discrepancy between pre-clinic and in-clinic self-reported data was significant for fever, cough, fatigue, headache, body ache, diarrhoea, sore throat, loss of sense of smell/taste, shortness of breath, and contact with someone positive for coronavirus disease-2019 was significant (p<0.05).
Conclusion: Patients were found to be afraid of getting barred from seeing a consultant, had fear of hospital-based isolation or were in denial regarding the pandemic.
Key Words: COVID-19, Triage, Questionnaire, Screening, Symptoms.
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Kumar M, Abbas Z, Azami M, Belopolskaya M, Dokmeci AK, Ghazinyan H, Jia J, Jindal A, Lee HC, Lei W, Lim SG, Liu CJ, Li Q, Al Mahtab M, Muljono DH, Niriella MA, Omata M, Payawal DA, Sarin SK, Ségéral O, Tanwandee T, Trehanpati N, Visvanathan K, Yang JM, Yuen MF, Zheng Y, Zhou YH. Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy. Hepatol Int 2022; 16:211-253. [PMID: 35113359 DOI: 10.1007/s12072-021-10285-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022] [Imported: 09/02/2023]
Abstract
Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers.
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Abbas Z, Asim M, Saeed A, Siddiqui B, Abbas M. The Spectrum of Autoimmune Liver Disorders, Clinical Presentation, and Autoantibodies in Patients From a Tertiary Care Center in Pakistan. Cureus 2021; 13:e19789. [PMID: 34820249 PMCID: PMC8606176 DOI: 10.7759/cureus.19789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 01/10/2023] [Imported: 08/30/2023] Open
Abstract
Background The autoimmune illnesses that affect the liver include autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and overlap syndrome. In our patients, we aimed to address the complete spectrum of autoimmune liver disorders, clinical presentation, and autoantibodies. Methods The study included all the patients diagnosed with autoimmune liver disorder irrespective of age, gender, and ethnic background presented at the liver clinic of the hospital in the last two years. The diagnosis was based on characteristic clinical and laboratory findings, the presence of one or more characteristic autoantibodies, and/or histological abnormalities. The diagnosis of AIH was further validated by revised International AIH Group criteria using a scoring calculator. The diagnostic criteria for PBC required the presence of chronic elevation of alkaline phosphatase (ALP) with positive antimitochondrial antibody (AMA) or positive PBC-specific anti-nuclear antibodies (ANA) (sp-100, gp-210) tests and/or compatible histology. The patients of AIH-PBC overlap syndrome fulfilled the criteria for AIH in the setting of PBC. Patients having liver involvement in other autoimmune disorders were included in the study. Results The total number of patients was 124; 83 (67%) were females; mean age ± standard error of mean (SEM) was 44.97 ± 1.47 years with a range of 09-84 years. Type-1 AIH was seen in 68 (54.8%) patients, type-2 AIH in 10 (8.1%) patients, PBC in 22 (17.7%) patients, overlap of PBC with AIH in 10 (8.1%) patients, IgG4 disease in four (3.2%) patients, psoriasis-specific immune hepatitis in four (3.2%) patients, celiac disease-related hepatitis in three (2.4%) patients, sarcoidosis in two (1.6%) patients, and ichthyosis-associated hepatitis in one (0.8%) patient. There was a high prevalence of cirrhosis (50%) at the time of presentation; 19% of patients had decompensated liver disease. ANA was positive in 52/68 cases of AIH type-1, but anti-smooth muscle antibody (ASMA) was reactive only in nine cases and anti-soluble liver antigen (SLA) in five cases. There was no female preponderance in type-2 AIH (M:F = 6:4). AMA was reactive in 25 (78%) cases of PBC and overlap syndrome. Antibodies prevalent in PBC (AMA-M2, AMA-M2-3E, sp-100, gp-210, anti-Ro52) were also seen in some cases of AIH, though they did not fulfill the criteria of the overlap syndrome. Conclusion There is an unmet need for the early diagnosis of autoimmune liver diseases and the initiation of appropriate management to prevent complications.
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Thanapirom K, Teerasarntipan T, Treeprasertsuk S, Choudhury A, Sahu MK, Maiwall R, Pamecha V, Moreau R, Al Mahtab M, Chawla YK, Devarbhavi H, Yu C, Ning Q, Amarapurkar D, Eapen CE, Hamid SS, Butt AS, Kim DJ, Lee GH, Sood A, Lesmana LA, Abbas Z, Shiha G, Payawal DA, Yuen MF, Chan A, Lau G, Jia J, Rahman S, Sharma BC, Yokosuka O, Sarin SK. Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure. Hepatol Int 2021; 16:171-182. [PMID: 34822057 PMCID: PMC8844167 DOI: 10.1007/s12072-021-10266-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/24/2021] [Indexed: 12/21/2022] [Imported: 09/02/2023]
Abstract
Background and aims Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database. Methods A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis. Results Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36–0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43–0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred. Conclusions The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were significantly higher than those with cirrhosis in alcoholic CLD. The presence of cirrhosis and its stage should be evaluated at baseline to guide for management. Thai Clinical Trials Registry, TCTR20191226002. Supplementary Information The online version contains supplementary material available at 10.1007/s12072-021-10266-8.
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Abbas Z, Ali SS, Shazi L. Interferon alpha versus any other drug for chronic hepatitis D. Hippokratia 2021. [DOI: 10.1002/14651858.cd011727.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] [Imported: 09/02/2023]
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Abbas Z, Saad M, Asim M, Abbas M, Samejo SA. The effect of twelve weeks of treatment with ezetimibe on HDV RNA level in patients with chronic hepatitis D. TURKISH JOURNAL OF GASTROENTEROLOGY 2021; 31:136-141. [PMID: 32141822 DOI: 10.5152/tjg.2020.18846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] [Imported: 08/30/2023]
Abstract
BACKGROUND/AIMS Sodium taurocholate co-transporting polypeptide (NTCP) is the receptor for the hepatitis B virus (HBV) and hepatitis D virus (HDV) entry into hepatocytes. Ezetimibe is a cholesterol-lowering drug that possesses the pharmacophore features to inhibit NTCP. This study evaluates the efficacy of ezetimibe in patients with chronic HDV infection in a nonrandomized trial. MATERIALS AND METHODS This proof of concept phase 2 trial evaluated the efficacy and safety of ezetimibe 10 mg daily in (interferon treatment-experienced or interferon ineligible) patients with chronic hepatitis D (CHD). Forty-four patients with CHD were recruited, 38 male and 6 female patients, mean age 35.2±8.7 (range 19-64). Fifteen (34%) patients were on concomitant nucleoside therapy, and cirrhosis was present in 14 subjects. The primary therapeutic endpoint was a decline in HDV RNA at one log or more from the baseline at week 12. RESULTS The mean HDV RNA level was 5.4±1.3 log10 IU/mL. HBeAg was non-reactive in 43 (98%). HBV DNA was undetectable in 28 (64%). One patient stopped treatment at week 4, and one patient did not follow-up. One log or more reduction in the HDV RNA levels was observed in 18/44 (41%) patients. No log reduction occurred in 16 patients, and 8 experienced a log increase. No adverse effects from the concomitant nucleoside analogue use or clinical cirrhosis were observed. The drug exhibited a positive safety profile. CONCLUSION Treatment of CHD patients with ezetimibe resulted in a one log reduction of viral load in 43% (18/42) of the patients who completed the 12 weeks of therapy.
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Choudhury A, Vijayaraghavan R, Maiwall R, Kumar M, Duan Z, Yu C, Hamid SS, Jafri W, Butt AS, Devarbhavi H, Ning Q, Ma K, Tan SS, Shukla A, Dhiman R, Duseja A, Taneja S, Eapen CE, Goel A, Treeprasertsuk S, Al-Mahtab M, Ghazinyan H, Kim DJ, Sahu MK, Lee GH, Lesmana LA, Lesmana RC, Shah S, Abbas Z, Sollano JD, Rao PN, Kulkarni A, Shiha G, Shrestha A, Dokmeci AK, Yuen MF, Payawal DA, Kalista KF, Prasad VGM, Lau GK, Karim F, Jain P, Kumar G, Arora V, Pamecha V, Sinha P, Sarin SK. 'First week' is the crucial period for deciding living donor liver transplantation in patients with acute-on-chronic liver failure. Hepatol Int 2021; 15:1376-1388. [PMID: 34608586 DOI: 10.1007/s12072-021-10206-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/30/2021] [Indexed: 12/13/2022] [Imported: 09/02/2023]
Abstract
BACKGROUND AND AIMS Acute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT). METHODS Altogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant. RESULTS The ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p < 0.01) contributing to 23% of the first week and 55% of all-cause 28-day mortality. In a matched cohort analysis, the actuarial survival with LT (n = 41) and conditional survival in the absence of transplant (n = 191) were comparable, when the condition, i.e., transplant was adjusted. The comparison curve showed differentiation in survival beyond 7 days (p < 0.01). CONCLUSIONS ACLF is a rapidly progressive disease and risk stratification within the first week of hospitalization is needed. 'Emergent LT' should be defined in the first week in the ACLF patients; the transplant window for improving survival in a live donor setting.
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Qadeer MA, Abbas Z. A surgical mask worn by the patient in addition to the barrier box reduces the droplet spray during endoscopy. J PAK MED ASSOC 2021; 71:1703. [PMID: 34111105 DOI: 10.47391/jpma.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] [Imported: 09/02/2023]
Abstract
Recent guidelines for the prevention of COVID-19 advocate that all the elective procedures should be postponed as these produce aerosols that may affect the staff engaged. Sagami R et al and Neven L et al published the use of a barrier box to prevent the spread of droplets.1, 2 We have done some modifications to this technique.
Our endoscopic shield is made of three plastic square walls with a height and width of 50 cm and a length of 40 cm. The wall facing the patient has a hole of 10cm for insertion of the scope. The foot and head sides of the cube are left open. The opening in the head side helps the assistant to keep the patient in proper position, along with the mouth-piece and nasal prong. One may argue that it would lead to the spread of droplets but the previous study has shown that the droplets fall more on the wall facing the patient’s mouth, hence placing the surgical mask over the patient’s face further reduces the head-ward spread of droplets.3 This also helps to facilitate the to and fro movement of the box so that the intubation hole moves away and the intact part of the front wall faces the mouth.
A surgical mask with a small hole is placed in a way that the hole is aligned with the mouthpiece hole. The shield is placed over the patient’s head. The scope is passed through the endoscopic port made in the wall of the shield facing the patient and endoscopy is performed.
This technique has a few advantages. First, it gives free access to the assistant during the procedure. Second, putting the face mask further reduces the risk of the spread of droplets. Third, an appropriate window for endoscope insertion allows the operator to work at ease, especially during challenging procedures.
Continuous....
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Verma N, Dhiman RK, Singh V, Duseja A, Taneja S, Choudhury A, Sharma MK, Eapen CE, Devarbhavi H, Al Mahtab M, Shukla A, Hamid SS, Jafri W, Butt AS, Ning Q, Chen T, Tan SS, Lesmana LA, Lesmana CRA, Sahu MK, Hu J, Lee GH, Sood A, Midha V, Goyal O, Ghazinian H, Kim DJ, Treeprasertsuk S, Mohan Prasad VG, Dokmeci AK, Sollano JD, Shah S, Payawal DA, Rao PN, Kulkarni A, Lau GK, Duan Z, Chen Y, Yokosuka O, Abbas Z, Karim F, Chowdhury D, Prasad AS, Sarin SK. Comparative accuracy of prognostic models for short-term mortality in acute-on-chronic liver failure patients: CAP-ACLF. Hepatol Int 2021; 15:753-765. [PMID: 34173167 DOI: 10.1007/s12072-021-10175-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/08/2021] [Indexed: 02/07/2023] [Imported: 09/02/2023]
Abstract
BACKGROUND Multiple predictive models of mortality exist for acute-on-chronic liver failure (ACLF) patients that often create confusion during decision-making. We studied the natural history and evaluated the performance of prognostic models in ACLF patients. METHODS Prospectively collected data of ACLF patients from APASL-ACLF Research Consortium (AARC) was analyzed for 30-day outcomes. The models evaluated at days 0, 4, and 7 of presentation for 30-day mortality were: AARC (model and score), CLIF-C (ACLF score, and OF score), NACSELD-ACLF (model and binary), SOFA, APACHE-II, MELD, MELD-Lactate, and CTP. Evaluation parameters were discrimination (c-indices), calibration [accuracy, sensitivity, specificity, and positive/negative predictive values (PPV/NPV)], Akaike/Bayesian Information Criteria (AIC/BIC), Nagelkerke-R2, relative prediction errors, and odds ratios. RESULTS Thirty-day survival of the cohort (n = 2864) was 64.9% and was lowest for final-AARC-grade-III (32.8%) ACLF. Performance parameters of all models were best at day 7 than at day 4 or day 0 (p < 0.05 for C-indices of all models except NACSELD-ACLF). On comparison, day-7 AARC model had the numerically highest c-index 0.872, best accuracy 84.0%, PPV 87.8%, R2 0.609 and lower prediction errors by 10-50%. Day-7 NACSELD-ACLF-binary was the simple model (minimum AIC/BIC 12/17) with the highest odds (8.859) and sensitivity (100%) but with a lower PPV (70%) for mortality. Patients with day-7 AARC score > 12 had the lowest 30-day survival (5.7%). CONCLUSIONS APASL-ACLF is often a progressive disease, and models assessed up to day 7 of presentation reliably predict 30-day mortality. Day-7 AARC model is a statistically robust tool for classifying risk of death and accurately predicting 30-day outcomes with relatively lower prediction errors. Day-7 AARC score > 12 may be used as a futility criterion in APASL-ACLF patients.
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Siddiqui B, Kamran M, Tikmani SS, Azmat R, Mushtaq Z, Zafar SB, Khan MT, Yakoob J, Abbas Z. Frequency and risk factors of non-alcoholic fatty liver disease in Helicobacter pylori-infected dyspeptic patients: A cross-sectional study. SAGE Open Med 2021; 9:20503121211025421. [PMID: 34211711 PMCID: PMC8216349 DOI: 10.1177/20503121211025421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/27/2021] [Indexed: 11/15/2022] [Imported: 09/02/2023] Open
Abstract
Background In dyspeptic patients with Helicobacter pylori contributes to non-alcoholic fatty liver disease. However, little evidence available from Pakistan. Objective The study aims to determine the frequency and risk factors of non-alcoholic fatty liver disease in dyspeptic patients with Helicobacter pylori. Methods This cross-sectional study was conducted between 22 November 2016 and 30 June 2018. Adults of age between 18 and 90 years who attended the out-patient department due to abdominal discomfort, pain, fullness, and bloating who underwent upper gastrointestinal tract endoscopy were enrolled after taking informed consent. Patients with celiac disease, inflammatory bowel disease, taking alcohol, pregnant women and lactating mothers, known cases of hepatitis B and C, and history of recent antibiotic use were excluded. Data on age, gender, smoking, alcohol use, dyslipidemia, hypertension, type 2 diabetes mellitus, and ischemic heart disease were collected. Non-alcoholic fatty liver disease was diagnosed through ultrasonography. Helicobacter pylori infection was detected using a carbon urea breath test. Results A total of 698 patients were screened for eligibility, and 399 (57.2%) had Helicobacter pylori infection and were enrolled in the study after consent. The median age was 50.1 (interquartile range = 14.5) years and 209 (52.4%) were males. Frequency of non-alcoholic fatty liver disease in patients with Helicobacter pylori dyspeptic patients was 153 (38.3%). Factors associated with non-alcoholic fatty liver disease in the presence of Helicobacter pylori were dyslipidemia 7.38 (95% confidence interval = 2.4-22.71), type 2 diabetes mellitus 5.96 (95% confidence interval = 1.86-19.07), hypertension 3.0 (95% confidence interval = 1.21-7.45), and moderate gastritis 2.81 (95% confidence interval = 1.2-6.59). Conclusion The frequency of non-alcoholic fatty liver disease in Helicobacter Pylori dyspeptic patients was 38.3%. Male gender, dyslipidemia, hypertension, ischemic heart disease, and moderate gastritis were associated with non-alcoholic fatty liver disease.
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Shukla A, Shreshtha A, Mukund A, Bihari C, Eapen CE, Han G, Deshmukh H, Cua IHY, Lesmana CRA, Al Meshtab M, Kage M, Chaiteeraki R, Treeprasertsuk S, Giri S, Punamiya S, Paradis V, Qi X, Sugawara Y, Abbas Z, Sarin SK. Budd-Chiari syndrome: consensus guidance of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2021; 15:531-567. [PMID: 34240318 DOI: 10.1007/s12072-021-10189-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/11/2021] [Indexed: 02/07/2023] [Imported: 09/02/2023]
Abstract
Budd Chiari syndrome (BCS) is a diverse disease with regard to the site of obstruction, the predisposing thrombophilic disorders and clinical presentation across the Asia-Pacific region. The hepatic vein ostial stenosis and short segment thrombosis are common in some parts of Asia-Pacific region, while membranous obstruction of the vena cava is common in some and complete thrombosis of hepatic veins in others. Prevalence of myeloproliferative neoplasms and other thrombophilic disorders in BCS varies from region to region and with different sites of obstruction. This heterogeneity also raises several issues and dilemmas in evaluation and approach to management of a patient with BCS. The opportunity to recanalize hepatic vein in patients with hepatic vein ostial stenosis or inferior vena cava stenting or pasty among those membranous obstruction of the vena cava is a unique opportunity in the Asia-Pacific region to restore hepatic outflow closely mimicking physiology. In order to address these issues arising out of the diversity as well as the unique features in the region, the Asia Pacific Association for Study of Liver has formulated these guidelines for clinicians.
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Pandanaboyana S, Moir J, Leeds JS, Oppong K, Kanwar A, Marzouk A, Belgaumkar A, Gupta A, Siriwardena AK, Haque AR, Awan A, Balakrishnan A, Rawashdeh A, Ivanov B, Parmar C, M Halloran C, Caruana C, Borg CM, Gomez D, Damaskos D, Karavias D, Finch G, Ebied H, K Pine J, R A Skipworth J, Milburn J, Latif J, Ratnam Apollos J, El Kafsi J, Windsor JA, Roberts K, Wang K, Ravi K, V Coats M, Hollyman M, Phillips M, Okocha M, Sj Wilson M, A Ameer N, Kumar N, Shah N, Lapolla P, Magee C, Al-Sarireh B, Lunevicius R, Benhmida R, Singhal R, Balachandra S, Demirli Atıcı S, Jaunoo S, Dwerryhouse S, Boyce T, Charalampakis V, Kanakala V, Abbas Z, Nayar M. SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study. Gut 2021; 70:1061-1069. [PMID: 33547182 PMCID: PMC7871229 DOI: 10.1136/gutjnl-2020-323364] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023] [Imported: 09/02/2023]
Abstract
OBJECTIVE There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection. DESIGN A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups. RESULTS 1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection. CONCLUSION Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.
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Abbas Z, Abbas M. Challenges in Formulation and Implementation of Hepatitis B Elimination Programs. Cureus 2021; 13:e14657. [PMID: 33907651 PMCID: PMC8065944 DOI: 10.7759/cureus.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] [Imported: 08/30/2023] Open
Abstract
Nearly 257 million individuals have contracted hepatitis B infection around the world. However, only 10% of them know about their illness. Mother to child transmission, nosocomial spread, and sexual transmission are the major etiological factors. Finding the missing millions is a global issue. Hepatitis B care is more difficult compared to hepatitis C as not all patients require treatment and the selection of patients is not straightforward. To eliminate hepatitis B infection, the program should screen pregnant women and start antiviral therapy from the 28th week of pregnancy if hepatitis B virus (HBV) DNA≥ 200,000 IU/mL or hepatitis B e-antigen (HBeAg) reactive. Prevention of perinatal infection, birth dose and neonatal vaccination, post-vaccination monitoring of high-risk groups, catch-up vaccination, and registration of the carriers should be an integral part of the program. Continuum of care is important when planning the elimination program from addressing the risk factors, testing, and referral for treatment. The program should integrate test and treat hepatitis services with existing local health care services. There is a need to create the right environment, raise awareness, remove stigma, and increase screening of those at risk and manage those who require treatment. A national policy should be prepared for capacity building, fund allocation, and implementation strategies. Micro-elimination strategies should boost national elimination effects. Guidelines to diagnose and treat patients with hepatitis B should be simplified. Surveillance should be done to monitor progress, and determine the impact of the elimination program on incidence and mortality, and services.
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Hasan MK, Yousaf MS, Tehami N, Ala K, Arain UA, Ahmad S, Kadir S, Abbas Z, Niaz SK. Optimal stent placement strategy for malignant hilar biliary obstruction: a management dilemma. Gastrointest Endosc 2021; 93:532-533. [PMID: 33478669 DOI: 10.1016/j.gie.2020.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022] [Imported: 09/02/2023]
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Abbas Z, Zaheer R. Non-alcoholic fatty liver disease: A real threat in Pakistan. J PAK MED ASSOC 2021; 70:2437-2440. [PMID: 33475559 DOI: 10.5455/jpma.95891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] [Imported: 08/30/2023]
Abstract
The rise in obesity, along with its association with unhealthy lifestyles and poor health awareness, has lead to an increasing prevalence of non-alcoholic fatty liver disease (NAFLD). Only a few studies have addressed the changing trends in obesity and have tried to estimate the frequency of NAFLD in Pakistan. Fatty liver is seen in about 15% of the general population. Insulin resistance, diabetes, dyslipidaemia, high body mass index (BMI) and waist circumference, and increasing age are associated with NAFLD. In patients without insulin resistance, dyslipidaemia is usually present. Lean NAFLD is not common. In facilities where elastography in unavailable, NAFLD fibrosis score may be used to predict NAFLD in such patients. There is a need to conduct population-based studies to understand the risks and to design initiatives to increase public awareness regarding this disease. NAFLD screening is advisable in overweight individuals, diabetic patients, and persons at high cardiovascular disease risk.
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The case for simplifying and using absolute targets for viral hepatitis elimination goals. J Viral Hepat 2021; 28:12-19. [PMID: 32979881 DOI: 10.1111/jvh.13412] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] [Imported: 09/02/2023]
Abstract
The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries' progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.
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Duseja A, De A, Taneja S, Choudhury AK, Devarbhavi H, Hu J, Hamid SS, Butt AS, Jafri SMW, Ghazinian H, Chawla YK, Dhiman RK, Duan Z, Chen Y, Tan SS, Lee GH, Lim SG, Kim DJ, Sahu M, Sollano JD, Carpio G, Mohan Prasad VG, Abbas Z, Lesmana LA, Lesmana CR, Eapen CE, Goel A, Sood A, Midha V, Goyal O, Dokmeci AK, Ning Q, Chen T, Ma K, Payawal DA, Lau GKK, Al Mahtab M, Rahman S, Alam MS, Shukla A, Shrestha A, Shah S, Kalal CR, Kumar G, Jain P, Paulson I, Sarin SK. Impact of metabolic risk factors on the severity and outcome of patients with alcohol-associated acute-on-chronic liver failure. Liver Int 2021; 41:150-157. [PMID: 32970356 DOI: 10.1111/liv.14671] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] [Imported: 09/02/2023]
Abstract
BACKGROUND Metabolic risk factors may impact the severity and outcome of alcoholic liver disease. The present study evaluated this effect in patients with alcohol-associated acute-on-chronic liver failure (ACLF). METHODOLOGY One thousand two hundred and sixteen prospectively enrolled patients with ACLF (males 98%, mean age 42.5 ± 9.4 years, mean CTP, MELD and AARC scores of 12 ± 1.4, 29.7 ± 7 and 9.8 ± 2 respectively) from the Asian Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) database were analysed retrospectively. Patients with or without metabolic risk factors were compared for severity (CTP, MELD, AARC scores) and day 30 and 90 mortality. Information on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia were available in 1028 (85%), 1019 (84%), 1017 (84%) and 965 (79%) patients respectively. RESULTS Overall, 392 (32%) patients died at day 30 and 528 (43%) at day 90. Overweight/obesity, T2DM, hypertension and dyslipidaemia were present in 154 (15%), 142 (14%), 66 (7%) and 141 (15%) patients, respectively, with no risk factors in 809 (67%) patients. Patients with overweight/obesity had higher MELD scores (30.6 ± 7.1 vs 29.2 ± 6.9, P = .007) and those with dyslipidaemia had higher AARC scores (10.4 ± 1.2 vs 9.8 ± 2, P = .014). Overweight/obesity was associated with increased day 30 mortality (HR 1.54, 95% CI 1.06-2.24, P = .023). None of other metabolic risk factors, alone or in combination, had any impact on disease severity or mortality. On multivariate analysis, overweight or obesity was significantly associated with 30-day mortality (aHR 1.91, 95% CI 1.41-2.59, P < .001), independent of age, CTP, MELD and AARC scores. CONCLUSION Overweight/obesity and dyslipidaemia increase the severity of alcohol-associated ACLF, and the former also increases the short-term mortality in these patients.
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