Use of hepatocyte transplantation after extensive liver resections in experiment

he aim of our research is to prove, that the transplanted hepatocytes can survive and compensate for inadequate liver function in experimental animals. Thesis discusses the basic principles of hepatocyte transplantations, the process of their adaptation and effect on the organism as well as possibilities of their further use as a promising treatment method.In the experiment we used hepatocytes isolated and produced from explanted livers of laboratory rats. Hepatocytes form the basis of liver tissue and are responsible for a number of metabolic processes ocurring in the liver, therefore is the possibility of their use as a cell therapy one of the alternative treatment methods for liver failure.Into the laboratory experiment, rats of the Sprague Dawleyspecies were placed, which we divided into five groups of equal numbers. Groups consisted of healthy rats, rats after 2/3 liver resection and rats with liver damage induced by intraperitoneal administration of thioacetamide.Two groups with impaired liver had hepatocytes prepared in advance transplanted into their portal vein.Hepatocyte function was assessed in the blood serum and compared with a control group of healthy animals and groups with liver damage without the application of hepatocytes at the same time intervals.Whole experiment lasted 21 days. On the last day of the experiment all the animals were killed by decapitation.Livers of all animals were explanted and sent for histopathological analysis which used classical histological methods. After evaluating the results we observed significant changes of evaluated laboratory levels in blood serum and weight in experimental animals after the transplantation of hepatocytes in comparison with the laboratory results of the control group of healthy animals and groups with liver damage without transplanted hepatocytes. The results of our experiment show that by biochemical and histological analysis we managed to clearly prove the function of transplanted hepatocytes in the model of laboratory rat with impaired liver function (Tab. 5, Fig. 17 , Ref. 17) Keywords: liver, transplantation, hepatocytes, liver tumors, resection of liver, liver failure, experiment.

Treatment response to ursodeoxycholic acid in primary biliary cholangitis: A systematic review and meta-analysis

BACKGROUND

Several ursodeoxycholic acid (UDCA) treatment response definitions have been introduced in primary biliary cholangitis (PBC). However, the lack of a gold standard results in heterogeneity in second-line treatment research and clinical practice.

AIMS

This study aimed to explore which UDCA treatment response endpoint serves as the most accurate predictive model of long-term outcome.

METHODS

A systematic review and meta-analysis of UDCA treatment response endpoints (and corresponding validations) were performed.

RESULTS

Sixteen individual UDCA treatment response endpoints and 96 external validations were found. Barcelona, Paris-1, Paris-2, Rotterdam, Toronto and GLOBE and UK-PBC Risk Scores are currently most robustly validated in external populations. The results show that the continuous models (GLOBE and UK-PBC Risk Scores) serve as the most accurate predictive models. Besides standard UDCA treatment response endpoints, the alkaline phosphatase and total bilirubin normalization has been suggested as a new therapeutic target.

CONCLUSIONS

The GLOBE and UK-PBC Risk Scores are the most suitable for the real-world allocation of second-line therapies (obeticholic acid and fibrates). However, in the wake of the recent findings, alkaline phosphatase and total bilirubin normalization should be the primary outcome in trial research in PBC.

Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study

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.

Health system barriers to HPV vaccination in marginalized Roma communities in Slovakia

Background

People from marginalized Roma communities often experience poverty, limited access to education, employment, housing, and health care (HC). The aim of the study was to explore the perceptions of people from marginalized Roma communities and health professionals regarding health system (HS) barriers to HPV vaccination.

Methods

A qualitative study was conducted in the Kosice region as a part of the RIVER-EU project. Semi-structured interviews with marginalized Roma parents (N = 18), children (N = 15), and health professionals (N = 18) were audio-recorded and thematic analysis of the transcripts was performed in MAXQDA.

Findings

Four main themes were identified regarding HS barriers: 1. Lack of information (lack of culturally and linguistically appropriate information, lack of information provision from HC providers, unreliable and conflicting information on the internet), 2. Restricted access to HC providers (lack of capacities, work overload, long wait in the waiting room, distance, traffic connection), 3. Financial and organizational barriers (limited coverage of vaccination expenses from health insurance, picking up prescribed vaccines in a pharmacy by parents, parental consent), 4. Attitudes and behaviours of HC providers (neglect of care, double standard, inappropriate behaviour and communication, prejudices, racism).

Conclusions

The reasoning and perception of several barriers to HPV vaccination differ among groups of respondents. Nevertheless, HPV is not viewed as a priority by both - marginalized Roma and health professionals. HS fails to reach marginalized Roma with appropriate information about HPV and HPV vaccination. Moreover, the lack of capacities and motivation of HC providers to address these topics lead to a lack of awareness. Organization and health insurance coverage of vaccination pose additional barriers to HPV vaccination.

The possible role of machine learning in detection of increased cardiovascular risk patients - KSC MR Study (design)

INTRODUCTION

Currently, just a few major parameters are used for cardiovascular (CV) risk quantification to identify many of the high-risk subjects; however, they leave a lot of them with an underestimated level of CV risk which does not reflect the reality.

MATERIAL AND METHODS

The submitted study design of the Kosice Selective Coronarography Multiple Risk (KSC MR) Study will use computer analysis of coronary angiography results of admitted patients along with broad patients' characteristics based on questionnaires, physical findings, laboratory and many other examinations.

RESULTS

Obtained data will undergo machine learning protocols with the aim of developing algorithms which will include all available parameters and accurately calculate the probability of coronary artery disease.

CONCLUSIONS

The KSC MR study results, if positive, could establisha base for development of proper software for revealing high-risk patients, as well as patients with suggested positive coronary angiography findings, based on the principles of personalised medicine.

Practice Guidelines of the Central European Hepatologic Collaboration (CEHC) on the Use of Thrombopoietin Receptor Agonists in Patients with Chronic Liver Disease Undergoing Invasive Procedures

BACKGROUND

Second-generation thrombopoietin receptor agonists (TPO-RAs) are emerging as the new standard for managing thrombocytopenia (TCP) in patients with chronic liver diseases (CLDs) undergoing scheduled procedures. However, practical guidance for their routine use in CLD patients undergoing specific invasive procedures is lacking.

METHODS

These practice guidelines were developed by the Initiative Group for Central European Hepatologic Collaboration (CEHC), composed of nine hepatologist/gastroenterologist experts from Central Europe. Using an adapted Delphi process, the CEHC group selected ten invasive procedures most relevant to the hepatology/gastroenterology setting in the region. Consensus recommendations for each invasive procedure are reported as a final percentage of expert panel responses.

RESULTS

A consensus was agreed that TPO-RAs should be considered for raising platelet count in CLD patients undergoing scheduled abdominal surgery, high-bleeding risk dentistry, endoscopic polypectomy, endoscopic variceal ligation, liver biopsy, liver surgery, liver transplantation and percutaneous ablation, but it was also agreed that they are less beneficial or not necessary for endoscopy without intervention and paracentesis.

CONCLUSIONS

Using a modified Delphi method, experts reached an agreement for TCP management in CLD patients undergoing ten invasive procedures. These practice guidelines may help with decision making and patient management in areas where clinical evidence is absent or limited.

Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma: Clinical Patterns, Outcomes, and Prognostic Factors for Overall Survival-A Retrospective Analysis of a Slovak Cohort

OBJECTIVE

To compare NAFLD-related HCC and other etiology-related HCC and to describe predictive factors for survival in patients with NAFLD-related HCC independent of the BCLC staging system.

METHODS

We performed a multicenter longitudinal retrospective observational study of patients diagnosed with HCC during the period from 2010 through 2016.

RESULTS

12.59% of patients had NAFLD-related HCC, and 21.91% had either NAFLD or cryptogenic etiology. NAFLD-related HCC patients were younger (p = 0.0007), with a higher proportion of women (p < 0.001) compared to other etiology-related HCC patients. The NAFLD group had a significantly lower proportion of patients with liver cirrhosis at the time of HCC diagnosis (p < 0.0001), and they were more frequently diagnosed with both diabetes and metabolic syndrome when compared to other etiology-related HCC (p < 0.0001). We did not find any difference in the overall survival or in the progression-free survival between NAFLD-related and other etiology-related HCC patients staged as BCLC B and BCLC C. NAFLD-related HCC patients with three or more liver lesions had a shorter overall survival when compared to patients with one or two liver lesions (p = 0.0097), while patients with baseline CRP values of ≥5 mg/L or with PLR ≥ 150 had worse overall survival (p = 0.012 and p = 0.0028, respectively). ALBI Grade 3 predicted worse overall survival compared to ALBI Grade 1 or 2 (p = 0.00021). In NAFLD-related HCC patients, PLR and ALBI remained significant predictors of overall survival even after adjusting for BCLC.

CONCLUSION

NAFLD-related HCC patients have a similar prognosis when compared to other etiology-related HCC. In NAFLD-related HCC patients, ALBI and PLR are significant predictors of the overall survival independent of the BCLC staging system.

Is elimination of HCV in 2030 realistic in Central Europe

According to the recent data presented by Central-European HCV experts, the estimated prevalence of HCV is between 0.2% and 1.7% in certain countries in this region. There are no financial limitations to access to treatment in most countries. Patients in these countries have access to at least one pangenotypic regimen. The most common barriers to the elimination of HCV in Central Europe are a lack of established national screening programmes and limited political commitment to the elimination of HCV. Covid-19 has significantly affected the number of patients who have been diagnosed and treated, thus, delaying the potential elimination of HCV. These data suggest that the elimination of HCV elimination projected by WHO before 2030 will not be possible in the Central Europe.

PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis

BACKGROUND & AIMS

Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes.

METHODS

The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome.

RESULTS

Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90-day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality.

CONCLUSIONS

This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis.

LAY SUMMARY

Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes.

Roma Ethnicity and Sex-Specific Associations of Serum Uric Acid with Cardiometabolic and Hepatorenal Health Factors in Eastern Slovakian Population: The HepaMeta Study

Background: Health characteristics associated with uric acid (UA) in the Roma minority remain less well known. The study sought to determine the ethnicity- and sex-specific associations of serum UA with health factors in Eastern Slovakian Roma and non-Roma populations. Methods: Data from the comparative cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The study enrolled 452 Roma subjects (35.2% men) and 403 non-Roma individuals (45.9% men) aged 18-55 years. Results: All study parameters differed between the sexes in both the Roma and non-Roma participants (p < 0.05). UA was related to sex with odds ratio for female sex 0.873, 95% CI 0.853-0.893 (p < 0.0001) per 10-unit increase of UA. Average level of UA ± standard deviation was lower in Roma than in non-Roma (226.54 ± 79.8 vs. 259.11 ± 84.53 umol/L; p < 0.0001). The Roma population presented with greater levels of high-sensitivity C-reactive protein (hsCRP) (3.07 ± 4 mg/L vs. 1.98 ± 2.83 mg/L; p < 0.0001) and ferritin in Roma males (403.78 ± 391.84 vs. 302.67 ± 236.26 mg/L; p < 0.0001). Conclusions: Serum UA is sex- and ethnicity specific. Elevated levels of hsCRP and ferritin particularly in Roma males can reflect low-grade systemic inflammation and thus serve as a marker of an increased cardiovascular risk.

Epidemiology and clinical course of primary biliary cholangitis in Eastern Slovakia

OBJECTIVE

To determine both the incidence and the prevalence of primary biliary cholangitis (PBC) in Eastern Slovakia and to describe its clinical course and the response to ursodeoxycholic acid (UDCA).

METHODS

We recorded data of patients with PBC, who were followed up in gastroenterology and hepatology centers in Eastern Slovakia during the period from June 30, 1999, through June 30, 2019.

RESULTS

The annual incidence of PBC varied from 0.7 to 1.5 cases per 100,000 inhabitants between 2014 and 2018. PBC prevalence steadily increased from initial 10.2 cases per 100,000 inhabitants in 2014 to 14.9 cases per 100,000 inhabitants in June 2019. The mean age at the time of diagnosis was 56.3 ± 10.9 years. 95.7% of patients were females, and female/male gender ratio was 22.3:1. In June 2019, prevalence in the female population was 28 cases per 100,000 women. At the time of diagnosis, three-quarters of patients were symptomatic and 10% of patients had liver cirrhosis. The mean follow-up was 7.3 ± 5.2 years. Response to UDCA was observed in 72.1% of patients. Patients with higher baseline alkaline phosphatase (ALP) levels, liver cirrhosis at entry or at the end of follow-up and women younger than 45 years responded worse to UDCA. One-quarter of patients had liver cirrhosis at the end of follow-up. During follow-up, 1.6% of patients underwent liver transplantation and 5.5% of patients died. Five-year and 10-year liver-related mortalities were 2.7% and 4.3%, respectively.

CONCLUSION

PBC prevalence in Eastern Slovakia is increasing, and most of the patients respond to therapy with UDCA.

What is the Role of the Horizontal Transmission of Hepatitis B Virus Infection in Young Adult and Middle-Aged Roma Population Living in the Settlements in East Slovakia?

Background: The aim of our work is to objectify the manner of transmission of HBV infection in young adult and middle-aged Roma people who live in the settlements. Methods: We used data from the cross-sectional study HepaMeta. We analyzed Roma people living in the settlements in East Slovakia, who have had HBsAg and anti HBc IgG antibodies examined. Results: We analyzed a cohort of 452 Roma participants with a mean of age 34.67 ± 9.14 years—159 (35.2%) were males. HBsAg positivity was diagnosed in 12.4% and the presence of anti HBc IgG antibodies was confirmed in 52% of participants. Prevalence of HBsAg positivity increases significantly with higher age, (p = 0.026), as well as the presence of anti HBc IgG antibodies (p < 0.0001). The prevalence of HBsAg positivity has doubled and anti HBc IgG positivity has tripled within two decades (<25 years vs. 35–45 years) in Roma settlements in East Slovakia. Conclusions: These findings allow us to express an opinion that horizontal transmission in adulthood may play an important role in the spreading of HBV infection.

The Roma Population Living in Segregated Settlements in Eastern Slovakia Has a Higher Prevalence of Metabolic Syndrome, Kidney Disease, Viral Hepatitis B and E, and Some Parasitic Diseases Compared to the Majority Population

Background: The Roma population is one of the largest marginalized population groups in Europe. The aim of our work was to summarize the morbidity of lifestyle-related diseases and infectious diseases in the Roma population living in segregated settlements. Methods: We used data from the cross-sectional study HepaMeta, in which we examined 452 Roma subjects with an average age of 34.7 ± 9.1 years, 35.2% of which were men, and 403 non-Roma subjects with an average age of 33.5 ± 7.4 years, 45.9% of which were men. We collected data by means of a questionnaire, anthropometric measures, and we analyzed blood and urine samples. Results: Roma subjects had a higher incidence of metabolic syndrome (RR: 1.478 (1.159-1.885), p < 0.0001), obesity or waist circumference >94 cm in men/80 cm in women (RR: 1.287 (1.127-1.470), p < 0.0001), and HDL-C < 1.03 mmol/L in men or <1.29 in women (RR: 2.004 (1.730-2.321), p < 0.0001) than their non-Roma counterparts. Subjects of the Roma population were more frequently diagnosed with kidney disease (RR: 1.216 (1.096-1.349), p < 0.0001), HBsAg positivity (RR: 4.468 (2.373-8.415), p < 0.0001), anti HBc IgG positivity (RR: 3.13 (2.598-4.224), p < 0.0001), and anti HEV positivity (RR: 2.972 (1.226-7.287), p < 0.0001). Serological markers of Toxoplasma gondii infection and Toxocara spp. were observed much more frequently among Roma than non-Roma subjects (RR: 1.868 (1.520-2.296), p < 0.0001, for Toxoplasma gondii; and RR: 21.812 (8.097-58.761), p < 0.0001, for Toxocara spp.). Conclusions: Poor socio-economic conditions, an unhealthy lifestyle, and barriers precluding access to healthcare are factors that affect the Roma population in settlements and lead to an increased prevalence of metabolic syndrome and its components, kidney disease, viral hepatitis B and E, and some parasitic diseases.

Serum Uric Acid in Roma and Non-Roma-Its Correlation with Metabolic Syndrome and Other Variables

Background: The Roma population is one of the major marginalized groups in Europe, having higher incidence of all spectrums of disease and a shorter life expectancy. Yet, the reasons for higher morbidity and its exact prevalence were not properly studied. Objectives: The objective of our study was to compare the frequency of metabolic syndrome (MetS) in Roma people to the non-Roma population in Slovakia, and to compare levels of uric acid and its correlation with components of metabolic syndrome. Methods: A group of 452 Roma people aged 18–55 years, was compared to a control group of 403 non-Roma people. The data were obtained by questionnaire, anthropometric measures, and analyzed blood and urine samples Results: The prevalence of MetS was significantly higher among Roma participants (131; 29.6%) compared with non-Roma participants (80; 20.1%), p = 0.001. Roma people significantly more often fulfilled obesity and low high-density lipoprotein (HDL) criteria of MetS (257, 58.9% vs. 180, 45.8%, p < 0.0001, and 312, 70.0% vs. 140, 34.9%, p < 0.0001). There was no difference in the triacylglycerols (TG), glycemia or blood pressure (BP) criteria of MetS. The Roma also presented with greater levels of high sensitivity C-reactive protein (hs-CRP). Baseline levels of uric acid (UA) among the Roma population were significantly lower compared with the majority population (226.54 ± 79.8 vs. 259.11 ± 84.53) (p < 0.001). The levels of UA significantly correlated with fulfilled criteria of MetS. Univariate regression showed that UA is a significant predictor of MetS in the whole cohort (unadjusted odds ratio (OR) 1.005; 95% CI 1.004–1.007; p < 0.0001) also after the adjustment for age, sex, and ethnicity (adjusted OR 1.008; 95% CI 1.005–1.010; p < 0.0001). Conclusions: We were able to show that prevalence of MetS among the Roma is higher than in the majority population. Moreover, the uric acid levels are significantly lower in the Roma group as well as when it comes to a cohort with MetS. Levels of UA, besides others, depend on ethnicity, age, and sex.

Pleiotropic effects of statins in the diseases of the liver

Statins are a class of molecules that inhibit HMG CoA reductase. They are usually prescribed as a lipid lowering medication. However, there is accumulating evidence that statins have multiple secondary effects both related and unrelated to their lipid-lowering effect. This narrative review of the literature aims to provide the reader with information from clinical studies related to the effect of statin and statins’ potential use in patients with liver diseases. In patients with advanced liver disease due to any etiology, statins exhibit an antifibrotic effect possibly through the prevention of hepatic sinusoidal microthrombosis. Two randomized controlled trials confirmed that statins decrease hepatic vein pressure gradient in patients with portal hypertension and improve the survival of patients after variceal bleeding. Lower rates of infections were observed in patients with cirrhosis who received statin treatment. Statins decrease the risk of hepatocellular carcinoma (HCC) in patients with advanced liver disease in general but particularly in patients with chronic hepatitis B and C. Statins in patients with chronic hepatitis C likely increase the virological response to the treatment with pegylated interferon and ribavirin and have the potential to decrease the rate of fibrosis. Finally, data from randomized controlled trials also confirmed that the addition of statin prolongs the survival of patients with advanced HCC even more than sorafenib. Statins are a very promising group of drugs especially in patients with liver disease, where therapeutic options can often be limited. Some indications, such as the prevention of re-bleeding from esophageal varices and the palliative treatment of HCC have been proven through randomized controlled trials, while additional indications still need to be confirmed through prospective studies.

Association between hepatitis B and metabolic syndrome: Current state of the art

Chronic hepatitis B (CHB) is a global health issue that increases the risk of liver cirrhosis and hepatocellular carcinoma in infected patients. Metabolic syndrome (MetS) is a disease endemic mostly to the developed countries. It is associated with high cardiovascular mortality and morbidity, diabetes mellitus as well as cancer. In this manuscript, we systematically review the published data on the relationship between MetS and CHB infection. Multiple studies have described highly variable correlations between CHB on one hand and MetS, non-alcoholic fatty liver disease and dyslipidemia on the other. No association between CHB and diabetes mellitus or atherosclerosis has been described as of now. The presence of MetS in patients infected with hepatitis B virus increases the risk of fibrosis, cirrhosis and hepatocellular carcinoma. Appropriate lifestyle, but also pharmacological interventions are needed to prevent the development of these complications.

Association between hepatitis B and metabolic syndrome: Current state of the art

Chronic hepatitis B (CHB) is a global health issue that increases the risk of liver cirrhosis and hepatocellular carcinoma in infected patients. Metabolic syndrome (MetS) is a disease endemic mostly to the developed countries. It is associated with high cardiovascular mortality and morbidity, diabetes mellitus as well as cancer. In this manuscript, we systematically review the published data on the relationship between MetS and CHB infection. Multiple studies have described highly variable correlations between CHB on one hand and MetS, non-alcoholic fatty liver disease and dyslipidemia on the other. No association between CHB and diabetes mellitus or atherosclerosis has been described as of now. The presence of MetS in patients infected with hepatitis B virus increases the risk of fibrosis, cirrhosis and hepatocellular carcinoma. Appropriate lifestyle, but also pharmacological interventions are needed to prevent the development of these complications.

Predictors of hepatorenal syndrome in alcoholic liver cirrhosis

BACKGROUND

Alcoholic liver disease is a major cause of liver cirrhosis and the hepatorenal syndrome is a serious complication. Risk factors for hepatorenal syndrome (HRS) in alcoholic liver cirrhosis are not entirely explored.

AIM

To assess the risk factors for hepatorenal syndrome in alcoholic liver cirrhosis.

PATIENTS AND METHODS

Consecutive patients with alcoholic liver disease were followed for two months, development of renal failure, classified either as HRS or renal failure not fulfilling criteria of HRS, was the main outcome.

RESULTS

Of 171 patients, 14 (8.2%) developed HRS and 13 (7.6%), renal failure not fulfilling the HRS criteria. A significant difference was found between patients with and without HRS in serum sodium (131.1±3.8 vs. 135.7±5.2; P = 0.003), creatinine, (94.1±26.8 vs. 80.3±20.2; P < 0.001), albumin (23.5±4.9 vs. 29.9±5.8; P < 0.001), INR (1.76±0.45 vs. 1.44±0.41; P < 0.001), bilirubin (252.3±179.4 vs. 91.2±101.0; P < 0.001), MELD (23±6 vs 15±5; P < 0.001) and MELD-Na score (27±5 vs. 18±6; P < 0.001). Multivariate analysis adjusted for sex and age showed that sodium together with creatinine are the strongest HRS predictors, followed by bilirubin with respective odds´ ratios (95% CI) of 1.041 (1.012-1.072) for creatinine, 0.870 (0.766-0.988) for serum sodium and 1.005 (1.001-1.010) for serum bilirubin.

CONCLUSION

Serum levels of sodium, creatinine and bilirubin are important predictors of the hepatorenal syndrome.

Higher prevalence of nephropathy in young Roma females compared with non-Roma females

OBJECTIVES

Ethnic differences in the prevalence of various chronic diseases, including end-stage renal disease, have been previously reported. Surprisingly, data focusing on the lower grade of chronic kidney disease (CKD) are scarce. Thus, the aim of this study was to explore differences in the prevalence of nephropathy between the Roma and non-Roma populations.

METHODS

Data from the cross-sectional population based HepaMeta study conducted in Slovakia were used. Nephropathy was defined as: a known history of any kidney disease; or the presence of proteinuria/hematuria; or glomerular filtration rate (GFR) < 60 ml/min. The odds ratio for the prevalence of nephropathy was calculated using binary logistic regression.

RESULTS

In an age-adjusted model, Roma females had OR of 1.56 for having nephropathy over non-Roma females (OR 1.56; 95% CI 1.01-2.42; p < 0.05). In addition, Roma females had a significantly lower GFR (mean difference 3.4 ml/min, t = -3.58, p < 0.001); all female patients with proteinuria were Roma.

CONCLUSIONS

This cross-sectional study on the young general population found that Roma females have half-higher odds for nephropathy than non-Roma females. Therefore, to prevent risks we should focus on searching for ethnic, social and medical determinants of CKD. Interventions to decrease the incidence of CKD in the target population should also address ethnic inequalities as well as female gender.

Gamma-glutamyl transpeptidase level associated with metabolic syndrome and proinflammatory parameters in the young Roma population in eastern Slovakia: a population-based study

BACKGROUND

Elevated gamma-glutamyl transpeptidase (GGT) is present approximately in half of all patients with non-alcoholic fatty liver disease (NAFLD). NAFLD is the liver manifestation of metabolic syndrome (MS). This study aimed to explore the relationship between GGT and MS or proinflammatory parameters.

METHODS

Data from the cross-sectional HepaMeta study conducted in Slovakia in 2011 among Roma living in rural communities were used. Participants (n = 446) were divided into 2 groups; those with elevated GGT and those with normal GGT levels. MS was diagnosed according to the International Diabetes Federation criteria; presence of central obesity and low density lipoproteins (LDL) or high density lipoproteins (HDL), high triglycerides, hypertension, glucose intolerance or type 2 diabetes. Participants were tested for the presence of MS and its components, and biochemical tests for lipid levels (total cholesterol, HDL, LDL, TG) and inflammatory parameters (high sensitivity C-reactive protein--hs-CRP and ferritin) were performed.

RESULTS

Of 446 Roma participants, only 29 (6.5%) had GGT levels above the normal value. After exclusion of patients with viral hepatitis and alcohol abuse, patients with elevated GGT suffered from MS more often (p < 0.001), and patients with more MS components had a higher risk of elevated GGT. We found a significant association between GGT and the individual MS components, except HDL (waist circumference > or = 94 cm in men or 80 cm in women: p < 0.01; BMI > 30: p < 0.001; fasting glucose > or = 5.6 mmol/l: p < 0.001; arterial hypertension: p < 0.05, and TAG > or = 1.7 mmol/l: p < 0.001). Patients with elevated GGT levels had also significantly higher hs-CRP (hs-CRP > 2 mg/l: p < 0.001; hs-CRP > 3 mg/l: p < 0.001) and ferritin (ferritin > 300 mg/l: p < 0.01) levels.

CONCLUSION

Patients with MS have more significantly elevated levels of GGT. There is a significant association of GGT with individual MS components, except HDL and inflammatory parameters (hs-CRP, ferritin).

Hepameta-- prevalence of hepatitis B/C and metabolic syndrome in population living in separated and segregated Roma settlements: a methodology for a cross-sectional population-based study using community-based approach

BACKGROUND

Roma represent one of the largest and oldest minorities in Europe. Health of many of them, particularly those living in settlements, is heavily compromised by poor dwelling, low educational level, unemployment, and poverty rooted in generational poverty, segregation and discrimination. The cross-sectional population-based study using community based approach aimed to map the prevalence of viral hepatitis B/C and metabolic syndrome in the population living in separated and segregated Roma settlements and to compare it with the occurrence of the same health indicators in the majority population, considering selected risk and protective factors of these health indicators.

METHODS

The sample consisted of 452 Roma (mean age = 34.7; 35.2% men) and 403 non-Roma (mean age = 33.5; 45.9% men) respondents. Data were collected in 2011 via questionnaire, anthropometric measures and analysed blood and urine samples. A methodology used in the study as well as in the following scientific papers is described in the Methods section (i.e. study design, procedures, samples, methods including questionnaire, anthropometric measurements, physical measurements, blood and urine measurements).

CONCLUSIONS

There are regions of declining prosperity due to high unemployment, long-term problems with poverty and depleted resources. Populations living in these areas, i.e. in Central and Eastern Europe in Roma settlements, are at risk of poverty, social exclusion and other factors affecting health. Therefore, we should look for successful long-term strategies and tools (e.g. Roma mediators, terrain work) in order to improve the future prospects of these minorities.

The prevalence of Chlamydia trachomatis in the population living in Roma settlements: a comparison with the majority population

BACKGROUND

We aimed to study the occurrence of Chlamydia trachomatis infection in the population living in Roma settlements and to compare the obtained results with the prevalence in the majority population.

METHODS

We examined 340 people for the presence of bacterium C. trachomatis, 208 of them were Roma (66 men, 142 women) and 132 were from the majority population (75 men, 57 women). Respondents were aged 18-55 years (mean age = 33.44, STD = 9.57). The occurence of C. trachomatis was detected by direct proof of the pathogen by polymerase chain reaction (PCR).

RESULTS

Of 340 respondents included in the study, 22 (6.5%) showed positivity for C. trachomatis infection, 15 of them were Roma (7.2%) and 7 non-Roma (5.3%). The highest positivity was detected in Roma women (8.5%), while positivity in both non-Roma women and men was 5.3%, and in Roma men 4.5%. We did not confirm any significant contribution of age, gender or ethnicity to the occurrence of C. trachomatis infection.

CONCLUSIONS

Despite the increased number of people with risk factors in the Roma community, no significant difference in the occurrence of C. trachomatis infection was found. Neither age nor gender contributes to the probability of C. trachomatis infection. Nevertheless, there are other health consequences which might be more pronounced among the population living in Roma settlements due to barriers to the health care and their lower ability to benefit from health care services provided.

High hepatitis B and low hepatitis C prevalence in Roma population in eastern Slovakia

BACKGROUND

Viral hepatitis B and C prevalence in the Roma population of eastern Slovakia is largely unknown. This study aimed to explore the prevalence and associated risk factors of chronic viral hepatitis B and C among Roma living in segregated communities in eastern Slovakia.

METHODS

Data from the cross-sectional HepaMeta study conducted in Slovakia in 2011 among Roma living in rural communities were used. Participants were tested for the presence of HBsAg, anti-HBc IgG and anti-HCV. The risk factors were assessed mainly via a structured questionnaire/interview.

RESULTS

Altogether 452 Roma were screened, and 11 were excluded due to missing data. A total of 441 patients were included (mean age 34.7 +/- 9.14 years; 35.2% men). 12.5% of participants were HBsAg positive, 40.4% anti-HBc IgG positive while negative for HBsAg and 47.2% of participants were negative for all serological markers of hepatitis B. Hepatitis C prevalence was very low (0.7%), while 2 out of 3 anti-HCV positive participants were coinfected with hepatitis B. Risk factors for hepatitis B infection were male sex, higher age, tattoo, and previous imprisonment. No difference was found in intravenous drug use, blood transfusions and sexual behaviour.

CONCLUSION

More than half of the Roma residing in eastern Slovakia have been infected at one point in life with the hepatitis B virus, and 12.5% are HBsAg positive. Hepatitis C prevalence is very low, which is probably due to very low intravenous drug use.

Does the population living in Roma settlements differ in physical activity, smoking and alcohol consumption from the majority population in Slovakia?

BACKGROUND

Several studies have revealed a high prevalence of risk factors associated with unhealthy lifestyle among individuals with lower socioeconomic status. In Slovakia, one of the most socially and health-disadvantaged groups is the Roma minority. The aim of this study is to explore differences in physical activity, smoking and alcohol consumption between the population living in Roma settlements and the majority population in Slovakia.

METHODS

Data from the cross-sectional epidemiological HepaMeta study conducted in Slovakia in 2011 were used. The sample consisted of 452 Roma (mean age = 34.7; 35.2% men) and 403 non-Roma (mean age = 33.5; 45.9% men) respondents. The differences in health-related behaviour between the population living in Roma settlements and the majority population were analysed using logistic models separately for males and females.

RESULTS

These data show a clear difference between the population living in Roma settlements and the majority population with regard to leisure-time physical activity (only in women) and smoking, although not alcohol consumption. The prevalence of leisure-time physical activities such as walking or some other type of sport was significantly lower among Roma women than among non-Roma women. Men and women living in Roma settlements are more likely to smoke on a daily basis and they are heavier smokers in comparison with the majority population. HepaMeta study did not find differences in alcohol consumption between the Roma and non-Roma men. However, Roma women reported less frequent recent drinking and binge-drinking of 6 or more doses of alcohol on a single occasion.

CONCLUSION

The higher prevalence of unhealthy lifestyle activities among Roma seem to contribute to these inequalities in cardiovascular diseases morbidity and mortality in comparison with the majority population.

Clinical and biochemical determinants of metabolic syndrome among Roma and non-Roma subjects in the eastern part of Slovakia

BACKGROUND

The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabolic syndrome among populations of lower socioeconomic status is a cause of concern and calls for an effective public health response.

OBJECTIVES

The aim of this study was to determine the prevalence of metabolic syndrome in the Roma population compared with the non-Roma population in the eastern part of Slovakia and to determine the parameter which has the strongest association with metabolic syndrome.

RESULTS

123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. In the subgroup of Roma men, we found that waist circumference conferred the highest chance of MS (more than 12-times), followed by triglycerides (TG) (3.670-times). In the subgroup of non-Roma men, we found that waist circumference conferred the highest chance of MS (more than 16-times), followed by high-density lipoprotein (HDL) (4.348-times increased risk per one unit decrease in HDL). In the subgroup of Roma women as well as non-Roma women, we found that serum TG conferred the highest chance of MS, followed by waist circumference for Roma women. Comparing non-classical risk factors for MS we found that only age (with OR 1.977) and high-sensitivity C-reactive protein (hsCRP) (OR 1.887) were significant and independent predictors of MS in Roma men. Among Roma women apolipoprotein B100 was also found to be an independent predictor of MS, besides age and hsCRP.

CONCLUSION

Our study confirmed that the prevalence of metabolic syndrome is strongly associated with hypertriglyceridemic waist, besides other risk factors, a marker of the atherogenic metabolic triad among younger Roma population, which may be the reason for the increased cardiovascular (CV) morbidity and mortality in elderly Roma compared with non-Roma. In light of these results, better prevention of CV events for Roma minority settlements in Slovakia should be provided.

Socioeconomic characteristics of the population living in Roma settlements and their association with health and health-related behaviour

BACKGROUND

The aim of this study was to compare socioeconomic characteristics of the Roma population living in Roma settlements with the majority population. Moreover, it was aimed to assess socioeconomic differences in health and health-related behaviour within the population living in Roma settlements.

METHODS

Data from the cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The sample consisted of 452 Roma (mean age = 34.7; 35.2% men) and 403 non-Roma (mean age = 33.5; 45.9% men) respondents. Roma in selected settlements were recruited by local Roma community workers. Respondents from the major population were randomly selected from a list of patients from general practitioners. Data were collected via questionnaire, anthropometric measures and analysed blood samples. Differences in socioeconomic characteristics between the population living in Roma settlements and the majority population were tested using the chi-square test. The contribution of selected socioeconomic characteristics on health and health-related behaviour of the population living in Roma settlements was assessed by logistic regression models adjusted for age and gender.

RESULTS

The population living in Roma settlements is characterised by significantly lower socioeconomic standards, and the living conditions are significantly worse compared with the majority. With few exceptions, the study did not confirm any significant association between socioeconomic indicators and health and health-related behaviour within the population living in Roma settlements.

CONCLUSIONS

The deteriorating effect of living in Roma settlement on health and health-related behaviour seems to be immense regardless differences in socioeconomic characteristics or living condition within the settlement population.

Regional and ethnic aspects of viral hepatitis B among pregnant women

OBJECTIVES

The aim of this study was to determine the prevalence of HBV infection among pregnant women in districts of Eastern Slovakia with a diverse prevalence of Roma population.

METHODS

Overall 59,279 serum samples from 9 regional departments of clinical microbiology from Eastern Slovakia were collected in the period from January 2008 till December 2009 and analysed.

RESULTS

The number of HBsAg positive samples overall and during pregnancy was 1.74% and 2.12%, respectively. Comparing districts with higher (> 5%) and lower (< 5%) Roma population, there was no significant difference in the prevalence of HBsAg positive samples overall (1.95% vs.1.62%). However, in the subgroup of pregnant women the prevalence of HBsAg positive samples (2.72% vs. 0.95%) differs significantly (p < 0.01).

CONCLUSIONS

The prevalence of HBV infection among pregnant women in Eastern Slovakia did not rapidly exceed the estimated nationwide prevalence. However, in districts with higher Roma population the expected higher prevalence of HBV infection was confirmed. This indicates the need to pay special attention to the prevention of hepatitis B in these districts.

Urogenital chlamydiosis among Slovak women

OBJECTIVE

To investigate the prevalence of urogenital chlamydial infections in women from Eastern Slovakia and to compare the occurrence in women with and without clinical signs of disease.

MATERIAL AND METHODS

We examined a total of 1978 women from Eastern Slovakia for the presence of C. trachomatis over a three year period. Antichlamydial antibodies of classes IgG and IgA were detected by ELISA while PCR was applied to detect pathogen.

RESULTS

3.6 % of the population had presence of antibodies while 10.1 % of the women showed presence of bacteria by PCR.

CONCLUSIONS

Obtained results when compared with clinical examination revealed clear distinction, which was age dependent. Lower age categories were more likely affected by acute infection with positivity for IgA and IgG antibodies as well as PCR. Middle age categories showed significantly higher level of IgG antibodies in comparison to IgA, while pathogen was readily detected by PCR. In women older than 51 years the results reflected more likely a past infection that is presence of only IgG and negative PCR (Tab. 4, Ref. 18).

Coenzyme Q(10) and selenium in statin-associated myopathy treatment

The objective of this study was to evaluate the possible benefits of coenzyme Q10 and selenium supplementation administered to patients with statin-associated myopathy (SAM). Sixty eligible patients entered the pilot study. Laboratory examination (CoQ10, selenium, creatin kinase) and intensity of SAM (visual scale) were performed at baseline, after 1 month, and at the end of study at month 3. Plasma levels of CoQ10 increased from 0.81 ± 0.39 to 3.31 ± 1.72 μmol/L in the active group of patients treated by CoQ10, compared with the placebo (p = 0.001). Also, the symptoms of SAM significantly improved in the active group (p < 0.001): the intensity of muscle pain decreased from 6.7 ± 1.72 to 3.2 ± 2.1 (p < 0.01, -53.4 ± 28.2%); muscle weakness decreased from 7.0 ± 1.63 to 2.8 ± 2.34 (p < 0.01, -60 ± 24.0%); muscle cramps decreased from 5.33 ± 2.06 to 1.86 ± 2.42, p < 0.01, -65 ± 28%); tiredness decreased from the initial 6.7 ± 1.34 to 1.2 ± 1.32 (p < 0.01, -82 ± 22%). We did not observe any significant changes in the placebo group. In conclusion, supplementation of statin-treated patients with CoQ10 resulted in a decrease in the symptoms of SAM, both in absolute numbers and intensity. Additional selenium supplementation was not associated with any statistically significant decrease of SAM. However, it is not possible to draw any definite conclusions, even though this study was carried out in double-blind fashion, because it involved a small number of patients.

Slovak trial on cardiovascular risk reduction following national guidelines with CaDUET® (the STRONG DUET study)

INTRODUCTION

The efficacy and safety of single-pill amlodipine/atorvastatin for reducing blood pressure (BP), low-density lipoprotein cholesterol (LDLC), and predicted 10-year cardiovascular (CV) risk have been demonstrated in low CV risk countries. The Slovak Trial on Cardiovascular Risk Reduction Following National Guidelines with CaDUET® (amlodipine besylate/atorvastatin calcium; Pfizer, Morrisville, PA, USA; STRONG DUET) study evaluated its clinical utility in Slovakia, one of the highest CV risk regions in Europe.

METHODS

This was a two-phase study involving 100 outpatient cardiologist and internist departments in Slovakia. Phase 1 assessed BP control and CV risk profiles in adults with treated hypertension, and phase 2 was an open-label, multicenter, observational study. In the phase 2 study, patients with treated but uncontrolled hypertension and three or more coronary heart disease risk factors received single-pill amlodipine/atorvastatin (5/10 or 10/10 mg) for 12 weeks. Major outcomes were the percentage of patients achieving target BP (≤140/90 mmHg) and/or LDL-C (≤3 mmol/L) and reductions in predicted 10-year CV risk.

RESULTS

Of the 4,672 phase 1 patients, 80.8% had uncontrolled hypertension and 61.4% had dyslipidemia. Of the 1,406 phase 2 patients, 90.3% of patients achieved target BP at week 12, 66.3% achieved target LDL-C, and 60.7% achieved both. The mean 10-year CV risk was reduced by 49% (P < 0.0001); treatment was well-tolerated and safe.

CONCLUSION

Single-pill amlodipine/atorvastatin was associated with significant improvements in BP, LDL-C target attainment, and 10-year CV risk in patients with uncontrolled hypertension in Slovakia. The treatment was well-tolerated and safe. Use of single-pill amlodipine/atorvastatin in high CV-risk countries could lead to significant improvements in CV risk management.

Celiac disease manifested during the treatment of chronic hepatitis C by pegylated alpha interferon and ribavirin

Authors report a case of patient suffering from haemophilia A and hepatitis C virus infection acquired probably after blood transfusions and substitution factors application. He was treated with pegylated interferon alpha and ribavirin, with the development of malabsorption symptoms during the therapy. Celiac disease was established by histological, histochemical and serological examinations. oth, interferon alpha and ribavirin treatment as well as virus of hepatitis C may trigger coeliac disease in genetically predisposed individuals. The immunological mechanism of celiac disease include balance disruption between Th1 and Th2 immunological response with Th1 predominance. Only few similar cases have been published in the professional literature to date. Development of celiac disease during interferon alpha therapy with haemophilia A was not published until now (Fig. 3, Ref. 13).

Circulating markers of liver fibrosis progression

INTRODUCTION

Fibrogenesis is a typical reaction of the liver to injury. In the case of overstimulation of fibrogenesis clinically significant fibrosis and, eventually, cirrhosis occur. Treatment of liver cirrhosis is limited, therefore it is important to screen and monitor patients at risk of cirrhosis. Noninvasive parameters are ideal for this purpose due to their risk profile and repeatability.

METHODS

Systematic review of literature.

RESULTS

Among large number of proposed biomarkers, there is a distinct difference between two groups or classes. Class I biomarkers are associated with the process of fibrogenesis, their presence in the serum is the result of the increased turnover of extracellular matrix. Class II biomarkers and their combinations are mostly markers of liver function or structural damage. We have identified 27 Class I and 13 Class II biomarkers that have been proposed in the literature. We have evaluated in detail those which reached limited clinical application.

CONCLUSION

General clinical acceptance of these biomarkers is low because of various drawbacks. Simple and readily available biomarkers have low accuracy in predicting liver fibrosis and more advanced markers have low cost-benefit ratio. Therefore liver biopsy remains the "gold standard" for diagnosis of fibrosis. However potential noninvasive alternatives exist and their implementation could be valuable.

Impact of TTV and SENV infection in chronic hepatitis B or C on liver histology and therapy outcome

AIM

To determine the influence of TTV and SENV on histological findings and viral response in patients with chronic viral hepatitis B and C.

BACKGROUND

The clinical impact of TTV or SENV coinfections in these patients remains unclear.

METHODS

Serum and liver biopsy specimens from chronic hepatitis B and C patients, 107 with liver biopsy and 105 who had finished complete antiviral therapy, were investigated for the presence of TTV and SENV.

RESULTS

The Ishak score determined from 107 liver biopsy samples compared according to TTV or SENV coinfection was similar. Among 39 chronic hepatitis C patients with and 43 without virological response, we have found 9 and 3 SENV positive (p < 0.05) and 18 and 28 TTV positive patients, respectively (not significant). However 11 of 32 biopsy samples obtained in the responder's group and 19 of 31 in non-responders were TTV positive (p < 0.05). No similar differences were observed among 23 chronic hepatitis B patients. TTV clearance after interferon therapy exceeded 80%, clearance of SENV 90%.

CONCLUSION

TTV or SENV infections did not negatively influence the severity of histological features or the antiviral response in patients with chronic hepatitis B and C. Both viruses were highly sensitive to interferon therapy (Tab. 5, Ref. 29).

[Does carbohydrate-deficient transferrin have diagnostic value in non-alcoholic fatty liver disease?]

Non-alcoholic fatty liver disease (NAFLD) is an acquired metabolic liver disease in the consequence of triglyceride accumulation within liver cells. It is accompanied by necrobiotic inflammatory reaction, fibrosis and also by liver cirrhosis. Its distinction from alcoholic fatty liver disease (AFLD) can be difficult. Clear anamnesis may help, but if the patient does not inform us about the alcohol consumption, the differentiation is not easy.

AIM

Our aim was to determine the value of carbohydrate deficient transferrin (CDT) in patients with non-alcoholic fatty liver disease, as well as to analyze the background of high CDT values, according to the anamnesis.

PATIENTS AND METHODS

39 patients (21 female and 18 male) with ultrasound signs of fatty liver disease were studied. CDT, body mass index (BMI) and HOMA index were determined.

RESULTS

Mean value of CDT was: 2.39+/-0.52% (in male 2.51+/-0.61, in female 2.28+/-0.4). No significant difference was found among the two sexes. The diversity of CDT values was normal. The value of BMI belonged to the overweight area without any significant difference between the two sexes.

CONCLUSION

On the basis of the results, NAFLD and AFLD can be differentiated according to the CDT value, and this value could be a higher specific value than the activity of gammaglutamyl transpeptidase, however, anamnesis and other factors are as well very important in achieving the correct diagnosis.

HIV prevalence and clinical care for HIV-positive pregnant women in Slovakia

OBJECTIVE

To evaluate clinical care for HIV positive pregnant women who delivered in Slovakia from 1985 till 2008.

BACKGROUND

National guidelines for the prevention of mother-to-child transmission of HIV have not yet been established.

METHOD

Retrospective analysis of 14 HIV-infected pregnant women and their infants. Factors examined include maternal social, demographic, immunological and virological characteristics, method of HIV testing, antiretroviral therapy during pregnancy, delivery and puerperium, mode of delivery, mode of infant feeding, pregnancy outcomes and HIV status of infants.

CONCLUSIONS

Due to the increase in cases of HIV-infected pregnant women within the last several years, it would be advisable to create National Guidelines for PMTCT (Prevention of Mother-to-Child Transmission) in order to consolidate the care management in all HIV/AIDS care centers around Slovakia (Fig. 4, Ref. 7).

Nosocomial meningitis caused by Staphylococcus other than S. aureus in children: multicentre study

Analysing 101 cases of nosocomial meningitis due to staphylococci other than S. aureus within last 15 years, coagulase negative staphylococci represented the commonest pathogen. Major risk factor for staphylococcal meningitis was prior neurosurgery, mainly ventriculoperitoneal shunt insertion. Ten of 101 cases were caused by glycopeptide intermediate resistant strains in patients pretreated with multiple combination of antibiotics including vancomycin and shunt exchanges: 76% of strains were also oxacillin resistant.

Neuroinfections complicating foreign body implants after perinatal trauma or meningitis in 60 children

Meningitis after artificial implants in 60 children, mainly after foreign body infections (FBI) was caused more frequently by coagulase negative staphylococci and Ps. aeruginosa than other organisms and was significantly associated with perinatal trauma, hydrocephalus, haemorrhage or VLBW and had more neurologic sequels despite mortality was similar to other nosocomial meningitis.

[Prevalence of hepatitis C virus infection in Slovakia]

OBJECTIVE

To assess the prevalence of hepatitis C in the general Slovak population without any further evaluation or risk group stratification.

MATERIAL AND METHODS

A total of 3,608 remnant serum specimens from epidemiological surveys in 1997 (1,484 specimens) and 2002 (2,124) were analyzed. These were from randomly selected persons over 15 years of age from all over Slovakia. The anti-HCV antibodies were detected using the 4th generation ELISA test. In case of positive or borderline results, the presence of HCV RNA was determined qualitatively.

RESULTS

Of the 3,608 analyzed specimens, 55 (1.52 %) were anti-HCV-positive and 10 (0.28 %) were borderline positive. HCV RNA was detected in 24 cases (0.67 %). A comparison of the 1997 and 2002 results showed a statistically significant (p < 0.01) increase of anti-HCV-positive specimens. A similar--but not significant--increase was noted in HCV RNA-positive cases. Despite a slightly higher prevalence of HCV infection in females, no statistically significant gender differences were found. Whereas anti-HCV positivity increased slightly with age, most HCV RNA patients were from the middle age group, i.e. between 36 and 45 years of age. The geographic distribution of HCV cases across Slovakia was relatively even.

CONCLUSIONS

The prevalence of anti-HCV antibodies in subjects representing the general population of Slovakia older than 15 years was 1.52 %; chronic HCV infection was confirmed in 0.67 % of cases.

[Travel during pregnancy and possibilities of vaccination]

Pregnancy presents special medical problem where we need to take into account travel risks regarding pregnant women and the health limits as a consequence of pregnancy. It is also important to consider the fact that active prevention and treatment approaches are to a large degree limited by the pregnancy. The most optimal period for travelling is the second trimester. In most cases, the potential risk of administering the vaccine is theoretical and not based on clinical evidence. Pregnancy presents a special problem regarding many aspects of immunization: benefit of vaccination, potential disease risk to the mother and fetus and safety of vaccine to mother and fetus itself. In general, pregnant patients should avoid live vaccines. Vaccination with inactivated, conjugated, polysacahecride vaccines and toxoids is possible. The first trimester of pregnancy is the most vulnerable period because of theoretical risk of harmful effects to the fetus.

Detection of SEN virus in the general population and different risk groups in Slovakia

Sera of 426 adult persons were examined to assess the prevalence of SEN virus (SENV) infection in Slovakia and to determine the importance of different risk factors for parenteral transmission. SENV prevalence was determined by the PCR method using primers of SENV-D and SENV-H strains. Positive results were found in 10 of 37 patients with acute hepatitis of unknown etiology, 7 of 38 with acute hepatitis B, 17 of 44 with chronic hepatitis B, 29 of 102 with chronic hepatitis C, 36 of 72 hemodialysis patients, 2 of 33 health care workers and 24 of 100 persons from the control group. The highest prevalence of SENV was among hemodialysis patients, significantly higher than in the groups of health care workers, acute hepatitis B and controls. The lowest prevalence was in health care workers group, significantly lower also in comparison with groups of chronic hepatitis B and C. Among the possible risk factors of virus transmission the average duration of hemodialysis (1.15 vs. 0.50 years), number of surgeries (1.60 vs. 1.10) and transfusions (1.34 vs. 0.94) showed notable differences in terms of SENV infection. Bilirubin and aminotransferase levels did not differ between SENV-positive and -negative groups. No pathogenetic role of SEN virus in liver injury was confirmed.

[Spontaneous bacterial peritonitis in the patients with liver cirrhosis]

AIM OF THE STUDY

To assess objective incidence of spontaneous bacterial peritonitis (SBP), laboratory findings, effectivity of the treatment and mortality of cirrhotics with ascites and SBP.

PATIENTS AND METHODS

From June 1994 to June 1999 we performed 692 abdominal paracenteses in 169 cirrhotic patients (mean age 52,63 +/- 8,02 years, mean Child-Pugh score 10,41 +/- 3,02). Culture of ascitic fluid, total leucocyte and granulocyte count in ascites and total protein, albumin and cholesterol levels in ascites and serum were examinated. Diagnosis of SBP was established by criteria of Wilcox and Dismukes.

RESULTS

SBP was found in 27 patients by 1st paracentesis (16,0 %), in the other 13 patients by repeated paracentesis (7,7 %). 51 episodes of SBP (7,4 % of all paracenteses) were found in 40 patients. 48 episodes of SBP (94,7 %) were succesfully treated by ATB therapy, 8 patients with SBP died during hospitalization (15,7 %). Patients with SBP had significant lower total protein, albumin and cholesterol levels in serum and ascites compared to patients without ascites infection (all paramethers p <0,01).

CONCLUSION

SBP is a common complication in patients with advanced liver cirrhosis and ascites. Despite of effectivity of ATB therapy the hospital mortality of patients with SBP is high.

KEYWORDS

liver cirrhosis, ascites, spontaneous bacterial peritonitis, mortality.

[Infectious complications in patients with liver cirrhosis]

AIM OF THE STUDY

To assess the objective incidence of infectious complications in liver cirrhosis, to find out correlation among stage of liver cirrhosis, number of infectious complications and mortality in cirrhotic patients.

PATIENTS AND METHODS

93 patients with liver cirrhosis were hospitalized from June 1996 to November 1998 (age: 53,44 I 8,03 years, Child-Pugh score: 11,58 I 2,12). 6 patients were in class B, 87 in class C of Child-Pugh classification. Ascites was found in 81 patients, pleural effusion was found in 14 patients. Chest X-ray, examination of ascites and pleural efussion an urine culture were performed by admission, the other infections were actively screened after clinical signs.

RESULTS

Spontaneous bacterial peritonitis was found in 17 patients (18,28 %), secondary bacterial peritonitis in 5 patients (5,38 %), spontaneous bacteremia in 3 patients (3,23 %), spontaneous bacterial pleuritis in 3 patients (3,23 %), bronchopneumonia and infections of respiratory tract in 22 patients (23,66 %), uro-infection in 69 patients (74,19 %) and the other kinds of infection in 14 patients (15,05 %). Mortality of patients correlates with stage of liver cirrhosis and number of infectious complications.

CONCLUSION

Infections are common complications in hospitalized cirrhotics. Infectious complications are the most common cause of mortality of cirrhosis, patients with bronchopneumonia, secondary bacterial peritonitis or spontaneous bacterial pleuritis had bad prognosis. Early antibiotic treatment at the base of culture and sensitivity is an optimal therapeutic approach in cirrhotics with infections.