BACKGROUND:Hepatitis B virus(HBV)infection is a major cause of mortality and morbidity globally.The quest continues to identify viral factors that influence disease progression and severity as well as responses to tre...BACKGROUND:Hepatitis B virus(HBV)infection is a major cause of mortality and morbidity globally.The quest continues to identify viral factors that influence disease progression and severity as well as responses to treatment of HBV infection.Based on variations in HBV,the virus has been divided into a number of genotypes. DATA SOURCES:Review of published literature on HBV genotypes. RESULTS:HBV genotypes are likely to be important in determining the severity and progression of HBV-induced liver disease as well as responses to different anti-viral agents. CONCLUSION:Although HBV genotyping is not yet recommended for routine use in treating HBV infection, available data suggest that,as in hepatitis C virus infection, HBV genotyping is also likely to become a routine investigation for HBV treatment,perhaps in the not too distant future.展开更多
BACKGROUND:Acute-on-chronic liver failure(ACLF) is common in Bangladesh.Acute viral E hepatitis is sporadically encountered in this country each year,with a rising incidence in the rainy season.This study aimed to ide...BACKGROUND:Acute-on-chronic liver failure(ACLF) is common in Bangladesh.Acute viral E hepatitis is sporadically encountered in this country each year,with a rising incidence in the rainy season.This study aimed to identify the etiology of ACLF in Bangladesh. METHODS:In this retrospective study,69 ACLF patients were included.They presented to our department at the Bangabandhu Sheikh Mujib Medical University in Dhaka.History of diseases was recorded and appropriate investigations were conducted in all patients. RESULTS:Acute hepatitis E virus(HEV)infection was positive in 21.7%(15/69)of the patients,while 14.5% (10/69)had septicemia.Upper gastrointestinal tract hemorrhage was seen in 4.3%of the patients(3/69),while another 4.3%(3/69)had a positive history for alcohol or drugs.None of the patients tested positive for hepatitis A virus infection and no evidence of hepatitis B virus flare was found in any patient.No specific cause for ACLF could be identified. CONCLUSIONS:Acute HEV infection is a leading cause of ACLF in Bangladesh.Many patients were thought to have decompensation of cirrhosis,but subsequently were recognized as having ACLF by a retrospective review according to the definition of the Asian Pacific Association for the Study of the Liver Working Party Meeting on ACLF in New Delhi in early 2008.展开更多
BACKGROUND:Bangladesh is a densely populated country where about 10 million people are chronically infected with hepatitis B virus(HBV).The aim of the present study was to evaluate the biochemical,virological and hist...BACKGROUND:Bangladesh is a densely populated country where about 10 million people are chronically infected with hepatitis B virus(HBV).The aim of the present study was to evaluate the biochemical,virological and histological characteristics of HBeAg-negative chronic hepatitis B(CHB). METHODS:Patients were included in this study if they were chronically infected with HBV with detectable DNA.The patients who were co-infected with human immunodeficiency virus,hepatitis delta virus or hepatitis C virus,and previously subjected to antiviral treatment,and those with hepatocellular carcinoma were excluded.The study was conducted during the period of January 2001 to December 2007.During this period 2617 patients with CHB were studied.HBeAg-positive cases were included to compare the characteristics.Among them,237 cases underwent liver biopsy. RESULTS:2296 patients(87.7%)were male,with a mean age of 28.9±13.7 years.2375 patients(90.8%)had CHB,and 242(9.2%)were cirrhotic.HBV DNA levels were 7.6±1.5 copies/ml,ALT was 111.3±212.5 U/L,and AST was 91.5± 148.9 U/L.The number of HBeAg-negative CHB cases was 1039(39.7%).HBeAg-negative patients with a lower DNA load were older,and they had more fibrotic changes in the liver than HBeAg-positive patients.The two groups did not differ in necroinflammatory activity,but the former had lower ALT and AST values.Cirrhosis was more common in e-antigen-negative patients.CONCLUSIONS:e-antigen-negative CHB patients are older and have more hepatic fibrosis patients than HBeAg-positive patients,although they have similar necroinflammatory activity.展开更多
BACKGROUND:Hepatitis B virus(HBV)is encountered sporadically the year round in Bangladesh.It results in a wide range of liver diseases,with asymptomatic acute hepatitis at one end to hepatocellular carcinoma(HCC)at th...BACKGROUND:Hepatitis B virus(HBV)is encountered sporadically the year round in Bangladesh.It results in a wide range of liver diseases,with asymptomatic acute hepatitis at one end to hepatocellular carcinoma(HCC)at the other end of the spectrum. METHODS:All 1018 individuals of different age groups and sex with varied religious,educational and social backgrounds were tested for HBsAg by ELISA.The positive samples were further tested by ELISA for HBeAg.Before testing,blood samples were preserved at-20℃.The study was conducted in a semi-urban location on the outskirts of Dhaka. RESULTS:Of the 1018 individuals,5.5%tested positive for HBsAg.None were tested positive for anti-HCV.Among the HBsAg-positive population,58.93%were HBeAg- positive and the rest 41.07%HBeAg-negative.There was a male predominance and those who were tested positive were mostly between 16 and 50 years of age.Major risk factors for exposure to HBV appeared to be injudicious use of injectable medications,treatment by unqualified, traditional practitioners,mass-vaccination against cholera and smallpox,barbers and body piercing. CONCLUSION:HBV remains a major cause of morbidity and mortality in Bangladesh and we have a long way to go before we may bid farewell to this deadly menace.展开更多
BACKGROUND: Fulminant hepatic failure (FHF) is not uncommon in our clinical practice in Bangladesh. There was a rise in acute hepatitis E virus (HEV) in Bangladesh after the 2004 floods. At that time, most of the coun...BACKGROUND: Fulminant hepatic failure (FHF) is not uncommon in our clinical practice in Bangladesh. There was a rise in acute hepatitis E virus (HEV) in Bangladesh after the 2004 floods. At that time, most of the country was under water for more than a month, leading to sewage contamination of the water supply. The aim of this study was to investigate the etiology of FHF in Bangladesh. METHODS: In this retrospective study, 23 patients with FHF who presented with severe impairment of hepato- cellular function (i.e. encephalopathy, coagulopathy and jaundice) within 6 months of onset of symptoms were included. There were 17 men and 6 women, aged from 18 to 32 years. Four of the women were pregnant. Patients were tested for markers for common hepatotrophic viruses. A relevant history was taken and the Patient Record Book of the Unit was reviewed. RESULTS: 56.52% patients (13/23) had HEV infection, and all were anti-HEV IgM-positive tested by ELISA. HBV infection was detected in 34.78% patients (8/23), all of whom were tested positive for either HBsAg or anti-HBs IgM by ELISA. 8.7% patients (2/23) had a positive history for intake of alcohol and/or drugs. CONCLUSIONS: Acute HEV infection is the leading cause of FHF in Bangladesh. Sewage contamination of the water supply following floods contributes to a higher incidence of HEV infection. HBV infection is also important.展开更多
BACKGROUND:Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV).The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%.It has been estimated that this virus i...BACKGROUND:Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV).The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%.It has been estimated that this virus is responsible for 10%-35%cases of acute viral hepatitis,35.7%cases of fulminant hepatic failure, 33.3%-40.5%cases of chronic hepatitis and 46.8%cases of hepatocellular carcinoma in Bangladesh.The aim of this study is to compare the correlation between HBV DNA load and grade and stage of liver disease in patients with chronic hepatitis B(CHB). METHODS:Percutaneous liver biopsies done in 159 CHB patients revealed 62.9%(100 patients)had wild type HBV infection and the rest 37.1%(59)had pre-core/core promoter mutant HBV infection.HBV DNA load was measured using PCR in all patients. RESULTS:In the wild type CHB group,97%(97 patients) had moderate to high HBV DNA load and 3%(3)had low to moderate HBV DNA.In the pre-core/core promoter mutant group,74.6%(44 patients)had moderate to high HBV DNA and the rest 25.4%(15)had low to moderate HBV DNA.The patients with moderate to high HBV DNA of the patients with wild type CHB,78.4%(76 patients) had minimal to mild chronic hepatitis(HAI-NI 0-8)and 21.6%(21)had moderate to severe chronic hepatitis(HAI- NI 9-18).66.6%(2 patients)and 33.3%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively.In the moderate to high HBV DNA group,77.3%(75 patients) patients had minimal to moderate fibrosis(HAI-F 0-2)and 22.7%(22)(HAI-F 3-4)had severe fibrosis to cirrhosis.These figures were 33.3%(1 patient)and 66.6% (2)respectively in the patients with low to moderate HBV DNA load.On the other hand in case of patients with pre-core/core promoter mutant type CHB,in the moderate to high HBV DNA group,79.5%(35 patients)had minimal to mild chronic hepatitis(HAI-NI 0-8)and 20.5%(9)had moderate to severe chronic hepatitis(HAI-NI 9-18).93.3% (14)and 6.7%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively.In the moderate to high HBV DNA group,68.2%(30 patients)had minimal to moderate fibrosis(HAI-F 0-2)and 31.8%(14)(HAI-F 3-4)had severe fibrosis to cirrhosis.These figures were 86.7%(13)and 13.3%(2)respectively in patients with low to moderate HBV DNA load. CONCLUSIONS:The study shows that high HBV DNA load does not correlate with necro-inflammatory activity or extent of fibrosis in the liver in patients with either wild type or pre-core mutant type CHB.展开更多
Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleed...Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleeding worldwide.The outcome depends on bleeding and its complications as well as the severity of the underlying liver disease.Careful volume resuscitation,administration of antibiotics and vasoactive drugs,and early endoscopic therapy prevent rebleeding and death.People living in rural areas are first referred to a district hospital from the Upazila health complex for any medical emergency.So,commencing the resuscitation process as well as administration of the vasoactive drug(terlipressin)at the first attending hospital before being referred to a higher center will decrease the mortality in patients presenting with acute variceal bleeding.展开更多
文摘BACKGROUND:Hepatitis B virus(HBV)infection is a major cause of mortality and morbidity globally.The quest continues to identify viral factors that influence disease progression and severity as well as responses to treatment of HBV infection.Based on variations in HBV,the virus has been divided into a number of genotypes. DATA SOURCES:Review of published literature on HBV genotypes. RESULTS:HBV genotypes are likely to be important in determining the severity and progression of HBV-induced liver disease as well as responses to different anti-viral agents. CONCLUSION:Although HBV genotyping is not yet recommended for routine use in treating HBV infection, available data suggest that,as in hepatitis C virus infection, HBV genotyping is also likely to become a routine investigation for HBV treatment,perhaps in the not too distant future.
文摘BACKGROUND:Acute-on-chronic liver failure(ACLF) is common in Bangladesh.Acute viral E hepatitis is sporadically encountered in this country each year,with a rising incidence in the rainy season.This study aimed to identify the etiology of ACLF in Bangladesh. METHODS:In this retrospective study,69 ACLF patients were included.They presented to our department at the Bangabandhu Sheikh Mujib Medical University in Dhaka.History of diseases was recorded and appropriate investigations were conducted in all patients. RESULTS:Acute hepatitis E virus(HEV)infection was positive in 21.7%(15/69)of the patients,while 14.5% (10/69)had septicemia.Upper gastrointestinal tract hemorrhage was seen in 4.3%of the patients(3/69),while another 4.3%(3/69)had a positive history for alcohol or drugs.None of the patients tested positive for hepatitis A virus infection and no evidence of hepatitis B virus flare was found in any patient.No specific cause for ACLF could be identified. CONCLUSIONS:Acute HEV infection is a leading cause of ACLF in Bangladesh.Many patients were thought to have decompensation of cirrhosis,but subsequently were recognized as having ACLF by a retrospective review according to the definition of the Asian Pacific Association for the Study of the Liver Working Party Meeting on ACLF in New Delhi in early 2008.
文摘BACKGROUND:Bangladesh is a densely populated country where about 10 million people are chronically infected with hepatitis B virus(HBV).The aim of the present study was to evaluate the biochemical,virological and histological characteristics of HBeAg-negative chronic hepatitis B(CHB). METHODS:Patients were included in this study if they were chronically infected with HBV with detectable DNA.The patients who were co-infected with human immunodeficiency virus,hepatitis delta virus or hepatitis C virus,and previously subjected to antiviral treatment,and those with hepatocellular carcinoma were excluded.The study was conducted during the period of January 2001 to December 2007.During this period 2617 patients with CHB were studied.HBeAg-positive cases were included to compare the characteristics.Among them,237 cases underwent liver biopsy. RESULTS:2296 patients(87.7%)were male,with a mean age of 28.9±13.7 years.2375 patients(90.8%)had CHB,and 242(9.2%)were cirrhotic.HBV DNA levels were 7.6±1.5 copies/ml,ALT was 111.3±212.5 U/L,and AST was 91.5± 148.9 U/L.The number of HBeAg-negative CHB cases was 1039(39.7%).HBeAg-negative patients with a lower DNA load were older,and they had more fibrotic changes in the liver than HBeAg-positive patients.The two groups did not differ in necroinflammatory activity,but the former had lower ALT and AST values.Cirrhosis was more common in e-antigen-negative patients.CONCLUSIONS:e-antigen-negative CHB patients are older and have more hepatic fibrosis patients than HBeAg-positive patients,although they have similar necroinflammatory activity.
文摘BACKGROUND:Hepatitis B virus(HBV)is encountered sporadically the year round in Bangladesh.It results in a wide range of liver diseases,with asymptomatic acute hepatitis at one end to hepatocellular carcinoma(HCC)at the other end of the spectrum. METHODS:All 1018 individuals of different age groups and sex with varied religious,educational and social backgrounds were tested for HBsAg by ELISA.The positive samples were further tested by ELISA for HBeAg.Before testing,blood samples were preserved at-20℃.The study was conducted in a semi-urban location on the outskirts of Dhaka. RESULTS:Of the 1018 individuals,5.5%tested positive for HBsAg.None were tested positive for anti-HCV.Among the HBsAg-positive population,58.93%were HBeAg- positive and the rest 41.07%HBeAg-negative.There was a male predominance and those who were tested positive were mostly between 16 and 50 years of age.Major risk factors for exposure to HBV appeared to be injudicious use of injectable medications,treatment by unqualified, traditional practitioners,mass-vaccination against cholera and smallpox,barbers and body piercing. CONCLUSION:HBV remains a major cause of morbidity and mortality in Bangladesh and we have a long way to go before we may bid farewell to this deadly menace.
文摘BACKGROUND: Fulminant hepatic failure (FHF) is not uncommon in our clinical practice in Bangladesh. There was a rise in acute hepatitis E virus (HEV) in Bangladesh after the 2004 floods. At that time, most of the country was under water for more than a month, leading to sewage contamination of the water supply. The aim of this study was to investigate the etiology of FHF in Bangladesh. METHODS: In this retrospective study, 23 patients with FHF who presented with severe impairment of hepato- cellular function (i.e. encephalopathy, coagulopathy and jaundice) within 6 months of onset of symptoms were included. There were 17 men and 6 women, aged from 18 to 32 years. Four of the women were pregnant. Patients were tested for markers for common hepatotrophic viruses. A relevant history was taken and the Patient Record Book of the Unit was reviewed. RESULTS: 56.52% patients (13/23) had HEV infection, and all were anti-HEV IgM-positive tested by ELISA. HBV infection was detected in 34.78% patients (8/23), all of whom were tested positive for either HBsAg or anti-HBs IgM by ELISA. 8.7% patients (2/23) had a positive history for intake of alcohol and/or drugs. CONCLUSIONS: Acute HEV infection is the leading cause of FHF in Bangladesh. Sewage contamination of the water supply following floods contributes to a higher incidence of HEV infection. HBV infection is also important.
文摘BACKGROUND:Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV).The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%.It has been estimated that this virus is responsible for 10%-35%cases of acute viral hepatitis,35.7%cases of fulminant hepatic failure, 33.3%-40.5%cases of chronic hepatitis and 46.8%cases of hepatocellular carcinoma in Bangladesh.The aim of this study is to compare the correlation between HBV DNA load and grade and stage of liver disease in patients with chronic hepatitis B(CHB). METHODS:Percutaneous liver biopsies done in 159 CHB patients revealed 62.9%(100 patients)had wild type HBV infection and the rest 37.1%(59)had pre-core/core promoter mutant HBV infection.HBV DNA load was measured using PCR in all patients. RESULTS:In the wild type CHB group,97%(97 patients) had moderate to high HBV DNA load and 3%(3)had low to moderate HBV DNA.In the pre-core/core promoter mutant group,74.6%(44 patients)had moderate to high HBV DNA and the rest 25.4%(15)had low to moderate HBV DNA.The patients with moderate to high HBV DNA of the patients with wild type CHB,78.4%(76 patients) had minimal to mild chronic hepatitis(HAI-NI 0-8)and 21.6%(21)had moderate to severe chronic hepatitis(HAI- NI 9-18).66.6%(2 patients)and 33.3%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively.In the moderate to high HBV DNA group,77.3%(75 patients) patients had minimal to moderate fibrosis(HAI-F 0-2)and 22.7%(22)(HAI-F 3-4)had severe fibrosis to cirrhosis.These figures were 33.3%(1 patient)and 66.6% (2)respectively in the patients with low to moderate HBV DNA load.On the other hand in case of patients with pre-core/core promoter mutant type CHB,in the moderate to high HBV DNA group,79.5%(35 patients)had minimal to mild chronic hepatitis(HAI-NI 0-8)and 20.5%(9)had moderate to severe chronic hepatitis(HAI-NI 9-18).93.3% (14)and 6.7%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively.In the moderate to high HBV DNA group,68.2%(30 patients)had minimal to moderate fibrosis(HAI-F 0-2)and 31.8%(14)(HAI-F 3-4)had severe fibrosis to cirrhosis.These figures were 86.7%(13)and 13.3%(2)respectively in patients with low to moderate HBV DNA load. CONCLUSIONS:The study shows that high HBV DNA load does not correlate with necro-inflammatory activity or extent of fibrosis in the liver in patients with either wild type or pre-core mutant type CHB.
文摘Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleeding worldwide.The outcome depends on bleeding and its complications as well as the severity of the underlying liver disease.Careful volume resuscitation,administration of antibiotics and vasoactive drugs,and early endoscopic therapy prevent rebleeding and death.People living in rural areas are first referred to a district hospital from the Upazila health complex for any medical emergency.So,commencing the resuscitation process as well as administration of the vasoactive drug(terlipressin)at the first attending hospital before being referred to a higher center will decrease the mortality in patients presenting with acute variceal bleeding.
