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Aim of investigation. To study parameters of activity of liver tissue enzymes and blood lymphocytes in children with chronic viral hepatitis B (CVH B).Material and methods. 20 patients with CVH B in the age of 12 to 15 years were investigated: 10 children – with the 2-nd stage of process chronization and 10 – with the 3-rd stage. In liver tissue obtained at guided biopsy, and in lymphocytes discharged from blood activity of metabolic enzymes was determined by bioluminescent method.Results. Metabolic reactions in liver tissue of children depend on stage of chronization of process, at the 3-rd stage the functional lesion of liver cells it is more profound. Metabolism of lymphocytes in children depend on severity of disease as well, thus at children with the 3-rd stage of chronization more severe functional depression of lymphocytes took place.Conclusions. Intensity of reactions of metabolism of liver cells and lymphocytes in 12–15 years old children with CVH B, depends on stage of chronization of infectious process. Lesions of liver cells and lymphocytes are more profound at the 3-rd stage, than at the 2-nd. Pattern of interrelation of enzyme scores of the liver and lymphocytes allows to postulate, that the latter reflect specificity and orientation of metabolic changes in liver tissue.

Hepatitis B is an infectious disease resulting from infection with the hepatitis B virus. Chronic hepatitis B (CHB) is characterized by prolonged inflammation in the liver, the development of fibrosis, liver cirrhosis and hepatocellular carcinoma. Factors of the immune system play a critical role in the pathogenesis of CHB. Thanks to chemokines, immune cells migrate to the site of inflammation to implement their effector functions. The CX3CL1/Fractalkine chemokine is the only member of the CX3C family of chemokines with unique structural and functional properties. Its receptor CX3CR1 is expressed mainly on the surface of cytotoxic effector lymphocytes such as NK cells, TNK and cytotoxic T lymphocytes. The purpose of our study was to analyze the content of CX3CL1/Fractalkine in the blood plasma of patients with CHB and the analysis of this chemokine with liver fibrosis. The concentration of CX3CL1/Fractalkine was determined in the blood plasma of patients with CHB using a multiplex assay based on xMAP technology. Blood plasma from patients with chronic viral hepatitis C (CHC) and autoimmune liver diseases (AILD) was used as a comparison group. The control group consisted of healthy individuals. For statistical analysis of data, nonparametric statistics methods were used: Kruskal–Wallis test, Spearman correlation coefficient ROC-analysis. It was shown a reduced level of CX3CL1/Fractalkine in patients with CHB compared with the control group (p = 0.0003) and with the comparison groups of CHC (p 0.0001) and AILD (p = 0.0005). A reduced concentration of CX3CL1/Fractalkine was shown in the blood plasma of CHB patients with initial fibrosis (p = 0.0092) and severe fibrosis/cirrhosis (p = 0.0009), while in patients with severe fibrosis/cirrhosis, a significantly reduced level of this chemokine was established compared with the initial degree of liver fibrosis (p = 0.0081). Correlation analysis revealed a highly significant inverse relationship between the severity of liver fibrosis and the content of CX3CL1/Fractalkine in the blood plasma of patients with CHB (Spearman r = –0.33; p = 0.02). Thus, the chemokine CX3CL1/Fractalkine is included in the immunopathogenesis of CHB; its reduced content is characteristic only of CHB and does not change in other chronic liver diseases. It is involved in the processes of liver fibrosis during infection with the hepatitis B virus. The concentration of the chemokine CX3CL1/Fractalkine depends on the stage of liver fibrosis in CHB, and a decrease in the level of CX3CL1/Fractalkine in the blood plasma can serve as a negative factor in the development of CHB.

Patients with rheumatic diseases infected with hepatitis B virus (HBV) are difficult to manage not only due to the presence of risk factors for the development and rapid progression of liver cirrhosis, but also due to the likelihood of reactivation of this infection. Despite the successes achieved in the fight against HBV, the virus cannot be completely defeated due to the presence of hidden forms of the disease, escaping the field of vision of a rheumatologist and an infectionist. Based on the results of the analysis of current publications, the paper presents the rationale for a complete immunological screening of patients with rheumatic diseases when prescribing antirheumatic therapy. The issues of the role of COVID-19 in the exacerbation of chronic viral hepatitis B, antiviral prevention and monitoring are discussed, the classification of antirheumatic drugs according to the risk of HBV reactivation is presented.

Objective: to evaluate the completeness of screening for hepatitis B virus (HBV) infection in HBsAg-positive patients admitted to a rheumatology hospital and to follow the history of HBV reactivation/seroversion during antirheumatic therapy. Material and methods. The results of initial and repeated (if applicable) hospitalizations were analyzed in 80 patients with rheumatic diseases (RD), including 55 (69%) women and 25 (31 %) men, with Australian surface antigen (HBsAg), admitted to the V.A. Nasonova Institute of Rheumatology from January 1, 2020 to July 20, 2022 (30 months). Results and discussion. The total number of hospitalizations to the clinic during the observation period, including repeat admissions, was 13,681. The number of hospitalizations in 80 patients with HBV infection during the observation period, including repeat admissions, was 144, of which for systemic vasculitis – 6 (8 %), other systemic connective tissue diseases – 16 (20 %), osteoarthritis and post-traumatic changes of joints – 14 (15 %), inflammatory joint diseases – 42 (54 %). Cases of HBV reactivation/seroverion, both in anamnesis and during observation, were detected in 9 (11 %) patients, and most frequently (n = 5) they were registered during methotrexate therapy. Conclusion. HBV infection in patients with RD leads to significant difficulties in the selection of drug therapy, due to the risk of reactivation of the infection. The results obtained indicate incomplete screening of patients with RD for HBV infection during the preclinical phase. Further investigation is needed to develop clear recommendations for the management of patients with RD infected with HBV.

Hepatitis B virus (HBV) infection is a global health challenge, and clearance or persistence of HBV is mostly determined by host immune responses, Therefore, this study aimed to determine HBV effects in chronic HBV patients living in Baghdad receiver operating characteristic (ROC) analysis. The impact of HBV genotypes on liver-function parameters was explored A case-control study was conducted during June-October 2018 on 80 chronic HBV patients and 96 matched control. The results revealed that most patients were males 50 (62.5%), while female patients accounted for 30 (37.5%). The sera of patients were positive for anti-HBc (hepatitis B core antigen) IgG and -HbsAg (hepatitis B surface antigen) antibodies, while they were negative for anti-Hbc IgM antibody. Such profile is consistent with the interpretation of chronic HBV infection. Four liver-function tests (LFTs); total serum bilirubin (TSB), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were assessed. Significantly increased levels of ALP, ALT and AST were observed in HBV patients compared to normal healthy control, while TSB showed no significant variation. However, in receiver operating characteristic (ROC) analysis, only ALP and AST occupied an excellent area under curve (AUC > 0.90).

Objective: To evaluate the diagnostic efficacy of chronic viral hepatitis B (CHB) with significant liver fibrosis (S2) in patients with nonalcoholic fatty liver disease (NAFLD) by using noninvasive diagnosis and their combined models, and to explore their clinical features. Methods: A total of 104 inpatients with CHB diagnosed and complicated with NAFLD (hepatic steatosis suggested by liver biopsy) were retrospectively collected from January 2018 to January 2023 in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University. Liver biopsy was performed in all patients. General data, laboratory test results, liver hardness (LSM), FIB-4, APRI, GGT/PLT, AST/PLT and other results of patients were collected and grouped according to different fibrosis stages (S) to explore the clinical and pathological characteristics of patients with

Tenofovir disoproxil fumarate is the first-line antiviral therapy for chronic viral hepatitis B, but long-term use is associated with renal failure and hypophosphatemic osteomalacia. Tenofovir disoproxil fumarate-induced osteoporosis and secondary hyperparathyroidism are less commonly reported. Herein, we describe the case of a patient with bone and multijoint pain who was initially misdiagnosed as having normocalcemic primary hyperparathyroidism associated with prolonged exposure to tenofovir disoproxil fumarate. The patient's 24-h urinary calcium and phosphorus excretion levels and serum calcium levels were at the lower end of the normal range. After reviewing these findings, the diagnosis was amended to osteoporosis and secondary hyperparathyroidism caused by tenofovir disoproxil fumarate. In this report, we describe the differences in clinical and laboratory manifestations of hyperparathyroidism induced by tenofovir disoproxil fumarate and normocalcemic primary hyperparathyroidism. We also discuss relevant pathophysiological mechanisms and propose a feasible treatment strategy. [ABSTRACT FROM AUTHOR]

Background and Aim: Early diagnosis and treatment of chronic hepatitis B (CHB) disease are important for the prevention of complications such as cirrhosis and hepatocellular cancer. Liver biopsy is an invasive, complicated, and expensive diagnostic method, which is the gold standard for detecting fibrosis. The aim of this study was to investigate the role of these tests in predicting liver fibrosis and treatment decision. Materials and Methods: A total of 1051 patients diagnosed with CHB between 2010 and 2020 in the Gaziantep University Gastroenterology Department were retrospectively evaluated. AAR, API, APRI, FIB-4, KING score, and FIBROQ score were calculated at the time of onset diagnosis. In addition, the Zeugma score, a new formula that is thought to be more sensitive and specific, was determined. Noninvasive fibrosis scores were compared according to the biopsy results of the patients Results: In this study, the area values under the curve were 0.648 for the API score, 0.711 for the APRI score, 0.716 for the FIB-4 score, 0.723 for the KING score, 0.595 for the FIBROQ score, and 0.701 for the Zeugma score (p<0.05). No statistically significant difference was obtained for the AAR score. The KING, FIB-4, APRI, and Zeugma scores were the best indicators for detecting advanced fibrosis. For KING, FIB-4, APRI, and Zeugma scores, the cutoff value for the prediction of advanced fibrosis were ≥8.67, ≥0.94, ≥16.24, and ≥9.63 with a sensitivity of 50.52%, 56.77%, 59.64%, and 52.34%, specificity of 87.26%, 74.96%, 73.61%, and 78.11%, respectively (p<0.05). In our study, we compared the globulin and GGT parameters with fibrosis, which we used in the Zeugma score formula. Globulin and GGT mean values were significantly higher in the fibrosis group (p<0.05). There was a statistically significant correlation between fibrosis and globulin and GGT values (p<0.05, r=0.230 and p<0.05, r=0.305, respectively). Conclusion: The KING score was found to be the most reliable method for the noninvasive detection of hepatic fibrosis in patients with chronic HBV. The FIB-4, APRI, and Zeugma scores were also shown to be effective in determining liver fibrosis. It was shown that the AAR score was not sufficient for detecting hepatic fibrosis. The Zeugma score, a novel noninvasive test, is a useful and easy tool to evaluate liver fibrosis in patients with chronic HBV and has better accuracy than AAR, API, and FIBROQ. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis B (CHB) patients who are under the treatment of antiviral agents should be monitored in routine control visits. However, during the COVID-19 pandemic, the visits were interrupted. Objectives: This study aimed to investigate whether these patients were affected regarding clinical, laboratory, and treatment outcomes. Methods: This prospective study consisted of CHB patients aged > 18 who were applied to 3 tertiary centers between 14 February and 30 March 2022. The patients were selected from the ones who regularly applied to outpatient clinics and under the treatment of antiviral agents before the pandemic. The demographic and laboratory values, including serologic, biochemistry, and molecular results, were compared between the 2 groups who came and did not come to control visits. Results: A total number of 220 patients were included. More than half (n = 142, 64.5%) were female. The median age was 44 years (19 - 73). A hundred and forty-two (64.5%) patients did not come to control visits during the pandemic. The most common reason was anxiety about COVID-19. The tenofovir treatment was replaced with entecavir (ETV) due to osteopenia and with alafenamide due to osteopenia and/or renal failure. The previous agents were re-started in 27 (79.5%) patients who discontinued the treatment. Conclusions: The COVID-19 pandemic negatively impacted the follow-up of CHB patients. In this regard, 15.5% of patients stopped their treatments. The patients who stopped their follow-ups and continued tenofovir disoproxil fumarate (TDF) had proteinuria and decreases in bone mineral density (BMD) and estimated glomerular filtration rate (eGFR) levels. [ABSTRACT FROM AUTHOR]

Chronic viral infections represent a leading cause of global morbidity and mortality. Chronic HBV, HCV, and HIV infections result in cytokine perturbations that may hold key implications in understanding the complex disease mechanisms driving virus persistence and/or resolution. Here, we determined the levels of various plasma cytokines using a commercial Bio-Plex Luminex cytokine array in chronic HBV (n = 30), HCV (n = 15), and HIV (n = 40) infections and correlated with corresponding plasma viral loads (PVLs) and liver parameters. We observed differential perturbations in cytokine profiles among the study groups. The cytokines levels positively correlated with PVL and liver transaminases. The monocyte-derived cytokines viz., MIP-1β, IL-8, and TNF-α, and Th2 cytokines like IL-4, IL-5, and IL-13 showed a better correlation with liver enzymes as compared to their corresponding PVLs. Our investigation also identified two cytokines viz., IL-5 and IL-7 that inversely correlated with HBV DNA and HIV PVLs, respectively. Regression analysis adjusted for age showed that every increase of IL-5 by one unit was associated with a reduction in HBV PVL by log10 0.4, whereas, every elevation by a unit of IL-7 was associated with decreased HIV PVL by log10 2.5. We also found that IL-7 levels correlated positively with absolute CD4+ T cell counts in HIV-infected patients. We concluded that plasma IL-5 and IL-7 may likely have a key role on viral control in HBV and HIV infections, respectively. A noteworthy increase in cytokines appears to bear protective and pathological significance, and indeed is reflective of the host’s versatile immune armory against viral persistence.

Hepatitis B is most common among young people, which is explained by the ways of infection – parenteral, sexual and vertical. Mother-to-child transmission is the main route of infection for children in areas where the hepatitis B virus (HBV) is endemic.The available current data on the course and outcomes of chronic viral hepatitis B are contradictory in pregnant women. Some authors argue that the exacerbation of chronic hepatitis B is more common in the first and third trimesters in pregnant women, and with an increase in gestation, there is a deterioration in liver function and an increased risk of fulminant liver failure. Other researchers note a more severe course in the second half of pregnancy or in the first months after delivery.High replication of the virus increases the frequency of gestational diabetes mellitus, hemostatic disorders, the threat of termination of pregnancy, gestosis, fetoplacental insufficiency, risk of bleeding in childbirth, premature birth, untimely discharge of amniotic fluid, and the birth of premature babies.Children become chronic carriers of HBsAd in neonatal hepatitis. These findings suggest that transplacental infection before birth may be a mechanism contributing to higher rates of failed prevention in newborns born to women with a high viral load.We could not find data on the features of the course and outcomes of viral hepatitis D in pregnant women in the available sources,. At the same time, it is known that mixed infection is more severe.Polymorphisms of genes associated with the regulation of the state of the vascular wall can have a significant impact on the course of infection.The high prevalence of hepatitis D infection in different parts of the world indicates the need for a comprehensive study of this disease, followed by the development of special programs for the prevention, early diagnosis and treatment of hepatitis B and D in pregnant women.

Radmila Karpova,1 Andrey Gorbunov,1 Marina Mnatsakanyan,2 Aleksandr Pogromov,2 Irina Sokolova,2 Yuliya Shumskaya,2 Ksenia Russkova,3 Kirill Chernousov,1 Daria Momatyuk3 1Department of Faculty Surgery No.1, University Clinical Hospital No.1, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; 2Department of Hospital Therapy No.1, University Clinical Hospital No.1, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; 3Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, RussiaCorrespondence: Ksenia RusskovaInstitute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya st, Moscow, 119991, RussiaTel +79050164054Email russkova.ksy@gmail.comAbstract: Splenic marginal zone lymphoma (SMZL) is a type of non-Hodgkin’s lymphoma (NL) that occurs in 2 out of 100 cases and is more common in women aged > 60 years. A sluggish, asymptomatic course of the disease does not exclude transformation into a malignant form that occurs in 25% of patients with SMZL. Another equally important sign of an NL is thrombosis that occurs in 3.6% to 17.1% of the cases. In this report, we present a case of emergency splenectomy in a patient owing to difficulties in the diagnosis of SMZL, rapid onset of acute portal vein thrombosis, and the fulminant enlargement of the spleen accompanied by an increased risk of its rupture. Chronic hepatitis B was likely the trigger for transformation of the disease to an aggressive course. Portal vein thrombosis and the aggressive course of SMZL with rapid enlargement of the spleen and threat of its rupture in the background of viral hepatitis B required emergency splenectomy followed by anticoagulant, antiviral, and antitumor therapy.Keywords: splenic marginal zone lymphoma, SMZL, portal vein thrombosis, emergency splenectomy, chronic viral hepatitis B

The significant spread of chronic viral hepatitis in Ukraine and the whole world, an increase in the incidence of medical personnel, and the lack of wariness of the population regarding the diseases of this group make it necessary to have a statistical analysis of the etiology, diagnosis, treatment, and prevention of viral hepatitis among different population groups.Aim. To study and analyze the awareness about viral hepatitis B (HBV) and C (HCV) of patients who undergo treatment in various departments (infectious, surgical, therapeutic) and the students who didn't take the course of infectious diseases.Materials and methods. A questionnaire was developed to establish the level of awareness among patients with viral hepatitis. The study was conducted through a sociological survey (full-time, one-time, individual) with the preservation of confidentiality conditions. The study was conducted in the infectious department of Sumy Regional Infectious Diseases Clinical Hospital named after ZY Krasovitsky, Surgical Department of Sumy City Clinical Hospital №5, therapeutic department of Sumy Regional Clinical Hospital of the 4th year of Sumy State University Medical Institute in 2019. In total, 147 people took part in the survey: 20 were in treatment at the therapeutic ward, 20 - in the surgical ward, 20 - in the infectious diseases department, and 20 - 4th-year students.Conclusions. Viral hepatitis is currently one of the most pressing health problems. It is used for the sociological survey we developed to determine the level of knowledge of the population about the causative agent of viral hepatitis, transmission, prevention (not specific and specific), clinical features, laboratory methods of diagnosis, and treatment.Among all the surveyed results, recipients gave most of the correct answers to questions about the causative agent of viral hepatitis and transmission routes. The worst known are patients in the surgical wards about the presence of an effective hepatitis B vaccine (20.00%); patients of infectious and therapeutic wards (20.00% each) and 4th-year students (25.00%) - about the presence of effective hepatitis C therapy; (95.00%) and a reference group of physicians (100.00%) on the etiology of viral hepatitis. Patients in surgical wards (84.30%) answered the most frequently asked questions about the ways of transmission of viral hepatitis.

Infection caused by hepatitis B virus (HBV) remains an important global public health problem with high morbidity and mortality. In modern rheumatology the problem of HBV as a comorbid infection deserves undoubted attention, especially in immune inflammatory rheumatic diseases (IIRD). This fact makes it necessary to modify the treatment tactics of patients receiving modern antirheumatic therapy, including basic anti-inflammatory (BAID) and genetically engineered biological drugs (GEBD). Given the expected further increase in the use of GEBD and new oral targeted BAID (Janus kinase inhibitors) in the treatment of rheumatic diseases, rheumatologists should be aware of the potential risk, recommendations for screening and opportunities for prevention and monitoring of HBV-reactivation (HBV-r). Most of the literature on HBV-r has been obtained from haematology and oncology, which uses combinations of drugs with higher immunosuppressive potential, usually for a short period of time (months). This data should be interpreted with caution in regard to rheumatic diseases, where immunosuppression intensity is lower and therapy duration is longer (several years). In recent years, an attempt has been made to stratify the HBV-r risk according to the patient’s serological status and the type and duration of immunosuppressive treatment used. Based on the above factors, the American Gastroenterological Association has classified the risk of HBV-r as low (10%). However, appearance of new drugs and longer duration of their use in rheumatic diseases, wherethere are usually no established timeframes for discontinuation of treatment, require additional explanation of the recommendations on the curation and monitoring of HBV-r. This article presents modern data on HBV-r risk in patients with HBV during treatment with various BAID and GEBD, emphasizes the importance of screening examination for HBV-infection before the planned immunosuppressive therapy and highlights issues related to the tactics of prescribing antiviral prophylaxis and monitoring of these patients condition.

Purpose of the study: to prove the pathological effect of chronic viral hepatitis on sexual development (SD) and menstrual function of adolescent girls by analyzing the secondary sexual characteristics and to determine the features of disorders of menstrual function (DMF) in such patients. Materials and methods. The study involved 150 girls of pubertal age (12–17 years) who were divided into groups: the main group (n = 50) – patients with DMF and SD on the basis of chronic viral hepatitis B and C; comparison group (n = 50) – patients with DMF and SD on the basis of hepatobiliary system diseases (cholecystitis, dyskinesia of the biliary tract); control group (n = 50) – almost healthy girls. All patients underwent clinical analysis of menstrual function, appearance and development of secondary sexual characteristics, clinically determined the degree of SD and SD score calculated. Results. The whole spectrum of DMF in the main and comparison group was revealed. There were more patients with hypomenstrual type of DMF in the main group than in the comparison group: 37 (74%) against 28 (56%) (p

Hepatitis B virus (HBV) is often found and associated with immune-mediated inflammatory rheumatic diseases (IMIRDs), necessitating the modification of both antiviral and antirheumatic therapies. The review provides basic information about the structure of HBV, the course of chronic HBV infection, and the prevention of HBV reactivation in patients with IMIRDs who receive immunosuppressive therapy.

Patients with rheumatic diseases infected with hepatitis B virus (HBV) are difficult to manage not only due to the presence of risk factors for the development and rapid progression of liver cirrhosis, but also due to the likelihood of reactivation of this infection. Despite the successes achieved in the fight against HBV, the virus cannot be completely defeated due to the presence of hidden forms of the disease, escaping the field of vision of a rheumatologist and an infectionist. Based on the results of the analysis of current publications, the paper presents the rationale for a complete immunological screening of patients with rheumatic diseases when prescribing antirheumatic therapy. The issues of the role of COVID-19 in the exacerbation of chronic viral hepatitis B, antiviral prevention and monitoring are discussed, the classification of antirheumatic drugs according to the risk of HBV reactivation is presented.

Introduction: To explore the influence of intestinal flora on the occurrence, development and antiviral therapy of chronic hepatitis B (CHB), 16S rDNA amplification sequencing was performed to investigate the intestinal flora in CHB patients treated with entecavir (ETV) and Clostridium butyricum (CB). Methods: CHB patients were divided into the ETV group (treatment with ETV alone) and ETV + CB group (treatment with ETV and CB). After 8-week treatment, feces samples were collected and processed for 16S rDNA amplicon sequencing; blood samples were collected for the biochemical, immunologic and virologic evaluations, which were compared between groups. Results: ETV treatment for 8 weeks significantly decreased the serum levels of alanine aminotransferase (ALT), interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α) and HBV DNA compared to those before treatment, but there were no marked differences between the ETV group and ETV + CB group. The intestinal flora changed significantly in the CHB patients after ETV + CB treatment: there were marked differences in 13 unique species before treatment and 4 unique species after ETV + CB treatment; at the phylum level, the top five bacteria with significant difference between patients before treatment and ETV + CB patients were Firmicutes, Actinobacteria, Cyanobacteria, Euryarchaeota and Synergistetes. There were significant differences in 25 unique species in the ETV group and 4 unique species in the ETV + CB group; at the phylum level, the top five bacteria with significant difference between ETV patients and ETV + CB patients were Actinobacteria, Fusobacteria, Proteobacteria, Saccharibacteria and Synergistetes. Conclusion: ETV treatment improves the serum biochemical, immunologic and virologic variables, but additional CB fails to further improve these variables. Of note, additional CB affects the intestinal flora in the CHB patients treated with ETV. [ABSTRACT FROM AUTHOR]

Detecting new units of pathogenesis in the liver fibrosis due to alcoholism, chronic viral Hepatitis B and C, non-alcoholic fatty liver disease (NAFLD), autoimmune, parasitic and metabolic diseases and other, reveals perspective for new non-invasive serum biomarkers. In fibrosis, from the wide variety of markers enzymes, proteins and cytokines are mainly used. While direct biomarkers reflect the stage of fibrosis and fibrinogenesis, indirect markers allow assessment of the general liver functions. The combination of direct and indirect markers increases the diagnostic reliability and therefore these panels and indices are investigated quite intensively in recent years in order to decrease the number of liver biopsies without completely replace it, which is still regarded as the reference method.

Objective: To investigate the clinical efficacy of thymalfasin combined with entecavir in the treatment of chronic viral hepatitis B and its Influence on the serum HA, IV-C, LN levels and immune function. Methods: 102 cases of patients with CVHB admitted in our hospital from June 2013 to July 2017 were selected and evenly divided into two groups on the basis of random number table. The control group (51 patients) was treated with entecavir, while the observation group(51 patients) was combined with thymalfasin and entecavir. The clinical efficacy, changes of serum HA, Ⅳ-C, LN and peripheral blood T-cell subsets levels before and after treatment, as well as the occurrence of adverse reactions were recorded and compared between the two groups. Results: After 48 weeks of treatment, the overall effective rate of observation group reached 84.3%, which was much higher than that of the control group (P<0.05). Compared with those before treatment, the serum HA, Ⅳ-C, LN levels of both groups after 48 weeks of treatment decreased remarkably (P<0.01), the levels of CD3+, CD4+and CD4+/CD8+in peripheral blood were significantly higher than those before treatment(P<0.01), and the levels of serum HA, IV-C and LN in the observation group were significantly lower than those in the control group(P<0.01). The levels of CD3+, CD4+and CD4+/CD8+in peripheral blood were significantly higher than those before treatment(P<0.01).During the treatment, the adverse reaction rates of the control group and the observation group were 7.8% and 11.8%, respectively, and the difference was not statistically significant (P>0.05). Conclusion: Compared with ETV alone, thymus combined with ETV treatment of CVHB can effectively eliminate/alleviate the symptoms and signs of patients, improve their immune function and efficacy, and high safety, which may reduce serum HA, IV-C, LN levels. related. [ABSTRACT FROM AUTHOR]

Chronic viral hepatitis is a public health issue both worldwide and in Romania, where the prevalence of the disease is still high. We present the available therapies used for chronic viral hepatitis B treatment in children, worldwide and in Romania, indications and contraindications of treatment, benefits and disadvantages for each class. The present paper reviews only the treatment options and not profilactic measures for pediatric chronic viral hepatitis B. Currently, in Romania, standard Interferon is the treatment of choice. Entecavir is the only of the nucleotidic/nucleosidic analogues which is approved for children use, but not in those weighting less than 32.6 kg. Tenofovir, Adefovir and Lamivudine are not approved for pediatric chronic viral hepatitis B. Considering the fact that the disease progression is longer when the infection occurs earlier in life, efficient treatment is important for children with chronic viral hepatitis B. The availability of more treatment options provides a chance for patients who are nonresponsive to first line therapies.

Objective: To evaluate relationships between virological and morphological data in patients with chronic hepatitis B in phase immune control and reactivation.Materials and methods: The study involved 46 patients with chronic hepatitis B, indicators defined were content of surface antigen and hepatitis B virus DNA in the peripheral blood, the level of covalently closed circular HBV DNA in liver tissue and fibrosis stage and histological activity index (METAVIR).Results: The study found a direct correlation between the level of covalently closed circular DNA in liver puncture biopsies (number of copies per cell) and quantitative content of HBsAg in serum (r = 0,51, p = 0,03) in patients with chronic hepatitis B in phase immune control. Also in the immune control phase a direct correlation between the HBV DNA and the level of HBsAg in serum (r = 0.79, p = 0.0001) is shown. The level of covalently closed circular HBV DNA in liver puncture biopsy specimens did not differ in patients with chronic hepatitis B in the phase of immune control in the phase of reactivation (1,02 ± 0,01 copies / cell and 1,03 ± 0,03 copies / cell, p = 0.72). The index of histological activity and fibrosis were not correlated with any of the investigated virological indicator.Conclusion: Results of the study emphasized the complexity and ambiguity of the relationships between both virological and morphological indicators in patients with chronic hepatitis B, determined the direction for further study (in particular the assessment of the epigenetic regulation of the synthesis of circular covalently closed DNA), as well as set the stage for improving the principles of dynamic observing the patients with chronic hepatitis B in a phase of immune control.

Aim of investigation. To estimate epidemiologic state on viral hepatitis B in Sakha republic (Yakutia).Material and methods. Data of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) for Sakha republic (report form #1) and results of enzyme-linked immunoassay (EIA) for viral hepatitis markers (HBsAg, a-HBcor IgG, a-HDV, a-HCV) in population of 17 areas of republic were utilized.Results. In investigated region morbidity due to both acute and chronic forms of hepatitis B has a tendency to decrease. According to EIA results the prevalence of hepatitis B virus infection markers in population corresponds to criteria of intermediate intensity and for hepatitis D virus — to high intensity.Conclusions. Morbidity due to hepatitis is significantly higher: i.e. 5 times over that for the Russian Federation in general.

Chronic viral hepatitis B (CHB) still represents a significant world health problem despite obligatory and worldwide immunization against infections of viral hepatitis B. In some patients with chronic viral hepatitis B infections, in the natural course of the disease, progression towards cirhossis and hepatocellular carcinoma is primarily targeted by antiviral CHB therapy stopping further progression of the disease. Today on the market there exist two classes of pharmnaceutical drugs for treatment of CHB: a) immunomodulatory therapy with conventional interferon alpha (INF) and PEGylated interferon alpha-2a, b) and oral antiviral therapy with nucleos( t)ide analogues. Lamivudine was for quite a period the only medicament available on our market for the treatment of HVB and in most of our patients led to the development of resistance. As of two years ago, a new oral analogue from the group of nucleotides is being registered in Serbia for market use: tenofovir disoproxil (TDF). In our work we have analysed 69 patients with chronic viral hepatitis B treated in the Clinic for Infectious and Tropical Diseases KCS Belgrade in the period between years 2012 and 2014. All patients involved in this reasearch were previously treated with LAM, and on subsequent development of resistance to LAM, TDF was used. TDF showed an excellent efficacy, a high resistance barrier and very few unwanted side effects over several years of treatment. Our experience with the use of this drug does not pertain to and acount for its long term use, in view of its brief availability on our market.

• Higher MLR values are associated with 90-day mortality in patients with HBV-ACLF, and MLR can be used as a novel predictive marker to predict the prognosis of HBV-ACLF. • The predictive efficacy of MLR and NLR for HBV-ACLF 90-day mortality was comparable. Compared with traditional prediction models, MLR and NLR have the advantages of reliability, economy and convenience for blood routine parameters. • Changes in lymphocyte counts in MLR values were dominated by changes in CD8 + T cells, and a decrease in CD8 + T cell counts may be associated with poor prognosis in patients with HBV-ACLF. More studies are needed in the future to confirm and explore the potential mechanisms of lymphocyte changes in the prognostic impact of HBV-ACLF patients. Systemic inflammation is associated with the development and progression of hepatitis B-associated acute-on-chronic liver failure (HBV-ACLF). The neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic biomarker in patients with HBV-ACLF. However, the role of the monocyte-to-lymphocyte ratio (MLR) as a prognostic inflammatory biomarker in multiple diseases is rarely mentioned in HBV-ACLF. We included a total of 347 patients with HBV-ACLF who met the definition of the Chinese Guidelines for the Diagnosis and Treatment of Liver Failure (2018 edition). Among them, 275 cases were included retrospectively, and 72 cases were collected prospectively. Clinical characteristics and laboratory examination data were collected from medical records within 24 h after diagnosis to calculate MLR and NLR levels, and lymphocyte subpopulation counts were collected in prospectively included patients. Of the 347 patients with HBV-ACLF, 128 patients in the non-surviving group had a mean age of 48.87 ± 12.89 years; 219 patients in the survival group had a mean age of 44.80 ± 11.80 years and a combined 90-day mortality rate of 36.9%. The median MLR was higher in the non-survivors than in the survivors (0.690 vs 0.497, P < 0.001). MLR values were significantly associated with 90-day mortality in HBV-ACLF (OR 6.738; 95% CI 3.188–14.240, P < 0.001). The AUC for the predictive power of the combined MLR and NLR analysis for HBV-ACLF was 0.694, and the calculated MLR threshold was 4.495. In addition, in the analysis of peripheral blood lymphocyte subsets in HBV-ACLF, a significant decrease in the number of circulating lymphocytes was found in HBV-ACLF patients in the non-surviving group (P < 0.001), with a predominant decrease in the number of CD8 + T cells and no significant difference in the number of CD4 + T cells, B cells or NK cells. Increased MLR values are associated with 90-day mortality in patients with HBV-ACLF, and the MLR may serve as a potential prognostic indicator for patients with HBV-ACLF. Decreased CD8 + T-cell counts may be associated with poor survival in patients with HBV-ACLF. [ABSTRACT FROM AUTHOR]

AIM. To assess the relationship of different components of metabolic syndrome (MS), viral load, and HBeAg status to the risk for cirrhosis of the liver in patients with chronic hepatitis B (CHB). MATERIALS AND METHODS. Fifty-three patients with CHB were examined according to the conventional criteria for patients with chronic hepatitis (the 2012 EASL guidelines). Analysis is made in relation to the degree of liver fibrosis (LF), the presence of MS, abdominal obesity, and insulin resistance (IR). RESULTS. MS was detected in 22.6% of the patients with CHB. The duration of the latter in MS was noted to be longer; the patients with MS were accordingly older than those without MS. The patients of this category were significantly more frequently observed to have type 2 diabetes mellitus (DM2), and IR, hepatic steatosis, and >3 METAVIR scores for LF, and elevated activity of hepatic enzymes (alanine aminotransferase, aspartate aminotransferase). Marked LF was associated with a high viral load, obesity, DM2, patient age, and MS. The patients with MS showed a higher activity of hepatic enzymes than those with abdominal obesity without MS. CONCLUSION. The percentage of CHB patients with MS increases with disease duration and patient age. High viral load, disease duration, MS, obesity, and DM2 are associated with score >3 METAVIR scores for significant LF.

The features of the electrical and viscoelastic parameters of red blood cells obtained by dielectrophoresis in patients with chronic hepatitis B in depending on the level of viral load were investigated. It has been found that the summerized rigidity, viscosity, conductivity, index of aggregation and destruction, the relative polarizability significantly increased and polarizability at all frequencies, the velocity of cells to the electrodes, electric capacitance of membranes — decreased as ascending viremia. A marked change in the parameters of red blood cells in patients with high viral load, likely, reflects the expressed degree of disadaptation of erythrocytes. Correlation of electrical and viscoelastic parameters erythrocytes with the biochemical indices reflecting the level of dysproteinemia, cytolysis, immune-inflammatory syndrome have been installed. The data obtained allow us to supplement understanding of the pathogenesis of systemic manifestations of virus hepatitis B and association of high viral load with a significant change in the viscoelastic and electrical properties of red blood cells.

Abstract. A comparative analysis of immunological data was performed in the patients with HBV-induced liver cirrhosis, and in a group of patients with acute and chronic viral hepatitis B (AVHB, CVHB). Activation of B cell immune compartment (increase in CD22+ lymphocytes and IL4, circulating immune complexes in blood) was demonstrated in patients with liver cirrhosis, being also associated with increased numbers of CD16+ lymphocytes and T-cell deficiency. It was revealed that the differences are most expressed upon comparison of immunologic data from the patients with liver cirrhosis, and AVHB followed by clearance of the virus. When comparing these groups, the differences in immunological state between the patients with liver cirrhosis and CVHB did not depend on the phase of viral replication or integration.

Objective To explore the application value of real-time shear wave elastography(SWE)technique in diagnosing and staging of chronic viral hepatitis B and hepatic fibrosis and to establish Young’s modulus reference range for diagnosing and staging of hepatic fibrosis.Methods Forty-eight patients with chronic hepatitis B and fifty-eight healthy adults were enrolled and their Young’s modulus values of S5 and S6 segments of liver were measured. Histopathologic examination was performed on 48 patients with chronic hepatitis B. Comparative analysis was conducted between the pathological findings and Young’s modulus values, by means of which Young’s modulus reference range for diagnosis and staging of hepatic fibrosis was obtained. Results There was significant difference in Young’s modulus values of S5 and S6 segments of liver between chronic hepatitis B group and the normal control group(P <0.05). Young’s modulus values of S5 and S6 segments of liver in chronic hepatitis B group were(11.7±2.9) k Pa and(12.1±3.2) k Pa respectively,which were significantly higher than those in the normal control group,(5.7 ±1.1) k Pa and(5.8 ±1.3) k Pa respectively. Significant differences of Young’s modulus values were detected in every staging of hepatic fibrosis(P<0.05). S5 segment of liver Young’s modulus values inS0-S4 stages were(5.8±2.2) k Pa,(7.3±1.9) k Pa,(10.3±2.8) k Pa,(10.3±2.8) k Pa,and(25.3±3.6) k Pa, respectively. S6 segment of liver Young’s modulus values in S0-S4 stages were(5.7 ±2.3) k Pa,(9.2 ±2.1) k Pa,(10.5 ±2.1) k Pa,(14.7 ±4.5) k Pa, and(26.1 ±2.1) k Pa, respectively. Young’s modulus value of the liver rose with the increase of S stage. Conclusion SWE technique can establish the Young’s modulus reference range for hepatic fibrosis stage. Besides, it features high sensitivity, specificity and accuracy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of entecavir on serum levels of TNT-a and CEA in patients with chronic viral hepatitis B. Methods: 39 patients with chronic viral hepatitis B from our hospital were collected and randomly divided into experiment group and control group. 19 cases in the control group were treated with lamivudine. while another 20 cases in the experiment group were treated with entecavir. Then the serum levels of TNF-α CEA. and the liver functions and HBV DNA negative rate of the two groups before and after treatment were observed and compared. Results: The total effective rate of experiment group was 95.0%. which was higher than 73.7% in the control group, and the difference was statistical significance (P<0.05); Compared with before treatment, the serum levels of ALT. AST and TNF-a in the two groups decreased, and the experiment group were lower than those of the control group, and the differences were statistically significant (P<0.05); Compared with control group, the HBV DNA negative rate of the experiment group was higher, and the difference was statistically significant (P<0.05). Conclusion: Entecavir in the treatment of patients with chronic viral hepatitis B can effectively alleviate liver function, speculate that the mechanism is relate to reduce the TNT-a level and increase the negative rate of HBV DNA. [ABSTRACT FROM AUTHOR]

Chronic viral hepatitis is a public health issue both worldwide and in Romania, where the prevalence of the disease is still high. We present the available therapies used for chronic viral hepatitis B treatment in children, worldwide and in Romania, indications and contraindications of treatment, benefits and disadvantages for each class. The present paper reviews only the treatment options and not profilactic measures for pediatric chronic viral hepatitis B. Currently, in Romania, standard Interferon is the treatment of choice. Entecavir is the only of the nucleotidic/nucleosidic analogues which is approved for children use, but not in those weighting less than 32.6 kg. Tenofovir, Adefovir and Lamivudine are not approved for pediatric chronic viral hepatitis B. Considering the fact that the disease progression is longer when the infection occurs earlier in life, efficient treatment is important for children with chronic viral hepatitis B. The availability of more treatment options provides a chance for patients who are nonresponsive to first line therapies. [ABSTRACT FROM AUTHOR]

Chronic viral hepatitis is a public health issue both worldwide and in Romania, where the prevalence of the disease is still high. We present the available therapies used for chronic viral hepatitis B treatment in children, worldwide and in Romania, indications and contraindications of treatment, benefits and disadvantages for each class. The present paper reviews only the treatment options and not profilactic measures for pediatric chronic viral hepatitis B. Currently, in Romania, standard Interferon is the treatment of choice. Entecavir is the only of the nucleotidic/nucleosidic analogues which is approved for children use, but not in those weighting less than 32.6 kg. Tenofovir, Adefovir and Lamivudine are not approved for pediatric chronic viral hepatitis B. Considering the fact that the disease progression is longer when the infection occurs earlier in life, efficient treatment is important for children with chronic viral hepatitis B. The availability of more treatment options provides a chance for patients who are nonresponsive to first line therapies. [ABSTRACT FROM AUTHOR]

Background Hyaluronic acid (HA), ASAT to Platelet Ratio Index (APRI), ASAT/ALAT ratio, Fibrosis 4 score (FIB4) and FibroScan were studied as non-invasive markers of liver fibrosis (F) in chronic viral hepatitis B (CHB) and C (CHC), in an attempt to avoid the complications of liver puncture biopsy, considered the gold standard in the evaluation of F. The aim of our research was to study whether HA, APRI, ASAT/ALAT ratio, FIB4 and FibroScan are useful non-invasive markers in predicting severe F in Romanian patients. Patients and Methods This was a prospective multicenter transversal and observational study, which included 76 patients with CHB/CHC. The independent effect of studied markers was tested using multiple binary logistic regression. Results In patients with CHB and CHC, the APRI cut-off value for F4 was 0·70 ng/mL (Se = 77%, Sp = 78%), the FIB4 cut-off value was 2·01 (Se = 77%, Sp = 69%), and the FibroScan cut-off value was 13·15 (Se = 92%, Sp = 88%). For patients with CHB/CHC, there was a significant linear positive correlation between F and HA (r = 0·42, P = 0·001), FibroScan (r = 0·67, P < 0·001), APRI (r = 0·46, P < 0·001) and FIB4 (r = 0·51, P < 0·001). Considering age, sex and body mass index as possible confounding factors or covariates in multivariable logistic modelling, FibroScan was the unique test that able to significantly highlight the presence of F4 score in CHB/CHC patients (P = 0·009) while FIB4 test seems to have a tendency to statistical significance. Conclusion FibroScan, APRI and FIB4 are useful non-invasive tests for the evaluation of F4 in patients with CHB and CHC. [ABSTRACT FROM AUTHOR]