Hepatitis Monthly
Volume:19 Issue: 10, Oct 2019

Dexmedetomidine is a sedative and analgesic medication that is frequently used postoperatively in children after liver transplantation, hepatic dysfunction and liver failure.

The aim of this systematic review was to determine the role of dexmedetomidine in liver disease.

We systematically reviewed the literature from PubMed, Embase, Scopus, ProQuest, Web of Science, and The Cochrane Library from January 1980 to June 2019. The search strategy included a combination of Mesh and free keywords such as liver transplantation, liver diseases, liver failure, and dexmedetomidine.

From a total of 741 articles, 7 studies were included in this systematic review. In the selected studies, a total of 218 patients in the control and treatment groups were studied. Based on the Fixed effect model, MAP changes in the intervention group were 1.89 units less than the control group, which was not statistically significant (pooled mean difference = -1.89, 95% CI: -6.28 to 2.5, P value = 0.39).

DEX injection prior to anesthesia potentially had a protective effect on liver and intestinal function during hepatectomy with vascular occlusion.

Context: Mother-to-child transmission (MTCT) is one of the main transmission routes of chronic hepatitis B virus (HBV) infection. The successful rate of preventing MTCT has increased to over 90% after the administration of passive-active immunoprophylaxis (vaccine and hepatitis B immunoglobulin (HBIG)) on infants born to hepatitis B surface antigen (HBsAg)-positive mothers. However, 5%-10% of the infants had chronic HBV infection who were born to mothers with high HBV DNA levels. Therefore, the current domestic and international guidelines recommended that antiviral therapy in late pregnancy was to further decrease the MTCT rate. This study aimed at reviewing the mechanisms of MTCT and controversial issues in antiviral therapy for pregnant women with high viral load in order to provide clinicians with some strategies for preventing MTCT of HBV. Evidence Acquisition: Relevant English published papers were searched using online databases, including PubMed and EMBASE from January 2000 to January 2019. We summarized the findings of 61 relevant studies in this review.

The mechanism of MTCT is still unclear and further studies are needed. Antiviral therapy for pregnant women with high viral load can reduce the rate of MTCT and provide the appropriate safety for mothers and infants.

The mechanisms underlying MTCT of HBV is still unknown and more investigations are required. The efficacy and safety of taking tenofovir disoproxil fumarate (TDF) orally in pregnant women with high viral load in the second or third trimester of pregnancy to block MTCT of HBV have been proved. The withdrawal of antiviral therapy during pregnancy due to MTCT should not exceed 3 months after delivery at the latest. Most pregnant women tend to suffer from increased alanine aminotransferase (ALT) after discontinuing antiviral drugs during pregnancy. Accordingly, close ALT levels monitoring after drug discontinuation is essential.

Over recent decades, with the increase in the prevalence of childhood overweight/obesity, the prevalence of pediatric non-alcoholic fatty liver disease (NAFLD) has increased.

The aim of this study was to investigate the prevalence of NAFLD and its predisposing factors in overweight and obese children of Urmia, Northwest of Iran.

In this cross-sectional study, a total of 843 children aged 2 to 19 years were recruited out of 10800 children referred to the Digestive Disease Clinic of Shahid Motahari Hospital during 2016 - 2017. Anthropometric and laboratory measurements and abdominal ultrasound were performed for the children. Demographic data and their medical history were collected by a questionnaire. Unconditional logistic regression was used to predict the predisposing factors of NAFLD.

Fatty liver was diagnosed by ultrasound in 9.5% of overweight and 21.4% of obese children. The prevalence of NAFLD in obese children was 9.26% for the 2 - 5.9-year age group, 22.3% for the 6 - 11.9-year age group and 35.5% for the 12 - 19-year age group. Compared to the normal liver group, the adjusted odds ratios (ORs) [95% confidence interval (CI)] for predictive factors of NAFLD were as follows: ALT: 1.05 (1.03 - 1.09), ALK: 1.02 (1.01 - 1.03), AST: 1.04 (1.02 - 1.08), triglycerides: 1.1 (1. 08 - 1.21), TSH: 1.18 (1.1 - 1.40), FBS: 1.04 (1.01 - 1.08) and HOMA-IR: 1.19 (1.03 - 1.38). Compared to the age group of 2 - 5.9 years, the odds ratio of NAFLD was increased by 4 and 8 times in the age group 6 - 11.9 and 12 - 19 years, respectively.

There was a strong relationship between pediatric NAFLD and ALT, AST and HOMA-IR in the overweight and obese children. Our findings emphasized the importance of prevention of obesity and early intervention to prevent abnormalities among obese children.

Hepatitis B virus (HBV) infection during pregnancy is associated with an increased risk of premature birth, cesarean sections, low birth weight, and an increased number of hospitalizations in infants. There are no reported data on the impact of maternal HBV status on pregnancy and infant health outcomes in Botswana.

We aimed to evaluate the association of maternal HBsAg+/occult HBV infection at delivery with pregnancy and infant health outcomes in Botswana.

HBsAg positivity was tested using a murex HBsAg ELISA kit while occult HBV (OBI) was tested using COBAS® AmpliPrep COBAS® Taqman®.

The total number of maternal HBsAg+ and OBI infections was 57 out of 752 and termed as maternal HBV. Binary logistic regression was used to explore the possible impact of maternal HBV status on each outcome, adjusted for maternal HIV status, ART use during pregnancy, and maternal age.

In conclusion, there was no association between maternal HBsAg+/occult HBV infection and preterm birth (< 37 weeks), stillbirth, low birth weight (< 2.5 kg), and infant hospitalization (by 24 months).

Hepatitis E virus (HEV) superinfection has a significant impact on a natural course of chronic hepatitis B (CHB) patients with underlying chronic liver disease (CLD). These patients usually present with increased symptoms, rapid decompensation to liver failure, and increased mortality. An increasing rate of HEV infections worldwide with uncertainties in its prevention and treatment raises a great concern to this group of patients. Therefore, in this article, we reviewed recent studies describing the epidemiological patterns of HEV and Hepatitis B virus (HBV), both mono and dual infections. We also reviewed the literature on clinical interaction among HBV/HEV-superinfected patients with CLD and the potential preventive strategies.