Hepatitis Monthly
Volume:20 Issue: 4, Apr 2020

One of the most critical health issues in the world is the COVID-19 pandemic from the Coronaviridae family. There is a lack of knowledge regarding the disease, and liver involvement is controversial.

We aimed to analyze the laboratory investigations of COVID-19 patients focusing on liver enzymes and association with outcomes.

We enrolled 93 patients with COVID-19 referring to the Mazandaran University of Medical Sciences’ hospitals and 186 people from the normal population of Tabari Cohort. The laboratory tests included CBC, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), direct bilirubin, and total bilirubin. The lengths of hospital stay, critical care transfers, and deaths were the outcome measures investigated with lab results.

The counts of lymphocytes (833.3 ± 564.4 vs. 2465.1 ± 796.6 per mm3, P < 0.001) and platelets (209.4 ± 62.7 vs. 255.2 ± 63.8 per mm3, P < 0.001) were significantly lower in patients than in controls. Also, AST (39.5 ± 34.9 vs. 19.9 ± 7.5 U/L, P < 0.001), ALT (40.4 ± 46.5 vs. 21.6 ± 12.7 U/L, P < 0.001), and ALP (192.6 ± 91.2 vs. 222.2 ± 70.6 U/L, P = 0.004) were higher in patients than in controls. The most common hepatic impairment events were increased direct bilirubin (45.8%), ALT (30.3%), AST (29.2%), ALP (17%), and total bilirubin (10.2%), in sequence. The risk of transfer to intensive and critical care units was strongly associated with elevated levels of AST and direct bilirubin, and AST = 30.5 (U/L) had a sensitivity of 71.4% and specificity of 68.5% for critical and intensive care transfer. The mortality rate significantly increased with increased AST levels (P = 0.023).

Abnormal liver enzymes are frequent in COVID-19 patients. As AST is not specific for liver damage, the systemic inflammation induced by the virus might be responsible for these findings.

The purpose of the present study was to investigate the prognostic value of serum urea for 90 days and six months’ mortality in hospitalized patients with Decompensated Cirrhosis (DeCi).

We performed a single-center, observational prospective study with data from 456 enrolled patients with DeCi. The biochemical examination and patient demographics were obtained upon admission after 24 h. All patients were observed until death, loss to follow-up, or for six months. Univariate and multivariate analyses were used to determine whether serum urea was independently associated with the prognosis of DeCi patients. The AUROC was implemented to test the predictive accuracy compared to existing scores.

Serum urea was significantly higher in non-surviving patients than in surviving patients. Multivariate analysis demonstrated that the urea level was an independent predictor of 90 days’ (odds ratio: 1.084, P = 0.001) and six months’ (odds ratio: 1.070, P = 0.009) mortality. The ROC curves were established to evaluate the relative efficiencies of the urea level for predicting 90 days’ (AUROC: 0.728, P < 0.0001) and six months’ (AUROC: 0.715, P < 0.0001) mortality. The performance of the new scores, in which lg urea was added to the MELD score and the Child-Pugh score, was better than the MELD score and Child-Pugh score alone, respectively (P < 0.001).

Serum urea levels at admission may be useful for predicting long-term mortality in DeCi patients and the predictive value of MELD score and Child-Pugh score improved by adding lg urea.

This study was undertaken to assess the prevalence of HBV/HCV co-infection demographic characteristics of HIV/HBV and HIV/HCV co-infected patients and its risk factors in a group of HIV infected patients followed-up in an infectious diseases and clinical microbiology clinic.

Treatment-naïve patients attending the clinic between January 2015 and June 2018 were included. Sociodemographic characteristics of the participants, HIV infection risk factors, and laboratory findings were retrospectively evaluated using medical records.

Out of 717 patients, 645 were male with the mean age of 35.94 ± 11.69 years, of whom 270 (37.6%) were late presenters, and 377 (52.5%) were men who had sex with men (MSM). Of the patients, four out of 717 patients (0.5%) had HCV infection, and 32 (4.5%) had HBV co-infection. The heterosexual (HS) patients were significantly more likely to have HBV co-infection (P = 0.03). A comparison of the MSM and HS patients showed that the latter group of patients were significantly older and more likely to be late presenters (P < 0.001). Anti-HBc was positive in 216 of the patients (30.1%) who were considered to have previous exposure to HBV. A comparison of educational status in the patients showed that 70% of the MSM patients were high-school or university graduates (P = 0.008). Moreover, anti-HBs was positive in 65.7% of the MSM patients, and MSM and Heterosexual patients were not significantly different in terms of the presence of resolved HBV infection (P = 0.05).

Our study showed that the prevalence of HBV co-infection among the HIV infected patients was similar to the prevalence of HBV infection in the general population and that patients with the heterosexual route of transmission had higher rates of seropositivity. A high occurrence of co-infections in HS patients suggests that infections are likely to follow a chronic course in those with a delayed diagnosis. MSM patients who were known in the high-risk group for HIV infection, have higher vaccination ratios and education levels. So the efforts to increase awareness must not only be limited to high-risk groups but also all individuals.

 The hepatitis B virus (HBV) is one of the major causes of chronic liver disease. From the perspective of hospital workers (HWs), employees are at risk of hepatitis B infection because of occupational exposure. Apart from this occupational risk, health professionals may still be affected by HBV, depending on the epidemiological characteristics of the country and geographical region they live in.

 This study aimed to determine HBV, HCV, and HIV seroprevalence among HWs using data obtained from 21 hospitals located in six geographical regions in Turkey and the Turkish Republic of Northern Cyprus.

 The study was designed as a retrospective, multicentre, descriptive study. Twenty hospitals from Turkey and one hospital from the Turkish Republic of Northern Cyprus were involved in the study. The variables of the study were vaccination status against HBV and hepatitis A and HBsAg, anti-HBs, anti-HBcIgG, anti-HAV IgG, anti-HCV, anti-HDV, and anti-HIV serology results belonging to the previous year.

 Women constituted 58.9% (n = 5,622) of the HWs included in the study. The mean age was 36.3 ± 9.09 years (min = 18, max = 72). In terms of occupation, 42.5% (n = 4,064) were nurses/health officers, and 24.8% (n = 2365) were physicians. HBsAg seroprevalence was found to be 1.8% (n = 169; 95% CI = 1.5% - 2.0%), while anti-HBs seropositivity was 75.7% (n = 7,234). About 7.3% (n = 701) had natural immunity to hepatitis B. About 21.6% (n = 2,066) of the HWs did not receive hepatitis B vaccine.

 This study is the first study involving a large sample size from different locations of Turkey. According to the results, hepatitis B and hepatitis A vaccines should be administered to susceptible individuals and HWs.

Avicennia marina (A. marina) has been traditionally used in the treatment of various diseases due to its antiinflammatory and antioxidant properties.

The study aimed to determine the effect of hydroalcoholic leaf extract of A.marinaon apoptotic, inflammatory, oxidative stress, and lipid peroxidation indices and liver histology of type 1 diabetic rats.

In this laboratory research, a total of 40 male Wistar rats were randomly divided into five groups including the control group, type 1 diabetes mellitus (DM) group, diabetic group receiving 50 mg/kg of hydroalcoholic extract of A. marina, diabetic group receiving 100 mg/kg of A. marina, and the diabetic group receiving 200 mg/kg of A. marina. The control and DM groups were intraperitoneally administered with 0.5 mL of saline solution as the solvent for 30 days. The experimental groups were intraperitoneally administered with 0.5 mL of hydroalcoholic extract at doses of 50, 100, and 200 mg/kg for 30 days, respectively. Diabetes mellitus was induced by an intraperitoneal injection of 120 mg/kg of alloxan monohydrate. At the end of treatment, we measured the serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6. Also, we assessed the levels of BCL2-associated X protein (Bax), B-cell lymphoma 2 (Bcl-2), caspase-9, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), malondialdehyde (MDA), and 8-hydroxy-2’-deoxyguanosine (HOdG-8) using ELISA in liver tissues. Histological changes in the liver were also investigated.

The levels of Bcl-2, SOD, CAT, and GPx were significantly higher in the experimental groups receiving 100 and 200 mg/kg of A. marina in a dose-dependent manner than in the DM group. The levels of Bax, caspase-9, MDA, and HOdG-8 were significantly lower in the experimental groups in a dose-dependent manner. Also, the serum levels of TNF-α, IL-1β, and IL-6 were significantly lower in these groups in a dose-dependent manner (P < 0.05). However, the differences were not significant in the experimental group receiving 50 mg/kg of A. marina (P > 0.05). The results showed that A. marina extract improved the histological changes in the liver of diabetic rats in a dose-dependent manner.

The administration of the hydroalcoholic extract of A. marina can improve liver tissue damage and reduce diabetesrelated liver complications by decreasing apoptosis, inflammation, oxidative stress, and lipid peroxidation.