Hepatitis Monthly
Volume:20 Issue: 5, May 2020

Current gold standard methods of diagnosing portal hypertension (endoscopy and hepatic vein pressure gradient) are not only invasive but also very expensive. Consequently, new non-invasive methods have been studied over the years to assess their Applicability in replacing current invasive procedures. This review explores the current use of abdominal ultrasonography, Doppler ultrasonography, contrast-enhanced ultrasonography, various elastography techniques, computed tomography, and magnetic resonance imaging in evaluating portal hypertension while exploring their advantages and disadvantages.

  We gathered data from international papers published in Pubmed/Medline, Cochrane Library, Google Scholar, Web of Science, Wiley Online Library, and Research Gate databases until October 2019. Papers analyzing the associations between non-invasive tests and either portal hypertension or its complications were included in the study.

Liver stiffness (LS) and spleen stiffness (SS), regardless of the used elastography method, have shown promising results, with liver stiffness already included in current guidelines to avoid screening endoscopy. Overall, the results suggest that SS is superior to LS for screening for portal hypertension and the presence of EV, but there is a need for additional studies to certify the data and further evaluate which would provide the most accurate assessment and if other parameters need to be included to better diagnose portal hypertension.

Liver stiffness and spleen stiffness are the best currently available methods of detecting portal hypertension but require further research. They may reduce the number of hepatic vein pressure gradient measurements and endoscopies needed for the diagnosis and follow-up of patients with portal hypertension in the future.

Hepatitis C is one of the most dangerous viral infections causing chronic liver disease.

The current study aimed to estimate the pooled prevalence of hepatitis C in Iranian prisoners.

 Articles were identified through searching international databases, including PubMed, Scopus, Elsevier, Google Scholar, and Web of Science and Iranian databases, including Scientific Information Database (SID), Health.barakatkns, IranDoc, Civilica, and MagIran. We systematically reviewed all studies reporting the prevalence of HCV in Iranian prisoners. All studies conducted ELISA tests for the evaluation of HCV antibodies. In this study, a multilevel meta-analysis method was used to estimate the pooled prevalence.

The electronic search identified 147 records, 33 of which were relevant papers used for the pooled meta-analysis of HCV prevalence. Overall, the prevalence of HCV using a multilevel meta-analysis approach was 24.88% (95% CI = 19.12 - 31.69). The highest pooled HCV rate was related to Markazi province (59.47% [95% CI = 51.70 - 67.25]), while the lowest pooled HCV rate belonged to North Khorasan province (5.00% [95% CI = 2.44 - 7.55]). A decreasing HCV prevalence trend was observed between 1995 and 2018.

The results of the study showed that the prevalence of HCV is significantly high among prisoners in Iran. An enhanced training program is needed for prisoners and prison staff to improve the prisoners’ health status

Regarding the inconsistent reports on the potential relationship between cardiometabolic disorders, including metabolic syndrome (MetS), diabetes, hypertension (HTN) and chronic kidney disease (CKD), and elevated serum levels of liver enzymes, we conducted this study to test this hypothesis.

Men and women aged ≥ 19 years participated in the sixth examination of Tehran Lipid and Glucose study (TLGS) were recruited. Anthropometric and demographic measurements, as well as biochemical tests, were done for all participants. The odds ratio of cardiometabolic disorders in each tertile category of liver function tests (LFTs), including alanine transaminase (ALT), aspartate transaminase (AST), ALT/AST ratio, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and lactate dehydrogenase (LDH) were estimated using the multivariable logistic regression models.

The mean age (± SD) of participants was 48.2 (± 17.1) years, and 42.3% of the participants were men. After adjustment for confounding variables, elevated serum concentrations of ALT, AST, ALT/AST ratio, GGT, and ALP were positively associated with increased chance of develop MetS (OR = 3.80, 95% CI = 2.46 - 5.87 for ALT, OR = 1.52, 95% CI = 1.04-2.23 for AST, OR = 3.08, 95% CI = 2.05 - 4.63 for ALT/AST ratio, OR = 2.71, 95% CI = 1.80 - 4.09 for GGT, OR = 1.64, 95% CI = 1.12 - 2.38 for ALP). Elevated serum concentrations of ALT, ALT/AST ratio, GGT and ALP were also positively associated with risk of diabetes (OR = 4.32, 95% CI = 2.40 - 7.79 for ALT, OR = 3.28, 95% CI = 1.92 - 5.61 for ALT/AST ratio, OR = 2.52, 95% CI = 1.46 - 4.34 for GGT, OR = 1.74, 95% CI = 1.05 - 2.88 for ALP). Also, increased levels of ALT, GGT and ALP were positively associated with HTN (OR = 2.63, 95% CI = 1.66 - 4.17 for ALT, OR = 2.01, 95% CI = 1.30 - 3.13 for GGT, and OR = 1.90, 95% CI = 1.26 - 2.87 for ALP). Moreover, the elevated level of LDH was positively associated with CKD (OR = 2.43, 95% CI = 1.09 - 5.43).

Based on the results of the present study, LFT could be helpful for the early detection of cardiometabolic disorders.

Hepatitis A Virus (HAV) is among the main endemic human enteric viral diseases that directly or indirectly affect children’s performance at primary schools in low-income countries. Limited information is available on the presence of HAV, with particular reference to drinking water supplies of primary schools in Sindh, Pakistan.

The present study estimated the risk of HAV infection through drinking water sources using Quantitative Microbial Risk Assessment (QMRA) in primary schools of Sindh, Pakistan.

The QMRA model was applied to estimate the potential health risks of HAV using indicator organisms, i.e., fecal coliforms. Microbial analysis was conducted using a membrane filtration method. The exponential dose-response model was used to calculate the probability of infection.

The highest daily risk of HAV infection for schoolchildren was calculated as 35.0 per 10,000 schoolchildren in Karachi district with an annual risk of 66%, whereas the lowest risk was 3.0 per 10,000 schoolchildren in Larkana with 7.8% of the annual risk. The mortality risk due to HAV ranged from 4.0 to 29 deaths per 10,000 children per year.

Overall, the drinking water quality of primary schools of Sindh was found very poor. The estimated daily and annual risks of hepatitis A to primary school children were moderate to high. To halt enteric virus transmission through drinking water sources, there is a dire need to invest in the provision of comprehensive water sanitation and hygiene facilities at schools.