Hepatitis Monthly
Volume:20 Issue: 8, Aug 2020

End-Stage Liver Disease (ESLD) causes several clinical and psychological comorbidities. Some accompanying psychiatric disturbances have significant effects on the patients’ quality of life.

Thus, we aimed to evaluate some psychological characteristics of ESLD patients.

A cross-sectional study was conducted on 91 ESLD patients aged 18 - 70 years. We assessed the patients using the California Verbal Learning Test (CVLT), Fatigue Severity Scale, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. Also, we measured the demographic and some laboratory data of the participants. The data were analyzed by SPSS version 21 software, and P values of less than 0.05 were considered significant.

The study included 68 men and 23 women with a mean age of 41.9 ± 13.72 years (range 19 - 68). The mean scores of fatigue (40.6 ± 14.8) and anxiety (12.98 ± 2.76) were more than the normal range. The most significant association was seen between age and CVLT items (attention (P = 0.01), immediate memory (P < 0.001), short delay free recall (0.01), and short delay cued recall (0.03).

End-stage liver disease patients had anxiety, fatigue, and memory disorders in addition to their poor clinical conditions. Although the main treatment of ESLD is liver transplantation but the psychological and cognitive problems before transplantation in these patients are prognostic factors for post-operation compliance and follow up.

Both ammonia and manganese (Mn) play a key role in the pathogenesis of hepatic encephalopathy (HE) and cause similar morphological and functional changes in astrocytes.

To investigate the interaction between brain Mn and ammonia in HE rats.

Three rat models of minimal HE (MHE), chronic manganism (CHM), and chronic hyperammonemia (CHA) were constructed. A total of 48 Sprague-Dawley rats were divided into one control group (n = 6), MHE groups (n = 18, among which six rats were used to evaluate the MHE model), CHM groups (n = 12), and CHA groups (n = 12). The CHM, CHA, and the rest of MHE rats were randomly divided further into two subgroups, according to the MgSO4 treatment (oral administration of 496 mg/kg/day for seven weeks): MHE-7W and MHE + Mg-7W; CHM-7W and CHM + Mg-7W; and CHA-7W and CHA + Mg-7W, respectively. Rats’ blood ammonia, brain Mn, glutamine synthetase (GS), and glutamine (GLN) levels were measured and compared among groups.

Significantly higher brain Mn content in MHE-7W and CHM-7W rats, higher blood ammonia levels, brain GS activity, and GLN content were observed in MHE-7W, CHM-7W, and CHA-7W rats than in control rats. After MgSO4 treatment for seven weeks, significantly lower brain Mn content, blood ammonia levels, and GLN content were observed in MHE, CHM, and CHA rats.

Our study showed that brain Mn accumulation could increase brain ammonia levels, while the accumulation of brain ammonia had no effect on the content of brain Mn.

Syphilis is a global health issue, which continues to occur at high rates worldwide, particularly in HIV-infected men, who have sex with men (MSM). Hepatitis can present as an uncommon manifestation of syphilis, and the diagnosis may be overlooked in favor of more common causes of liver injury in this group.

This study aimed to determine the prevalence and risk factors of syphilitic hepatitis among HIV-infected individuals diagnosed with acute syphilis.

This cross-sectional study was conducted on HIV-infected individuals who regularly attended a tertiary clinic in Istanbul. The data were collected and analyzed between 2016 and 2019. Cases of syphilitic hepatitis were included according to the following criteria: (I) VDRL-confirmed Treponema pallidum infection after or simultaneously diagnosed with HIV infection; (II) elevated liver enzymes, including ALT, AST, and ALP, that resolved after penicillin treatment; and (III) exclusion of other causes of hepatitis. Sociodemographic characteristics of the participants, clinical and laboratory findings were evaluated using medical records.

Among 1,057 HIV-infected patients, 141 (13.3%) were diagnosed to have an early stage of syphilis, 138 of them were male. Nine (6.4 %) out of 141 patients had syphilitic hepatitis, and all of them were self-identified MSM. Moreover, 5 out of these 9 patients were simultaneously diagnosed with syphilis and HIV infection. Up to 10-fold increase in ALT/AST was noted in all of them, and a 3.5-fold increase in bilirubin was observed in two cases. The most prominent laboratory abnormalities in syphilitic hepatitis patients were the detection of a considerable increase in ALP and HIV RNA levels.

Syphilitic hepatitis is not encountered rarely in HIV-infected individuals, predominantly MSM populations. Since HIV/syphilis coinfected patients are more infective as a result of higher HIV RNA levels, early diagnosis, and treatment are crucial.

Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC). The exact molecular contributors to the development of HBV-related HCC are not yet completely understood. Recent studies demonstrated that the deregulation of the Wnt pathway is highly associated with the development of HCC. Besides, HBV is known to have roles in the deregulation of this pathway. The present study evaluated the molecular aspects of the Wnt pathway in HBV-related HCC in liver tissue samples. Viral characterization was done by identifying the HBx mutations and the assessment of intrahepatic viral load. The expression of Wnt pathway genes was assessed using real-time PCR and methylation-specific PCR. The intrahepatic viral load was significantly higher in tumor samples than in normal tissues (P = 0.0008). Aberrant expression was observed in Wnt-1, Wnt-7a, FZD2, FZD7, β-catenin, URG7, c-Myc, SFRP5, and GSK3β, among which Wnt1, FZD2, SFRP5, Gsk3β, and URG7 were associated with HBV. HBx mutations at positions I88, L116, and I127 + F132 were associated with the decreased expression of GSK3β and overexpression of URG7 and Wnt1. Alterations in the expression level of β-catenin, as well as some mutants of HBx, were correlated with the level of c-Myc. HBV-related HCC seems to be mostly coordinated with epigenetic behaviors of HBx, such a multi-functional peptide with suppressing/trans-activating functions.

Liver fibrosis due to Hepatitis B Virus (HBV) infection is an important public health concern worldwide. An accurate assessment of liver fibrosis is crucial for the identification of susceptible patients to severe clinical conditions and selection of treatment for patients with Chronic Hepatitis B (CHB) infection. Today, the development of simple, accurate, cost-effective, and non-invasive liver fibrosis tests is essential in clinical practice.

According to liver biopsy as the reference standard, we compared the efficacy of hepatic arterial blood flow index (HBI) versus liver stiffness measurement (LSM), aspartate aminotransferase-to-platelet count ratio index (APRI), and fibrosis index based on 4 factors (FIB-4) to predict various degrees of liver fibrosis among 87 patients with CHB infection.

Spearman’s rank correlation coefficient of HBI versus the degree of liver fibrosis, according to the METAVIR scoring system, was 0.672 (P < 0.001). The area under the receiver operating characteristic curve (AUROC) of HBI (0.884; 95% CI: 0.806 - 0.961; P = 0.000) was greater than that of LSM (0.807; 95% CI: 0.703 - 0.912; P = 0.00), APRI (0.684; 95% CI: 0.556 - 0.812; P = 0.009), and FIB-4 (0.757; 95% CI: 0.641 - 0.873; P = 0.000) for the diagnostic analysis of significant liver fibrosis (≥ F2); similar results were obtained for the prediction of other liver fibrosis stages.

The present findings shed new light on the association of HBI with the degree of liver fibrosis in patients with CHB infection. Hepatic Arterial Perfusion Scintigraphy (HAPS) with the measurement of HBI is a promising diagnostic method of liver fibrosis stage, which can guide therapy in CHB patients, although further large-scale studies are needed.