Hepatitis Monthly
Volume:17 Issue: 10, Oct 2017

Context: Nonalcoholic fatty liver disease (NAFLD) is increasing with the increased rate of obesity and reduced physical activity in children worldwide. Despite high prevalence of the disease, a standard and acceptable diagnostic method is not available. The current study aimed at collecting all related articles and evaluating the challenges.
The current study searched Scopus, Web of Science, and PubMed. Articles and guidelines in English in the field of invasive and noninvasive diagnostic methods for NAFLD and nonalcoholic steatohepatitis (NASH) in children and adolescents up to Oct 2016 were used. It was tried to evaluate all laboratory and radiologic methods, biomarkers, and scores in addition to mention the challenges.
Ultrasonography and laboratory evaluation, which were routine methods in early diagnosis, did not have enough accuracy in this field. Diagnosis of steatosis and fibrosis and determining the severity of disease were achieved by fibro scan and controlled attenuation parameter (CAP) without the challenges of computed tomography (CT) scan and magnetic resonance imaging (MRI). Fatty liver can be predicted with high accuracy by body analyzer, anthropometric, and DEXA methods.
Diagnosis and prediction of fatty liver should be done in all children with obesity aged > 3 years, and physician should seek the genetic and metabolic causes in children aged

Hepatitis B virus (HBV) is the main infectious agent that causes liver disease and may lead to an acute or chronic HBV infection. Evidence from many studies have determined that host genetic factors play a significant role in determining immunization, clinical course, and recovery from HBV infection. A 32-bp deletion in the region of CCR5 gene (CCR5 ∆32) is one of the mutations that is known to provide genetic protection against chronic HBV infections.
In this study, the researchers aimed at assessing the protective effect of CCR5 ∆32 in subjects, who had recovered from HBV infection, as well as subjects that developed chronic HBV infection, in Birjand, Iran.
The study consisted of 60 patients with chronic HBV infection (patient group) and 120 patients, who had previously recovered from HBV infection (control group). Genomic DNA was extracted from blood samples by the salting out method, and then samples were analyzed for the CCR5 ∆32 genotype utilizing the gap-polymerase chain reaction (Gap-PCR) technique. Variables were analyzed using the Chi-square test and P values less than 0.05 were considered as statistically significant.
The researchers found only one heterozygous CCR5 ∆32 mutation in the control group and absolutely no homozygous CCR5 Δ32 mutation in either the patient or control group.
Because of no significant visible correlation between carrying the mutation and the possibility of recovery from HBV infection in the city of Birjand, it seems the protective effect of this mutation is absent in Birjand’s population.

Since the number of hepatitis patients requiring liver transplantation is on the rise and the waiting list for such operation is long, the quality of life of these patients will be affected. Providing any care and health services requires an understanding of these patients’ real experience and their specific needs.
Therefore, this study aimed to explore the life experiences of hepatitis patients waiting for liver transplantation.
This was a qualitative study with content analysis approach. Participants in this study consisted of 10 hepatitis patients on the waiting list for liver transplantation, who were selected through purposive sampling. For data collection, semi-structured interviews were conducted and data were analyzed using Landman and Grantham and constant comparison methods.
The participants included 10 hepatitis patients with a mean age of 41.4 years, and 34.8 months average time being on the waiting list. The main themes of “life turmoil (being troubled for the family and living with hardship), “searching” (searching for information and search for a change in treatment approach), spirituality (trust and faith in God and relaying on Imams (Tavasol)), and “new concerns” (unhappiness in life and challenge and consequence of waiting) were extracted from the data.
Hepatitis patients’ experiences included family economic problems, exacerbation of the disease and its complications, lack of adherence to treatment regimen, and physical and psychosocial problems. Knowing and understanding the issues and problems of these patients can create positive changes in their time when waiting for liver transplantation, and can empower them in this difficult time so they can have a more successful transplantation.

Infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem.
The aim of this study was to measure the prevalence of HCV infection and determine the risk factors associated with HCV among male people who inject drugs (PWID) in Kermanshah, Iran.
In this cross sectional study, the samples were recruited from 2 drop-in centers and related community outreach sites, using snowball sampling. The questionnaire consisted of 3 sections, including demographics, drug use patterns, and risky behaviors. HCV infection was tested in venous blood samples, collected from the participants, using the ABON rapid test kit. Logistic regression analysis was used to determine the association between HCV status and the associated factors, reported as odds ratio (OR) and 95% confidence interval (CI).
The mean age of the participants was 36.7 ± 8.5 years (range, 18 - 65 years). Over half of the participants (54.8%) tested positive for HCV antibodies; in other words, they had been exposed to the virus. Adjusted OR for people reporting shared equipments within the past month was 3.36 times higher than the OR of people who reported no shared equipments (P = 0.000). The adjusted OR of positive HCV among those who injected twice or more per day was 4.33 (P = 0.000), compared to those who injected only once a day (or less). With over half the participants having evidence of HCV exposure, there is a need to increase the coverage of harm-reduction programs, especially sterile injection equipment programs. Moreover, increasing access to harm-reduction programs and HCV treatment can ultimately reduce the opportunities for HCV transmission.

Hepatocellular carcinoma is an unfortunate consequence in cirrhotic patients. Most of the cases are diagnosed by imaging modalities; however, some of them are missed and would be diagnosed only after thorough examination of the explanted liver following transplantation.
In this study, we aimed to evaluate the frequency of incidental HCCs that are diagnosed after transplantation based on pathological examination of the explanted livers.
We evaluated all the explanted livers during 5 years from 2012 to 2016 with clinical and pathological diagnosis of HCC. In the meantime, all of the clinicopathological findings were investigated such as demographic information, AFP level, tumor size, and tumor location.
The frequency of incidental HCC in our center was around 20%, more than 80% of which were less than 2-cm in size (early HCC). Majority of the cases were male patients above 40 years age, with the underlying causes of Hepatitis B, C, and AIH as well as tyrosinemia and PFIC.

Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal recessive disease characterized by recurrent episodes of severe pruritus and jaundice. Although the disease symptom will relieve spontaneously without leaving any hepatic injury, the ceaseless attacks would reduce the life quality of patients. However, there is not a validated treatment for BRIC yet. Considering the limited cases and the unpredictability of this disease, the publications of well-described case reports are necessary for the investigation of disease development and treatment efficacy.
A 26-year-old Chinese male, with clinical approved and genetic diagnosis of BRIC, experienced 3 attacks of recurrent intrahepatic cholestasis from 2010 to 2016. During hospitalizations, he received symptomatic treatments and plasmapheresis therapies. Both plasma exchange (PE) and plasma bilirubin adsorption (PBA) were conducted for him. The whole-exome sequencing revealed several single nucleotide polymorphisms (SNPs) as well as 2 novel mutations in ABCB11 (c.70A > T, p.Lys24*, exon2 and c.1417G > A, p.Asp473Asn, exon13). These SNPs and mutations might be associated with the BRIC development.
Both medications and plasmapheresis interventions could relieve the patient’s symptoms, however, neither could shorten the natural process of the disease. The 2 mutations (c.70A > T and c.1417G > A) in ABCB11 were first reported in a BRIC patient.