Assessment of viral hepatitis in Kosovo: mission report: 25–28 March 2019

The first assessment of viral hepatitis in Kosovo took place in Pristina and Prizren, from 25 to 28 of March 2019. The objective of this mission was to: evaluate the existing structures for prevention, diagnosis, staging, treatment, continuum of care and control of viral hepatitis in the area; interview key stakeholders and collect reports from public health authorities and local facilities; and conduct situation analysis to provide recommendations for developing a strategic plan. The mission also aimed to identify opportunities for expansion of linkages and synergies between the HIV and hepatitis C responses. The mission comprised experts from the Joint Tuberculosis, HIV and Viral Hepatitis Programme (WHO Regional Office for Europe); the Community Development Fund; the Robert Koch Institute and the WHO Office, Pristina.

Evaluation of serum levels and significance of soluble CD40 ligand in screening patients with hepatitis C virus-related hepatocellular carcinoma

The study's objective was to evaluate the clinical significance of sCD40L in HCV- associated hepatocellular carcinoma [HCV-HCC] patients. Sera concentration of circulating sCD40L and IL-10 were assayed using ELISA in 30 HCV positive patients with HCC, 30 HCV-positive patients with liver cirrhosis and 30 age-matched healthy volunteers with negative anti-HCV-Ab as a control group. Serum sCD40Lshowed statistically-significant high levels in HCV-HCC patients compared to HCV-cirrhotic patients and normal controls [P < 0.001]. Serum sCD40L had higher diagnostic value in HCC patients compared with serum AFP. High sensitivity and specificity of sCD40L was observed compared to AFP [90%, 86.7% and 83% and 80% respectively]. Significant positive correlation was detected between serum sCD40L and IL-10[r = 0.85 P < 0.001], AFP [r = 0.62 P < 0.05] and tumour staging [r = 0.5 P < 0.05]. The study concluded that sCD40L is a valuable diagnostic tool in early diagnosis and screening for HCV and HCC as well as routine follow up of HCV cirrhosis patients. Assessment of serum IL-10 levels in HCV patients may provide a possible predictive marker for disease progression

L'objectif de l'étude était d'évaler l'importance clinique du ligand de CD40 soluble [sCD40L] chez des patients attaints d'un carcinome hépatocellulaire [CHC] associé au virus de l'hépatite C [VHC]. Les concentrations sériques de sCD40L circulant et d'interleukine 10 circulante ont été analysées à l'aide de la méthode immuno-enzymatique chez 30 patients positifs pour le VHC avec un CHC, chez 30 patients patients positifs pour le VHC avec une cirrhose du foie, et chez 30 volontaires d'âge correspondant en bonne santé avec des anticorps anti-VHC négatifs servant de groupe témoin. Les concentrations sériques de sCD40L ont montré des niveaux statistiquement élevés chez les patients atteints d'un CHC associé au VHC par rapport aux concentrations sériques d'AFP. Les concentrations sériques de sCD40L avaient une valeur diagnostique plus élevée chez les patients atteints d'un CHC que les concentrations sériques d'AFP. Une sensibilité élevée et la spécificité du sCD40L ont été observées par rapport à l'AFP [90%, 86,7% et 83% et 80% respectivement]. Une corrélation positive significative a été détectée entre les concentrations sériques de sCD40L et d'IL-10 [r = 0,85 p < 0,001], l'AFP [r = 0,62 P < 0,05] et le stade de la tumeur [r = 0,5 p < 0,05]. L'étude a conclu que le sCD40L est un outil précieux pour le diagnostic et le dépistage précoces de l'infection à VHC et du CHC, ainsi que pour le suivi de routine des patients cirrhotiques positifs pour le VHC. L'évaluation des concentrations sériques d'IL-10 chez les patients positifs pour le VHC pourrait fournir un possible marqueur prédictif pour l'évolution de la maladie

Changes in adrenal steroidogenesis in spontaneous bacterial peritonitis and sterile ascites

Adrenal androgens, particularly dehydroepiandrosterone [DHEA], may have important regulatory effects on the immune system in humans. This study measured the changes in adrenal steroidogenesis in 13 non-infected cirrhosis patients with sterile ascites and 13 patients with spontaneous bacterial peritonitis and the relation with circulating interleukin-6 [IL-6] levels. Comparisons were made with 10 healthy age-matched control subjects. The severity of bacterial peritonitis in liver cirrhosis was significantly associated with enhanced serum IL-6 and cortisol levels, and a decrease in serum DHEA sulfate in relation to serum IL-6 concentrations. Careful, long-term studies on DHEA administered to cirrhosis patients are needed to assess its safety in improving a number of pathological conditions that complicate liver cirrhosis

Effects of single-dose praziquantel on morbidity and mortality resulting from intestinal schistosomiasis

The long-term effect of single-dose praziquantel on morbidity and mortality from Schistosoma mansoni was investigated in surveys in 1987 and 1994 in central Sudan. Prevalence of infection dropped from 53% to 34%, and intensity of infection [400 eggs/g of faeces] from 31% to 18%. There was a reduction in hepatomegaly and hepatosplenomegaly, although splenomegaly alone was unchanged. Prevalence of periportal fibrosis decreased from 14% to 10%. Endoscopic investigation of patients with fibrosis showed a reduction in oesophageal varices from 47% to 30%. Mortality due to bleeding varices was high [community-wide, up to 11/100 infected patients with bleeding]. Thus praziquantel mass treatment can be spaced to a much longer period, reducing the expense of treatment, delivery and distribution

Hepatic fibrosis due to fascioliasis and/or schistosomiasis in Abis 1 village, Egypt

An epidemiological study of fascioliasis and/or schistosomiasis was conducted in Abis 1 village. Stool specimens were collected from 2492 individuals and examined. Fascioliasis, alone or combined with schistosomiasis, was more prevalent among children aged between 5 years and 15 years than in adults. Serum procollagen III peptide [PIIIP] levels were determined as an indicator of active fibrosis, and liver histopathology and ultrasonography used as indicators of established fibrosis. PIIIP levels were significantly higher in children than in adults, and in mixed infections than in fascioliasis alone. In adults, fibrosis around granulomata detected by histopathology and grade 3 periportal fibrosis detected by sonography were encountered more frequently in dual than in single infections

Gastric mucosal function in portal hypertensive gastropathy secondary to schistosomal hepatic fibrosis: effect of sclerotherapy

Gastric mucosal function in portal hypertensive gastropathy secondary to schistosomal hepatic fibrosis [SHF] was evaluated. Group I comprised 20 patients with no bleeding; 10 had portal hypertensive gastropathy [PHG]. Group II comprised 20 patients with bleeding. Free acidity, total acidity, basal acid output, serum pepsinogen I, gastric mucosal blood flow [GMBF] and gastrin were significantly lower in group II, whereas serum gastrin and somatostatin staining were significantly higher. No histopathological changes were noted between both groups, In conclusion, bleeding caused by SHF results in hypoacidity, hypergastrinaemia and hypopepsinogenaemia. Estimated GMBF distinguishes patients with PHG and those who are bleeders