8 years post-marketing surveillance between Asari Radix and hepatocellular carcinoma: Nationwide population-based evidence against an association.

ETHNOPHARMACOLOGICAL RELEVANCE: Asari Radix (Xixin, Asarum heterotropoides Fr. Schmidt var. mandshuricum Kitag., Asarum sieboldii Miq., or Asarum sieboldii Miq. var. seoulense Nakai, Asarum spp.) is the only herbal medicine containing aristolochic acid that can be used in medical practice. However, scientific evidence regarding its safe use in relation to hepatocellular carcinoma (HCC) is lacking. AIM OF THE STUDY: The aim of this study was to use post-marketing surveillance to provide a scientific understanding of the relationship between Asari Radix and the development of HCC and suggest the maximum allowable amount of Asari Radix. MATERIALS AND METHODS: A retrospective, population-based cohort study was conducted, with patients randomly selected and divided into three cohorts: a non-hepatitis B virus (HBV)/hepatitis C virus (HCV) cohort, a HBV cohort, and a HCV cohort. Data were retrieved from the National Health Insurance Research Database of Taiwan from January 1, 1997 to December 31, 2013. The study period covered the initial 10 years of exposure to persistent HBV or HCV, followed by exposure to Asari Radix for an additional 8 years. RESULTS: After propensity score matching, 106,942, 3818, and 928 patients were included in the non-HBV/HCV, HBV, and HCV cohorts, respectively. These cohorts included 75, 50, and 42 HCCs and 1,564,943, 30,956, and 6938 person-years, respectively. All hazard ratios of exposure to 1-30 g, 31-60 g, 61-100 g, and 101-200 g of Asari Radix in these three cohorts showed negative associations between Asari Radix exposure and HCC development. Furthermore, the three cohorts demonstrated that exposure to under 200 g of Asari Radix was safe. CONCLUSIONS: Post-marketing surveillance showed that Asari Radix has no relationship with HCC development at an intake of under 200 g. The study is persuasive in furthering our knowledge of the maximum allowable amount of Asari Radix.

Hepatotropic viral infection associated systemic vasculitides-hepatitis B virus associated polyarteritis nodosa and hepatitis C virus associated cryoglobulinemic vasculitis.

Two hepatotropic viruses have been shown to have causal relationship with systemic vasculitis-hepatitis B with classical polyarteritis nodosa and hepatitis C with cryoglobulinemic vasculitis. The present paper provides an updated overview on the clinical presentations and management of these vasculitides. HBV associated PAN patients have higher weight loss, peripheral neuropathy, mononeuritis multiplex, abdominal pain, gastrointestinal manifestations requiring surgery, cardiomyopathy, orchitis, hypertension, and/or elevated transaminase levels. Microaneurysms are also more common in mesenteric artery. Skin manifestations, however are less common. These patients also have a severe disease as suggested by higher five factor score and higher BVAS. Though relapses are less common, mortality is higher in patients with HBV PAN as compared to non HBV PAN. Plasmapheresis has a role in treatment in clearing off immune complexes. The common clinical manifestations of HCV associated cryoglobulinemic vasculitis are skin lesions, peripheral neuropathy, glomerulonephritis, arthritis, and sicca symptoms. Though combination therapy comprising of pegylated interferon α and ribavirin is the first line of management, immunotherapy is needed for severe or life threatening manifestations. Recent randomized trials have shown the efficacy of rituximab in such situations.

Seroprevalence and risk factors of hepatitis B and hepatitis C virus infections in uttarakhand, India.

BACKGROUND AND AIMS: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are a serious global public health problem affecting billions of people. A population based serological survey was conducted in Uttarakhand, India to determine the prevalence and risk factors of HBV and HCV infections. METHODS: A cross-sectional study was conducted to achieve the primary objective of estimating the prevalence of HBsAg and anti-HCV seropositivity and to estimate the potential risk factors. RESULTS: A total of 495 volunteers completed the study questionnaire and underwent blood tests for HBsAg and anti-HCV serology. Of these, 339 (68.5%) were males and 156 (31.5%) were females. The mean age of the volunteers was 31 ± 4 years. The overall infection rate was 4.4% (n = 22) in the studied population. The seroprevalence of HBsAg was found to be 2.8% (n = 14) and of anti-HCV antibodies 1.8% (n = 9), whereas dual infection i.e. HBV and HCV infection was seen in 0.2% (n = 1). The overall analysis of risk factors of our data showed that persons who have received multiple blood transfusions, history of hepatitis among family members, visits to unregistered medical practitioners and uneducated people are at more risk for acquiring hepatitis B and hepatitis C infection. CONCLUSIONS: The results indicate an intermediate level of endemicity of HBV and HCV infection in this geographical area of Uttarakhand. Some independent risk factors like blood transfusion, intra familial transmission, and visit to unregistered practitioners were identified.