Evaluation of Liver Enzymes and calculation of AST to ALT ratio in patients with acute viral hepatitis

Background: Acute viral hepatitis is a common liver-associated abnormality encountered in clinical practice. The number of biochemical parameters is estimated to detect a hepatic abnormality, which can measure the severity and types of damage to hepatocytes, among which liver enzymes and bilirubin levels are assessed routinely which are raised in acute viral hepatitis.Objective: This study aims to assess the liver enzymes, such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, and calculation of AST to ALT ratio in acute viral hepatitis and to compare these parameters with the control group.Methodology: This study included a total of 81 subjects diagnosed with acute viral hepatitis as cases and age and sex-matched, the same number of healthy subjects as control. Serum levels of AST and ALT, alkaline phosphatase (ALP), and bilirubin were analyzed using standard methods. Serum AST to ALT ratio was calculated. Data analysis was done using SPSS Version 17.0 and the results were expressed as mean ±standard deviation (SD).Results: A mean serum activities of aminotransferases were statistically significantly raised in viral hepatitis compared to that in control.AST (514.85±350.66 VS 25.65±5.29; p<0.001) and ALT (781.65±525.69 VS 27.94±6.50; p<0.001). Similarly, serum levels of(ALP)were significantly increased in acute viral hepatitis compared to that in control (202.17±75.46 VS 98.83±27.99; p<0.001. However, a ratio of AST to ALT was decreased significantly (0.66±0.15 VS 0.94±0.21; p= 0.001) in acute viral hepatitis compared to that in control.Conclusion: Both the aminotransferases and bilirubin levels are raised significantly, where, a rise in ALT is greater than a rise in AST, hence, the ratio of AST to ALT is decreased significantly in acute viral hepatitis than that in control. Thus, this decreased pattern of AST to ALT can diagnose acute viral hepatitis at an early stage and can help appropriate care and treatment to the patients.

TO STUDY THE SEROPREVALENCE OF HEPATITIS C IN CASES OF ACUTE VIRAL HEPATITIS AND CIRRHOSIS OF LIVER

Background: Viral hepatitis is a global public health problem affecting millions of people worldwide. The main objective was to study the seroprevalence of hepatitis C in patients with acute viral hepatitis and cirrhosis of liver. Method: The study was carried out in the department of Medicine, Pt. J.N.M medical college and associated Dr B.R Ambedkar Memorial Hospital Raipur, Chhattisgarh from April 2002 to February 2003. Result: Maximum number of acute viral hepatitis cases were observed in the age group >24-34 years. Maximum numbers of cirrhosis of liver cases were observed in the age group > 44-54 years. There were 2 cases of acute viral hepatitis that tested positive for anti- HCV and both were males. There were 5 cases of cirrhosis of liver who were HBsAg Positive. Conclusion: HCV infection is quite prevalent in Raipur, Chhattisgarh and therefore, stresses the need for early detection so that further transmission could be prevented.

Differences in Incidence of Acute Viral Hepatitis between Foreigners and Autochthonous Population in Italy

Background: In European countries, the prevalence of HBV and HCV in refugees and migrants tends to reflect the prevalence in their countries of origin. The aim of this study is to analyse acute viral hepatitis cases diagnosed in Italy among foreign citizens and to compare incidence rates in foreigners and Italians. Methods: We analysed the cases of each viral hepatitis type among foreigners. Standardised incidence rates were compared between natives and foreigners. Results: Between 2004 and 2019, 15,872 cases of acute viral hepatitis were notified by 10 Italian regions, 14.8% among foreign citizens. Until 2012, the percentage increased gradually, while a fluctuating trend set in from 2013 onwards; in 2019, 23.9% of cases were foreigners. Data from the SEIEVA surveillance show higher standardised incidence rates of hepatitis A and B among foreign citizens; no significant difference emerged between Italians and foreigners in terms of their hepatitis C incidence. Conclusions: foreign citizens have an increased incidence of hepatitis A and B. Regarding hepatitis A, vaccination is strongly recommended to foreigners travelling to their countries of origin. Screening tests for hepatitis B and C infection should be offered to newly arrived migrants from high prevalence countries, or having specific risk factors.

Seroprevalence of Enterically Transmitted Hepatitis Viruses in Patients Attending a Tertiary Care Hospital in Maharashtra, India

BACKGROUND Hepatitis A & E viruses are enterically transmitted viruses responsible for acute viral hepatitis in developing countries. Hepatitis A virus (HAV) has worldwide distribution while hepatitis E virus (HEV) is restricted to tropical countries. HAV affects infants and young children while HEV affects older children and young adults. This study was conducted to determine the seroprevalence of HAV and HEV and their co-infection in patients presenting with acute viral hepatitis (AVH). METHODS 200 sera of patients suffering from suspected acute viral hepatitis (AVH) attending tertiary care rural hospital JNMC Sawangi, Wardha were included in the study. Serum samples were tested for IgM anti HAV and IgM anti - HEV for the detection of acute hepatitis A and acute hepatitis E using commercially available ELISA kit & Immunochromatography test (ICT) for comparison of ELISA and ICT. RESULTS The overall seroprevalence of HAV and HEV infection was found to be 19 %. The seroprevalence of HAV infection was found to be 13 %, HEV infection 5 % and HAV - HEV co - infection 1 %. HAV infection in males and females was found to be 16.07 % and 9.09 % respectively & HEV infection was found to be 5.35 % and 4.54 % respectively. In case of detection of HAV IgM, two serum samples were negative by ICT but positive by ELISA & for HEV IgM, one serum sample was negative by ICT but positive by ELISA. The sensitivity, specificity, positive predictive value and negative predictive value of HAV IgM was found to be 96 %, 98.8 %, 92.30 % & 99.43 % and for HEV IgM was found to be 90 %, 99.47 %, 90 % & 99.47 % respectively. CONCLUSIONS It is evident from this study that infection with enteric hepatitis viruses is not infrequent. Findings from this study emphasize the need to establish regular seroepidemiological surveys to keep track of epidemiology of these viruses. Results from rapid tests are comparable to ELISA with additional advantage of ease of interpretation and neither time consuming nor requiring special instruments. KEY WORDS Hepatitis A, Hepatitis E, Seroprevalence

Study protocol: epidemiological and clinical characteristics of acute viral hepatitis in Brazilian health services

IntroductionAcute viral hepatitis is a disease of great clinical importance. This study proposes actions to better characterise cases of acute hepatitis in Brazil and to provide relevant information to institutionalised health policies within the Unified Health System. Available data on acute hepatitis in Brazil need to be re-evaluated regarding the different hepatotropic agent (hepatitis A to E virus) frequencies, as well as other agents that can cause similar clinical conditions, such as Herpes Simplex Virus 1 and 2(HSV1, HSV2), Varicella Zoster Virus (VZV), Cytomegalovirus (CMV), Epstein Barr Virus (EBV), Human Herpes Virus 6 and 7 (HHV6, HHV7), arbovirus (yellow fever, dengue, chikungunya, Zika), parvovirus B19, adenovirus, parechovirus, enterovirus, HIV, leptospirosis, toxoplasmosis and syphilis, in addition to autoimmune hepatitis. In this context, the primary aim of this study is the clinical-epidemiological and molecular characterisation of acute viral hepatitis in Brazilian health services from all geographical regions of the country. The present article describes the study protocol.Methods and analysisThis study will evaluate 2280 patients with symptoms and/or signs suggestive of acute liver disease in Brazilian health institutions in all five geographic Brazilian regions. Demographic, epidemiological and clinical data will be collected, as well as blood samples to be analysed at Hospital Israelita Albert Einstein Clinical Laboratory.Ethics and disseminationEthics approval was obtained at the national research ethics committee (Conselho Nacional de Ética em Pesquisa— CONEP–CAAE 00952818.4.1001.0071) and at all participating sites. Results will be published in journals and presented at scientific meetings.

Epidemiological Study on Acute Viral Hepatitis Outbreak in Chattogram Cantonment Area

Introduction: Acute viral hepatitis (AVH) incidence had suddenly increased at Artillery Centre and School (AC&S) at Halishahore under Chattogram (Ctg) cantonment area from 16 April 2018 to 25 June 2018. Total 1304 cases of AVH got admitted and received treatment from Combined Military Hospital (CMH), Ctg during that period. Aim: To find out the incidence, cause, predisposing factors, clinical course and to prevent such outbreaks in future. Methods: This retrospective observational study was conducted from 16 April 2018 to 25 June 2018. Total 1304 acute viral hepatitis cases were studied for epidemiological analysis to find out the causes, mode of spread, laboratory findings and outcome. Results: Among 1304 AVH cases 90% belonged to age group of 18-45 years and most of them were combatants and the age range was 5 to 60 years with mean age 30.31±11.29 years. HEV was 99% etiological factor and patients’ hospital stay were 10 to 55 days. Thirteen cases developed hepatic encephalopathy, 01 case developed acute pancreatitis and 108 cases had thrombocytopenia. No specific source of contamination was detected within AC&S, although coliform bacteria were identified in drinking water supplied to the area by WASA of Ctg city. Conclusion: We came to the conclusion that the source of infection was contaminated water supplied by WASA of Chattogram city. As we had also found that high incidence of AVH due to HEV were prevailing in Ctg city area during the same period of the outbreak. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 3-7