Infection with hepatitis E virus (HEV), mostly genotype 1, is endemic in several developing countries. It can be asymptomatic, be associated with acute hepatitis or fulminant hepatic failure, or ...present as acute-on-chronic liver disease. Pregnant women are at particular risk of serious outcomes and death. Chronic HEV infection has not been reported from these areas. Diagnosis of acute hepatitis E depends on detection of IgM anti-HEV antibodies or HEV RNA. Current assays for IgM anti-HEV are suboptimal, with high rates of interassay discordance. Though they perform reasonably well in disease-endemic areas, positive test results in low-endemicity areas require confirmation using HEV RNA testing. Detection of IgG anti-HEV antibodies indicates exposure to HEV, either recent or remote. Assays for these too have low concordance, making comparisons of seroprevalence rates using different assays difficult to interpret. There is an urgent need to develop better assays for markers of HEV infection and exposure.
Hepatitis E, caused by infection with hepatitis E virus (HEV), is a common cause of acute hepatitis in areas with poor sanitation. The virus has four genotypes with one serotype: genotypes 1 and 2 ...exclusively infect humans, whereas genotypes 3 and 4 also infect other animals, particularly pigs. In endemic areas, both large outbreaks of acute hepatitis as well as sporadic cases occur frequently. These cases are usually due to genotype 1 or 2 HEV and are predominantly caused by fecal–oral transmission, usually through contamination of drinking water; contaminated food, materno‐fetal (vertical spread) and parenteral routes are less common modes of infection. The acute hepatitis caused by this virus has the highest attack rates in young adults and the disease is particularly severe among pregnant women. HEV superinfection can occur among persons with pre‐existing chronic liver disease. In non‐endemic regions, locally acquired disease was believed to be extremely uncommon. However, in recent years, an increasing number of cases, due mostly due to genotype 3 or 4 HEV, have been recognized. These are more often elderly men who have other coexisting illnesses, and appear to be related to zoonotic transmission from pigs, wild boars and deer, either food‐borne or otherwise. Also, chronic infection with genotype 3 HEV has been reported among immunosuppressed persons in these regions. A subunit vaccine has been shown to be effective in preventing clinical disease, but is not yet commercially available. Our understanding of hepatitis E epidemiology has undergone major changes in recent years, and the future may hold even more surprises.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. ...However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective.
A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs. Model parameters were estimated from published studies. Cost-effectiveness of HCV treatment using available DAAs was calculated, using a payer's perspective. We estimated quality-adjusted life years (QALYs), disability-adjusted life years (DALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted.
Compared with no treatment, the use of generic DAAs in Indian HCV patients would increase the life expectancy by 8.02 years, increase QALYs by 3.89, avert 19.07 DALYs, and reduce the lifetime healthcare costs by $1,309 per-person treated. Treatment became cost-effective within 2 years, and cost-saving within 10 years of its initiation overall and within 5 years in persons with cirrhosis. Treating 10,000 HCV-infected persons could prevent 3400-3850 decompensated cirrhosis, 1800-2500 HCC, and 4000-4550 liver-related deaths. The results were sensitive to the costs of DAAs, pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response.
Treatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Gut microbiota and liver disease Goel, Amit; Gupta, Mahesh; Aggarwal, Rakesh
Journal of gastroenterology and hepatology,
June 2014, Volume:
29, Issue:
6
Journal Article
Peer reviewed
Open access
Microbes are present in large numbers in each human being, in particularly in the gastrointestinal (GI) tract, and have long been believed to have some beneficial effects for their hosts. Till ...recently, however, we lacked tools for studying these organisms. Rapid technological advances in recent years have markedly improved our understanding of their role both in health and disease. Recent literature suggests that organisms in the GI tract, referred to collectively as gut microbiota, play an indispensable role in the maintenance of host's homeostasis. Alterations in the gut microbiota, that is in the nature and relative density of various constituent bacterial species, appear to have a role in pathogenesis and progression of several GI and hepatic diseases. This has also opened the vista for tinkering with gut flora in an attempt to treat or prevent such diseases. In this review, we have tried to summarize information on normal gut microbiota, laboratory techniques and animal models used to study it, and the role of its perturbations in some of the common hepatic disorders, such as non‐alcoholic fatty liver disease (including obesity), non‐alcoholic steatohepatitis, alcoholic liver disease, and liver cirrhosis and its complications.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
There are several types of research study designs, each with its inherent strengths and flaws. The study design used to answer a particular research question depends on the nature of the question and ...the availability of resources. In this article, which is the first part of a series on "study designs," we provide an overview of research study designs and their classification. The subsequent articles will focus on individual designs.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Logistic regression analysis is a statistical technique to evaluate the relationship between various predictor variables (either categorical or continuous) and an outcome which is binary ...(dichotomous). In this article, we discuss logistic regression analysis and the limitations of this technique.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
One of the first steps in planning a research study is the choice of study design. The available study designs are divided broadly into two types - observational and interventional. Of the various ...observational study designs, the descriptive design is the simplest. It allows the researcher to study and describe the distribution of one or more variables, without regard to any causal or other hypotheses. This article discusses the subtypes of descriptive study design, and their strengths and limitations.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Infection with genotype 1 or 2 hepatitis E virus (HEV) results primarily from human-to-human transmission through the fecal-oral route in low-resource countries. It presents primarily as "acute viral ...hepatitis" syndrome, usually a self-limiting illness. A few cases progress to acute liver failure, a serious illness with high fatality. Clinical disease is infrequent among children. Infection during pregnancy is associated with a higher risk of symptomatic disease, severe liver injury, and mortality. Severe disease is also encountered in persons with preexisting chronic liver disease. Some cases have associated extrahepatic features, particularly acute pancreatitis and neurological manifestations. Chronic infection appears to be extremely infrequent with these HEV genotypes. The exact pathogenesis of liver injury remains unknown, although the host immune response appears to be important for viral clearance as well as for induction of liver injury. Hormonal and immune factors appear to be responsible for the severe disease during pregnancy.
This paper presents a novel maximum power point (MPP) tracking (MPPT) algorithm for grid-connected wind energy generation systems (WEGS). This is a rapid tracking algorithm that uses the fact that ...the value of ¿ß,¿ an intermediate variable, especially defined for the purpose, remains constant ( =ß MPP ) for a given WEGS at the MPP irrespective of the wind velocity. The value of ß MPP is known in advance. The algorithm works in two stages. In the first stage, it uses large steps to quickly drive the operating point to lie within a narrow band with limits ß max and ß min . In the second stage, exact MPP is tracked using the ¿perturb and observe¿ method. No extra hardware or measurements (sensors) are required compared to the existing algorithms. Hence, the cost is not increased. Application of the proposed algorithm to an example WEGS shows that the time taken by the system to reach MPP is much smaller compared to most of the existing algorithms. A prototype matrix converter has been developed for grid interfacing and the proposed MPPT scheme has been implemented in conjunction with Venturini and space-vector-modulation-based switching schemes. All the results of this study are presented.
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