Salimur Rahman

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)

The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on acute-on-chronic liver failure (ACLF) in 2004, with a mandate to develop consensus guidelines on various aspects of ACLF relevant to disease patterns and clinical practice in the Asia-Pacific region. Experts predominantly from the Asia–Pacific region constituted this working party and were requested to identify different issues of ACLF and develop the consensus guidelines. A 2-day meeting of the working party was held on January 22–23, 2008, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and subsequently presented at the Annual Conference of the APASL at Seoul, Korea, in March 2008. The consensus statements along with relevant background information are presented in this review.

Jute Reinforced Polypropylene Composite: Effect of Surface Pretreatment by Photocuring with Acrylic Monomers

Jute fiber (hessian cloth) reinforced polypropylene (PP) composites were prepared by compression molding. The composite fabrication temperature, pressure and time were 190°C, 4 tons and 5 min, respectively. The jute content, in the composites was studied over mechanical properties and it was observed that the highest TS (70 MPa), BS (75 MPa) and bending-E-modulus (2.35 GPa) were produced by 60% jute content, but Youngs modulus was found to be the highest (1.95 GPa) at 38% jute content. To further improve the mechanical properties and interfacial adhesion behavior between jute and polypropylene, hessian cloth was pretreated with acrylic monomers, e.g., 1,4-butanediol diacrylate (BDDA), ethyl hexyl acrylate (EHA) and trypropylene glycol diacrylate (TPGDA) at different concentrations using 2% photoinitiator (Darocur-1116) under UV radiation of various intensities. Among all the monomers BDDA showed the best performance. The highest TS (90 MPa), BS (95 MPa), Youngs modulus (2.2 GPa) and bending-E-modulus (3.2 GPa) of the composite were obtained when hessian cloth was cured by soaking it for 10 min in a solution containing 3% BDDA, 2% photoinitiator in methanol, followed by exposure to six passes of UV radiation. Under this condition polymer loading (PL) of photocured hessian cloth was 14%.

Comparative study on presentation of biliary ascariasis with dead and living worms.

Background/Aim: Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis (BPA). The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms. Materials and Methods: We included 138 consecutive cases of BPA that occured during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparison was done by chi-square and independent t tests. Results: The age (mean ± SD) of the patients was 36.8 ± 16.1 years. Prevalence ratio between male and female patients was 1:5. Ninety eight patients contained living worms and 40 had dead worms. Males were more prone to develop dead worm BPA. The commonest presentation was biliary colic (131; 94.9%); others were acute cholangitis (30; 21.7%), obstructive jaundice (19; 13.8%), choledocholithiasis (20; 14.5%), acute pancreatitis (10; 7.2%), acute cholecystitis (6; 4.3%), liver abscess (2; 1.4%), hepatolithiasis (3; 2.2%), stricture of common bile duct (2; 1.4%), pancreatic abscess (1; 0.7%) and cirrhosis of liver (1; 0.7%). Choledocholithiasis, hepatolithiasis, liver abscess and cirrhosis were associated only with dead worms. We could successfully remove all the worms with endoscopic interventions, but 5 patients required surgical intervention as there were strictures and stones within the biliary tree or Ascaris were in gallbladder. Recurrences of stone and cholangitis occurred only in those with dead worms. Conclusion: Biliary ascariasis with dead worms is more dangerous than that with living worms. Endoscopic or surgical intervention may be required repeatedly in those with dead worms.

Clinical use of liver biopsy for the diagnosis and management of inactive and asymptomatic hepatitis B virus carriers in Bangladesh.

Patients with inactive chronic hepatitis B virus (HBV) infection are assumed to be free from liver disease. Accordingly, antiviral drug treatment is not recommended for these patients. However, the extent of liver damage in these patients has not been evaluated fully. The aim of this study was to evaluate the extent of liver damage in patients with inactive HBV. Liver biopsy was conducted in 141 inactive HBV carriers [HBeAg‐negative, low levels of HBV DNA (≤10,000 copies/ml) and normal levels of serum alanine aminotransferase (ALT)]. The extent of hepatic inflammation and fibrosis was evaluated in these patients by examining liver biopsy specimens. Although the patients were inactive HBV carriers, mild to moderate levels of necroinflammation (HAI necroinflammation score HAI‐N1 ≥ 7) were detected in 36 of 141 (26%) patients. Seventeen patients had a severe degree of hepatic fibrosis (HAI fibrosis score HAI‐F ≥ 3). A total of 10 patients had both considerable necroinflammation (HAI‐N1≥7) and severe fibrosis (HAI‐F ≥3). All 10 patients with significant hepatic inflammation and fibrosis were male and older than 25 years. However, all were HBeAg‐negative and expressed low levels of HBV DNA and normal ALT levels. The study demonstrates that features of liver damage were present in a considerable number of the patients. Assessment of liver biopsy specimens in a larger cohort of inactive HBV carriers is necessary to establish management guidelines for such patients. J. Med. Virol. 82:1350–1354, 2010.

Combination therapy with antiviral drugs and hepatitis B vaccine in incidentally-detected and asymptomatic chronic hepatitis virus B carriers at Bangladesh.

Abstract Asymptomatic chronic hepatitis B virus (HBV) carriers are at risk of developing complications of liver disease, but these patients are not recommended for treatment with antiviral drugs. In fact, antiviral drugs are ineffective in these patients in the immune tolerance phase, when they have inadequate levels of host immunity. We postulated that combination therapy of an immune modulator and antiviral drugs may have potential to help these patients. Twenty-five patients with incidentally-detected asymptomatic chronic HBV were immunized with hepatitis B vaccine (10 microg of hepatitis B surface antigen) intramuscularly five times (at 0, 1, 2, 6, and 12 mo) to induce HBV-specific immunity. The patients were also treated with lamivudine (100 mg) daily for 12 mo. The combination therapy was safe for all patients with asymptomatic chronic HBV, and no increases in alanine aminotransferase or liver damage were detected in any patient. Although all of the patients were expressing HBV DNA in their serum before treatment, HBV DNA became undetectable in 16 of 25 patients, and was reduced in 9 of 25 patients at the end of the combination therapy. Combination therapy with the antiviral agent lamivudine and an immune modulator (hepatitis B vaccine) represents a potential therapeutic option for the control of HBV without liver damage in asymptomatic chronic HBV carriers.

Systemic Inflammatory Response Syndrome in Acute on Chronic Liver Failure- Relevance of ‘Golden Window’- a Prospective Study

Systemic inflammatory response syndrome (SIRS) is an early marker of sepsis and ongoing inflammation and has been reported in large proportion of acute‐on‐chronic liver failure (ACLF) patients. Whether sepsis is the cause or the result of liver failure is unclear and is vital to know. To address this, the study investigated the course and outcome of ACLF patients without SIRS/sepsis.

Prevalence and Risk Factors of Asymptomatic Hepatitis C Virus Infection in Bangladesh

OBJECTIVES There are paucity of information about prevalence and risk factor of hepatitis C virus (HCV) in Bangladesh. METHODS Blood was collected from 1018 randomly selected subjects from a semi-urban area of Bangladesh. Anti-HCVs were checked in the blood twice using a third-generation commercial kit. The data of the questionnaires were analyzed to find possible risk factors. RESULTS Nine of the 1018 subjects (88%) were tested positive for anti-HCV. The HCV-positive subjects were >28 years old. Major risk factors for HCV infection were treatment by unqualified and traditional practitioners, history of mass-vaccination against smallpox, hair cutting and shaving by barbers, and body piercing. However, known risk factors such as blood transfusion, surgery, invasive therapy, and intravenous drug use were not detected in any HCV-infected subjects. CONCLUSION Control of HCV infection in Bangladesh may be difficult because the risk factors are related to normal tradition and culture of Bangladeshi people.

Abdominal cystic echinococcosis in Bangladesh: a hospital-based study

INTRODUCTION Cystic echinococcosis (CE) is reported from nearly all geographic areas of Bangladesh, but little information is available on its epidemiologic and clinical features. The aim of this study was to describe the clinical manifestations of hepatic and abdominal CE cases presenting to tertiary referral hospitals in Dhaka, Bangladesh. METHODOLOGY A retrospective study was conducted via chart reviews of hepatic and abdominal CE patients under care at tertiary referral hospitals in Dhaka, Bangladesh, between 2002 and 2011. Age, sex, education level, occupation, urban versus rural residence, drinking water source, history of dog ownership, cyst type and location, and clinical manifestations were recorded for all patients. RESULTS Of the 130 patients enrolled, 92 (70.8%) were female and 38 (29.2%) were male. The majority of patients were from rural (76.2%) rather than urban (23.8%) areas. All cases were from the northern part of the country, with no cases reported from the south or southeast. Most patients were between 21 and 40 years of age. A total of 119 patients (91.5%) had cysts only in the liver, with the remaining 8.5% having cysts in both the liver and lungs or in the abdominal cavity. Seventy-six (58.5%) of the hepatic cysts were stage CE1, indicating recent infection. CONCLUSIONS Active transmission of Echinococcus granulosus appears to be occurring in Bangladesh, as indicated by the high number of CE1 hepatic cysts seen at tertiary care hospitals. Community ultrasound screening studies are warranted to better define the distribution of cases and risk factors for parasite transmission.

Precore/Core Promoter Mutant Hepatitis B Virus Produces More Severe Histologic Liver Disease than Wild Type Hepatitis B Virus

Introduction: The aim of this study is to compare Knodell and HAI scores in patients with wild type and precore/core promoter mutant CHB to see if there is any difference in severity of liver injury between these two types of HBV. Methods: We did percutaneous liver biopsies of 155 CHB patients. 102 (65.8%) of them were infected wild type HBV and the rest 53 (34.2%) were infected with precore/core promoter mutant CHB. Results: 11/53 (20.8%) patients with precore/core promoter mutant CHB had moderate to severe CH (HAI score 8–18). In contrast, moderate to severe CH was seen in 19/102 (18.6%) patients with wild type CHB. Fibrosis score was >2 in 15/53 (28.3%) precore/core promoter mutant CHB as opposed to 20/102 (19.6%) patients with wild type CHB. Conclusion: The study shows that precore/core promoter mutant HBV produces more severe histologic liver disease compared to wild type HBV.

Biochemical, Virological, Immunological and Histopathological Features of 702 Incidentally Detected Chronic Hepatitis B Virus Carriers in Bangladesh

Background/Aims: Simultaneous assessment of biochemical, virological, and histological parameters of incidentally detected chronic hepatitis B virus (HBV)-infected subjects in Bangladesh were done to develop strategies for containment of HBV and management of liver diseases of these patients. Methods: A total of 702 chronic HBV carriers detected incidentally were enrolled in the study. Levels of HBV DNA and alanine aminotransferase (ALT) in sera were measured. The extent of hepatic inflammation and liver fibrosis was evaluated in all patients by examining liver biopsy specimens. Results: Of the 702 patients, 358 (50.7%) exhibited HBV DNA levels >105 copies/ml. ALT levels were above the upper limit of normal (ULN; >42 U/l) in more than 50% of the patients. High levels of HBV DNA (>105 copies/ml), increased ALT (>1.0 × ULN), moderate hepatic inflammation (HAI-NI ≥7) and severe hepatic fibrosis (HAI-F ≥3) were detected in 60 patients. Conclusion: As considerable numbers of apparently healthy subjects are unaware of the fact that they are chronically infected by HBV, many of whom have already developed progressive liver damage, emergency strategies would be needed for the containment and management of HBV infection in developing countries.