Tumay Doganci

Current therapeutic approaches in childhood chronic hepatitis B infection: A multicenter study

Background and Aim:  The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection.

The efficacy and side effects of interferon alpha 2a (Roferon) on chronic hepatitis B virus infection in Turkish children

Chronic hepatitis B virus infection in children is a progressive disease. The efficacy of recombinant interferon alpha in the treatment of chronic viral hepatitis B in children is still inconclusive. We evaluated the efficacy of interferon alpha 2a on 32 children aged 1–14 years with chronic hepatitis B. The children received recombinant interferon alpha 2a 5 megaunits/m2 three times weekly for 6 months. Complete response was seen in 31.2% of patients. Twenty-two children aged 4–14 years with chronic hepatitis B showing the similar characteristics were observed without treatment. Spontaneous seroconversion rate in this group was 4.5% (p<0.05). The age and sex of the patient, the route of transmission and the duration of HBsAg positivity were not found to be important, whereas mean alanine aminotransferase levels of the responders were statistically higher than in the non-responders (p<0.05). Early side effects, which include the flu-like symptom complex, were observed in all treated children but generally resolved within 2 weeks of therapy. Among the late side effects, autoimmune side effects manifested with the presence of antithyroid antibodies after the cessation of therapy was detected in one child. Two patients experienced seizure disorder during the therapy but have not required anticonvulsant therapy or discontinuation of interferon treatment. We conclude that interferon alpha 2a is an effective and tolerable form of therapy in children with chronic hepatitis B virus infection. Nevertheless, we recommend monitoring thyroid function before and after treatment as well as being cautious in using this form of treatment in children with coexistent seizure disorder.

Nonobstructive neonatal cholestasis: clinical outcome and scoring of the histopathological changes in liver biopsies.

The clinical outcome of nonobstructive neonatal cholestasis (NC) cases varies greatly and the prognosis is generally unpredictable. In this study, we aimed to evaluate the prognostic benefits of qualitative analysis of histopathological changes in nonobstructive NC cases. A total of 28 nonobstructive NC cases (18 neonatal hepatitis; 10 intrahepatic bile duct paucity) were studied. We analyzed the relationship between histopathological and clinical parameters. Hepatic inflammation, bridging necrosis, pericellular fibrosis, giant cell transformation, and extramedullary hematopoiesis were evaluated and scored according to their absence or presence in each case. The sum of the histopathological scores was accepted as “total pathological injury score.” The height percentiles, the presence and the degree of hepatomegaly and ascites, and serum alanine aminotransferase (ALT), albumin, and bilirubin levels and prothrombin time were also evaluated and scored. The patients were divided into 2 clinical course groups considered “good” or “bad” according to the total clinical scores. For statistical analysis, Pearsons chi-square test, Mann-Whitney U-test, and receiver operating characteristic curve were used. We found a statistically significant negative relation between the clinical course and total pathological injury score (P = 0.042) and pericellular fibrosis (P = 0.016). In conclusion, during the interpretation of liver biopsies of nonobstructive NC, scoring of histopathological changes should be done for assessing the clinical prognostic outcome.

Case of disseminated Langerhans’ cell histiocytosis presenting with sclerosing cholangitis

Langerhans’ cell histiocytosis is an uncommon disorder of childhood with a wide clinical spectrum. Although liver involvement is common in the disseminated form, presentation with hepatic disfunction is unusual. We describe an 18‐month‐old girl who presented with intrahepatic cholestasis. The patient was shown to have Langerhans’ cell histiocytosis with sclerosing cholangitis by liver biopsy and skin biopsy showing S‐100, CD1a positivity, and Birbeck granules by electron microscopy.

Current therapeutic approaches in childhood chronic hepatitis B infection

BACKGROUND AND AIM The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection. METHODS A total of 182 children with CHB infection were prospectively allocated to three random groups. Sixty-two patients in the first group received high-dose interferon (IFN)-alpha 2b (10 MU/m2) thrice/weekly alone for 6 months. In the second (n = 60) and third groups (n = 60), IFN-alpha was used for 6 months (5 MU/m2) thrice/weekly in combination with lamivudine (LAM) (4 mg/kg, maximum 100 mg/day) for 12 months. Lamivudine was started simultaneously with IFN in the second group, while it was started 2 months prior to IFN injections in the third group. RESULTS The initial mean alanine aminotransferase (ALT) values for the first, second and third groups were 109 +/- 93 IU/L, 101 +/- 64 IU/L and 92 +/- 42 IU/L, respectively (P > 0.05). At the end of the therapy, ALT values decreased to 82 +/- 111 IU/L, 38 +/- 41 IU/L and 29 +/- 16 IU/L in groups 1, 2 and 3, respectively. The mean ALT value of the first group was significantly different to the second and third groups (P = 0.046 and P = 0.002, respectively) at the end of the therapy and these differences were found to be sustained after 18 months. However, results in the second and third groups were similar (P > 0.05). There were no significant differences in HBeAg clearance and anti-HBe seroconversion at the initial stage, 12 months and 18 months between the three groups (P > 0.05). Hepatitis B virus (HBV) DNA clearance in the first group was different from the second and third groups, while the second and third groups had similar HBV DNA clearance ratios at 12 and 18 months. No significant difference was found in the complete response (normalization of ALT, clearance of HBV DNA and seroconversion of anti HBe) ratios of all groups (at 12 months: 28.8, 45.5, 35.8% and at 18 months 33.3, 49 and 34% in groups 1, 2 and 3, respectively, P > 0.05). CONCLUSIONS Although the ALT normalization and HBV DNA clearance ratios of IFN plus LAM combination groups were better than the high-dose IFN-alpha monotherapy group, no significant difference was found in the complete response ratios of all three groups.