We present a case report of a 59-year-old male diagnosed with pancreatic cancer with multiple abdominal metastases, in whom metagenomic next-generation sequencing unexpectedly identified Clonorchis sinensis genomic sequences in both bronchoalveolar lavage fluid and peripheral blood specimens. Subsequent examination further confirmed the presence of viable C. sinensis eggs in the stool samples. The findings underscore the prognostic significance of enhanced diagnostic protocols for parasitic infections in oncological cases. This investigation demonstrates the clinical utility of molecular diagnostic approaches and alternative biological specimens for detecting C. sinensis infection.

This study aims to investigate antiviral effectiveness, side effects, and disease outcomes in patients who have been using entecavir (ETV) and tenofovir disoproxil fumarate (TDF) for a long-term in chronic hepatitis B. Patients with chronic hepatitis B who had been using TDF or ETV for at least 10 years were included in this retrospective study. Co-infected patients, those receiving immunosuppressive therapy, and transplant patients were excluded. Of the study's total 173 patients (baseline mean age 43.4 ± 11.7 years), 110 (63.6%) were men. Thirty-three (19.1%) patients were cirrhotic, and hepatitis B e-antigen was negative in 131 (75.7%) patients at the baseline. Ninety-two (53.2%) patients used TDF and 81 (46.8%) used ETV for a mean of 156.76 ± 21.60 (120-204) months. Hepatitis B virus (HBV)-DNA negativity (<10 IU/mL) was achieved in 97.7% of all patients. Biochemical remission was achieved in 98.3% of all patients at the last visit. HBsAg became negative in only 5 (2.9%). Hepatocellular carcinoma (HCC) developed in 9 (5.2%) patients. All HCCs occurred after the 5th year of treatment. The age at HBV diagnosis was higher in HCC patients (P = .023), but the most important risk factor for the development of HCC was to have cirrhosis at baseline. Eight (4.6%) patients died in the follow-up, and 2 were due to liver disease and the remaining non-liver disease. At the end of follow-up, HBV-DNA negativity was achieved in almost all patients, and HBsAg sero-clearance was rarely achieved. Very few patients developed HCC and the long-term mortality rate was similar to the general population.

The Asia-Pacific region faces serious liver health challenges, primarily because of the comparatively high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, as well as the increasing disease burden of metabolic-associated steatotic liver disease (MASLD), alcohol-associated liver disease, and hepatocellular carcinoma (HCC). Despite MASLD being the cause with the highest growth rate worldwide, chronic HBV or HCV infection remains a prominent cause of HCC in the Asia-Pacific region. Despite widespread vaccination and the use of oral nucleos(t)ide analogs, the risk of HCC persists in patients with chronic HBV infection, and a customized surveillance program for HCC should be implemented. Because there are currently no effective vaccinations for chronic HCV infection, universal screening and link-to-care with appropriate costs for direct-acting antivirals are required. Furthermore, patients with chronic HCV infection who have achieved a sustained virological response (SVR) are still at risk of developing HCC, even if HCV eradication with antivirals significantly lowers that risk. Identifying candidates for whom HCC surveillance is consistently necessary, using surrogate indicators and risk classification, should be investigated. Targeted multidisciplinary research is required to address these issues. Finally, combining data science and biotechnology with artificial intelligence applications in healthcare can improve therapeutic and diagnostic results, particularly in regions with limited resources.

Drug pricing is a major driver of healthcare spending in the United States (US) and the cost of medications in the US is up to three time higher than other countries. This cross-sectional study aims to investigate the current price differences between hepatitis B (HBV) and hepatitis C (HCV) antiviral therapies in the US as compared to peer high-income countries.

Publicly available drug formularies for Canada, UK, Japan, France, Germany, Italy, and Australia were used to collect 2024 prices for seven HBV medications (lamivudine, adefovir, tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate, entecavir, peginterferon alfa-2a, emtricitabine/TDF) and seven HCV medications (sofosbuvir/velpatasvir, sofosbuvir/ledipasvir, sofosbuvir, ribavirin, elbasvir/grazoprevir, glecaprevir/pibrentasvir, sofosbuvir/velpatasvir/voxilaprevir). US prices were obtained from UpToDate®'s listed representative average wholesale price and Medicare Part D 2022 drug prices.

US prices for HBV originator medications were on average 4.71x (range 1.99-6.17x) the prices in the peer countries. US generic HBV drug prices for TDF, entecavir, and emtricitabine/TDF were on average 45% cheaper or 0.55x less than the average generic prices in peer countries (range 0.48-0.66x). US originator prices for HCV medications were on average 1.83x the prices in peer countries (range 0.63-2.66x).

HBV and HCV originator medications cost significantly more in the US compared to seven other major industrial countries. However, the introduction of HBV generic medications has lowered the cost of treatment for patients in the US. Future adoption of international reference pricing may help bridge remaining pricing disparities.

Non-alcoholic fatty liver disease (NAFLD) accounts for remarkable burden of death and costs worldwide with no recommended pharmacological intervention for the clinical management. This study aimed to investigate the efficacy and underlying mechanisms of rhubarb-derived polysaccharides (RP) in mitigating high-fat diet (HFD)-induced NAFLD and to analyze the primary monosaccharide components of RP. Forty male C57BL/6 mice were subjected to a dietary intervention consisting of either a high fat or chow diet for a duration of 12 weeks. RP (270, 540 mg·kg-1·d-1) was administered to the mice for 4 consecutive weeks from the 9th week. Various assessments were conducted, including histopathological examination, liver transcriptome analysis, non-targeted metabolomics analysis, and evaluation of protein expressions related to lipid and bile acid metabolism. This study found RP demonstrate a protective effect on the livers of NAFLD mice by inhibiting lipid accumulation and reducing hepatocyte inflammatory damage. The metabolomics analysis of multi-tissues revealed that the RP exert a hepatoprotective effect against NAFLD by restoring the altered bile acids (BAs) and fatty acids (FFAs) metabolism through the improvement of BA transporter, nucleus hormone receptor, lipogenesis protein, FFA transporter, and lipolysis proteins. Hence, RP may serve as a potential therapeutic agent for NAFLD.

A study indicated that ravidasvir (RDV) has excellent safety and tolerability when used with sofosbuvir (SOF) to treat chronic HCV infection. The aim of this study was to determine the time taken by RDV/SOF to achieve optimum viral load suppression in chronic hepatitis C patients with or without compensated cirrhosis. Data from the open-label, multicentre, single-arm, phase II/III clinical trial (STORM-C-1) were utilized. Time‒to-event analysis via Kaplan-Meier curves was performed to determine the time required to achieve optimum viral load suppression in both the cirrhotic and noncirrhotic groups. Multivariate logistic regression analyses were performed to identify potential predictors of achieving suppression within four and eight weeks. The time to achieve optimum viral load suppression ranged from six to 85 days and from five to 148 days among noncirrhotic and cirrhotic patients, respectively. Among noncirrhotic patients, 80.6% achieved optimum viral load suppression within 4 weeks, and 92.6% achieved this within 8 weeks. Among cirrhotic patients, 76.1% and 90.4% achieved optimum viral load suppression within 4 and 8 weeks, respectively. Notably, optimum viral load suppression differs from sustained virological response (SVR12), which is defined as undetectable HCV RNA 12 weeks after treatment completion. While the study demonstrates promising early viral suppression, it does not evaluate the efficacy of a shortened regimen. Further research is needed to assess whether shorter treatment durations maintain high SVR12 rates without compromising treatment success.

Hepatitis C virus (HCV) infection poses a global health challenge, yet its epidemiology in Qatar remains underexplored. This study estimated HCV antibody (Ab) prevalence in Qatar and examined associated socio-demographic factors. From January 2017 to December 2019, the Ministry of Public Health conducted a national HCV awareness and surveillance campaign. A total of 81,615 individuals, including both Qatari nationals and expatriate residents from 137 countries, underwent HCV antibody testing using the Elecsys Anti-HCV II electrochemiluminescence immunoassay. Probability weights were applied to adjust for age, sex, and nationality, to the testing sample. Logistic regression assessed factors associated with HCV Ab positivity. Among individuals tested, 1149 were positive, 80,299 were negative, and 167 were indeterminate. The estimated HCV Ab prevalence in the study sample was 1.4% (95% CI 1.3-1.5%). The weighted HCV Ab prevalence in the resident population of Qatar was also estimated at 1.4% (95% CI 1.2-1.7%). HCV Ab positivity was strongly associated with age, with higher adjusted odds ratios (AORs) in older individuals. Disparities were noted among certain nationalities, with Bangladeshis and Tunisians having lower odds of infection, while Pakistanis, Egyptians, and Yemenis had higher odds of being infected. Males had a 1.97-fold (95% CI 1.47-2.65) higher odds of being HCV Ab positive compared to females. The considerable HCV Ab prevalence in Qatar underscores the need for targeted interventions, prevention and harm reduction strategies, and expanded testing and treatment programs to advance progress toward the 2030 elimination target.

Despite the effectiveness of hepatitis B virus (HBV) antiviral treatment therapy in reducing the risk of liver-related complications, such as cirrhosis and hepatocellular carcinoma among chronically infected patients, medication non-adherence continues to hamper the successful management of the infection. The extent of HBV treatment adherence, associated facilitators, and barriers in South Sudan is not established. This study aimed to explore the predictors of medication non-adherence among HBV patients attending a public health facility in, South Sudan.

We conducted a facility-based cross-sectional study of 392 convenience-selected patients using a pretested interviewer-administered questionnaire premised on the information-motivation-behavioral skills (IMB) adherence model between December 2023 and March 2024. The relationship between medication non-adherence and antecedent variables was ascertained by logistic regression analysis.

The sample was predominantly male (64.3%), and the mean age was 31.06 (30.19-31.93) years, with 28.1% reporting no formal education. The patients demonstrated inadequate HBV information (4.33±1.93), low motivation (8.20±2.69), and inadequate behavioral skills toward medication adherence (8.45±2.99), as measured on their respective rating scales. Further, more than two-thirds of the patients (70.2%) were HBV medication non-adherent. Younger age (AOR = 4.74, 95% CI = 2.13-10.56), being currently unmarried (AOR = 3.25, 95% CI = 1.76-6.01), unemployment (AOR = 4.19, 95% CI = 1.84-9.56), and increased behavioral skills (AOR = 1.12, 95% CI = 1.84-9.56) significantly influenced medication non-adherence. Lower education (AOR = 0.21, 95% CI = 0.10-0.46) and information adequacy (AOR = 0.63, 95% CI = 0.53-0.75) were associated with lower odds of non-adherence.

The study highlights key factors influencing the concerning rate of medication non-adherence among HBV patients in South Sudan. While these identified factors may explain the lingering burden of HBV-related complications, targeted interventions addressing demographic, socioeconomic barriers, and HBV-specific education are essential to enhance adherence and improve health outcomes.

Estimates of chronic hepatitis B virus (HBV) prevalence and critically the amount of infection that is undiagnosed or unlinked to care are uncertain-even in countries like UK where vertical transmission and overall prevalence are very low. In the absence of country of birth data, we aim to estimate HBV prevalence through combining public health surveillance data on antenatally screened women by ethnic group and multipliers generated from non-antenatally screened populations by ethnic group with English population denominators. Of 714,287 women aged 16-49 years with ethnic group data tested as part of antenatal care between 2015 and 2021, 4174 (0.6%) were HBsAg-positive; 94% in people of ethnic groups other than White British. Of 1,447,467 people tested for HBsAg with ethnic group data from other testing sources (primary and secondary care excluding occupational health and renal services), 27,628 (1.9%) were HBsAg-positive; 87% in people of ethnic groups other than White British. We estimate that the overall number and prevalence of people with chronic hepatitis B in England is 268,767 (95% CI: 227,896-314,044) and 0.58% (95% CI: 0.50-0.68). Approximately two-thirds were male, one-third female, and 68% were aged under 50. We estimate that over 83% of HBV infections are in people of ethnic groups other than White British, with 23% in people from Black ethnic groups, 21% from other White ethnic groups and 19% in Asian ethnic groups. These estimates are the first step towards establishing whether England can meet World Health Organisation targets to eliminate HBV as a public health problem-using methods that can also be used by other countries.

Hepatitis C virus (HCV) infection remains a public health concern, significantly affecting vulnerable populations including people who use drugs and in prisons. This study assessed the feasibility of a new prison-based test-and-treat model for HCV in two prisons in Kedah, Malaysia.

The model was tested on participants newly admitted between June 2022 and December 2023 to one of the two selected prisons, one for pretrial detention and the other for serving sentences. It features a streamlined test-and-treat procedure within prisons, encompassing anti-HCV (exposure) testing, HCV ribonucleic acid (RNA) (current infection) testing, pretreatment assessments, and treatment initiation. The outcome assessment focused on (I) screening coverage, (II) implementation success across the HCV care cascade, ranging from anti-HCV detection, HCV RNA confirmation, treatment initiation, and completion to a sustained virological response rate and (III) practicality within resource-limited prison environments.

All 18,811 (100%) newly admitted participants were screened for HCV during the study period, with 4,054 (21.6%) of them testing positive for anti-HCV (HCV exposure). A total of 793 (19.6%) participants underwent HCV RNA testing, with 655 (82.6%) confirmed to have HCV infection. Those with HCV RNA test results were mainly male (98.1%), with nearly half (48.2%) aged 40-49 years. A vast majority (95.7%) reported at least one HCV risk factor, primarily injection drug use (95.2%). Of the 655 participants with a positive HCV RNA test, 648 (98.9%) completed pretreatment assessments. Antiviral treatment was initiated in 319 (49.2%) of them, with 165 (51.7%) completing the full course. Among those who completed treatment, 80 (48.5%) underwent HCV RNA testing 12 weeks after treatment, with 77 (96.3%) achieving a sustained virologic response.

This new prison-based test-and-treat model for HCV infection demonstrates promising feasibility, as indicated by high screening coverage and successful implementation across the HCV care cascade using existing resources. These findings suggest the potential for broader adoption of this model in correctional facilities. Further research is needed to improve treatment completion and address factors contributing to dropout.

To ensure that health services are high-quality, trusted and used by the population, their design and improvement should start from the perspective of what matters to people. Patient journey mapping (PJM) is one research method that centers the experiences of individuals living with health conditions and follows their pathways through care and recovery. This paper describes a novel, qualitative PJM methodology used in Vietnam and the Philippines to inform the co-design of a people-centered viral hepatitis screening, care and treatment pathway for individuals living with chronic hepatitis, which is a significant public health concern in the Asia-Pacific region.

Data collection involved in-depth interviews with a purposive sample of 63 people living with hepatitis (demand-side) and focus group discussions with healthcare providers working in the same geographical areas (supply-side). Rapid deductive qualitative analysis was used to identify typical journeys, and related barriers and enablers. The methodology was implemented over 8 weeks, adapting the Consolidated Criteria for Reporting Qualitative Research (COREQ).

This paper demonstrates how a PJM methodology that incorporates patient and HCP perspectives can be feasibly implemented in two LMIC contexts, while fulfilling many of the criteria identified by the COREQ guidelines. Sharing such methods and associated instruments may help to enable broader uptake and application in other LMIC settings, providing health systems practitioners with a critical tool to identify and overcome barriers in and promote the delivery of people-centered health services globally.

Despite limited uptake, especially in resource-limited contexts and at the primary healthcare level, PJM is a novel research method with the potential to make promising contributions to people-centered health service design.

As a highly complex organ with digestive, endocrine, and immune-regulatory functions, the liver is pivotal in maintaining physiological homeostasis through its roles in metabolism, detoxification, and immune response. Various factors including viruses, alcohol, metabolites, toxins, and other pathogenic agents can compromise liver function, leading to acute or chronic injury that may progress to end-stage liver diseases. While sharing common features, liver diseases exhibit distinct pathophysiological, clinical, and therapeutic profiles. Currently, liver diseases contribute to approximately 2 million deaths globally each year, imposing significant economic and social burdens worldwide. However, there is no cure for many kinds of liver diseases, partly due to a lack of thorough understanding of the development of these liver diseases. Therefore, this review provides a comprehensive examination of the epidemiology and characteristics of liver diseases, covering a spectrum from acute and chronic conditions to end-stage manifestations. We also highlight the multifaceted mechanisms underlying the initiation and progression of liver diseases, spanning molecular and cellular levels to organ networks. Additionally, this review offers updates on innovative diagnostic techniques, current treatments, and potential therapeutic targets presently under clinical evaluation. Recent advances in understanding the pathogenesis of liver diseases hold critical implications and translational value for the development of novel therapeutic strategies.

The Middle East and North Africa (MENA) region is the most affected by hepatitis C virus (HCV) infection globally. This study aimed to estimate HCV incidence among people who inject drugs (PWID) in MENA and evaluate the impact of interventions.

A mathematical model was extended and applied to 13 countries with at least one data point on the population size of PWID and HCV antibody prevalence among PWID, generating estimates for the period 2024-2030. The model was calibrated using multiple datasets, primarily derived from systematic reviews and meta-analyses. Multivariable uncertainty analyses were conducted.

Incidence rate among PWID in the 13 countries combined was 10.4 per 100 person-years (95% UI: 8.0-14.1), with an estimated 42,364 new infections annually (95% UI: 27,990-57,540), accounting for 16.9% (95% UI: 8.3-28.2) of all cases in these countries. These figures varied widely across countries. A 75% reduction in needle/syringe sharing decreased viremic chronic infection prevalence by 14.2% (95% UI: 11.3-17.1), incidence rate by 33.8% (95% UI: 30.2-40.5), and annual new infections by 24.4% (95% UI: 17.7-30.1). A 10% reduction in PWID numbers and a 20% reduction in injection frequency decreased chronic infection prevalence by 1.7% (95% UI: 1.4-2.5), incidence rate by 4.2% (95% UI: 3.9-4.4), and annual new infections by 11.1% (95% UI: 10.9-11.9). Achieving 75% direct-acting antiviral treatment coverage by 2030 decreased chronic infection prevalence by 65.3% (95% UI: 64.8-65.8), incidence rate by 34.5% (95% UI: 29.6-40.3), and annual new infections by 25.3% (95% UI: 19.9-29.3). Combinations of interventions reduced these epidemiologic outcomes by up to 80%.

MENA experiences considerable HCV incidence among PWID. While the interventions showed potential, only large-scale or multi-intervention strategies can achieve meaningful reductions in HCV transmission.

This publication was made possible by NPRP grant number 12S-0216-190,094 from the Qatar National Research Fund (a member of Qatar Foundation). The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions, or policies of World Health Organization.

Chronic hepatitis B often progresses silently toward hepatocellular carcinoma (HCC), a leading cause of mortality worldwide. Early detection of HCC is crucial, yet challenging.

To investigate the role of dynamic changes in alkaline phosphatase to prealbumin ratio (APR) in hepatitis B progression to HCC.

Data from 4843 patients with hepatitis B (January 2015 to January 2024) were analyzed. HCC incidence rates in males and females were compared using the log-rank test. Data were evaluated using Kaplan-Meier analysis. The Linear Mixed-Effects Model was applied to track the fluctuation of APR levels over time. Furthermore, Joint Modeling of Longitudinal and Survival data was employed to investigate the temporal relationship between APR and HCC risk.

The incidence of HCC was higher in males. To ensure the model's normality assumption, this study applied a logarithmic transformation to APR, yielding ratio. Ratio levels were higher in females (t = 5.26, P < 0.01). A 1-unit increase in ratio correlated with a 2.005-fold higher risk of HCC in males (95%CI: 1.653-2.431) and a 2.273-fold higher risk in females (95%CI: 1.620-3.190).

Males are more prone to HCC, while females have higher APR levels. Despite no baseline APR link, rising APR indicates a higher HCC risk.

The Hepatitis B surface antigen (HBsAg) as the only lipid-associated envelope protein of the Hepatitis B virus (HBV) acts as cellular attachment and entry mediator of HBV making it the main target of neutralizing antibodies to provide HBV immunity after infection or vaccination. Despite its central role in inducing protective immunity, there is however a surprising lack of comparative studies examining different HBsAgs and their ability to detect anti-HBs antibodies. On the contrary, various time-consuming complex HBsAg production protocols have been established, which result in structurally and functionally insufficiently characterized HBsAg. Here, we present an easy-to-perform, streamlined and robust method for recombinant S-HBsAg virus-like particle (VLP) production by transient expression in mammalian cells and purification from the cell lysate with the aim of displaying uniform antigenic epitopes on the surface to improve serological detection of anti-HBs antibodies. We not only compare assembly status and particle composition by transmission electron microscopy and mass photometry of our S-HBsAg and of commonly used HBsAg reference samples, but also assess their antigenic quality and functional suitability for anti-HBs antibody detection to identify the best performing sample for serological screenings. While we found that serum-isolated and recombinant HBsAg VLPs are assembled differently, our S-HBsAg VLPs detected anti-HBs antibodies with the highest sensitivity and specificity in multiplex serology when compared to yeast or serum HBsAg making it the most suitable antigen for analysis of HBV immunity through anti-HBs serostatus.

Cancer occurrence rates exhibit diverse age-related patterns, and understanding them may shed new and important light on the drivers of cancer evolution. This study systematically analyzes the age-dependent occurrence rates of 23 carcinoma types, focusing on their age-dependent distribution patterns, the determinants of peak occurrence ages, and the significant difference between the two genders. According to the SEER reports, these cancer types have two types of age-dependent occurrence rate (ADOR) distributions, with most having a unimodal distribution and a few having a bimodal distribution. Our modeling analyses have revealed that (1) the first type can be naturally and simply explained using two age-dependent parameters: the total number of stem cell divisions in an organ from birth to the current age and the availability levels of bloodborne growth factors specifically needed by the cancer (sub)type, and (2) for the second type, the first peak is due to viral infection, while the second peak can be explained as in (1) for each cancer type. Further analyses indicate that (i) the iron level in an organ makes the difference between the male and female cancer occurrence rates, and (ii) the levels of sex hormones are the key determinants in the onset age of multiple cancer types. This analysis deepens our understanding of the dynamics of cancer evolution shared by diverse cancer types and provides new insights that are useful for cancer prevention and therapeutic strategies, thereby addressing critical gaps in the current paradigm of oncological research.

Hepatitis C virus (HCV) infection is a significant risk factor for liver cirrhosis and hepatocellular carcinoma (HCC). Traditionally, the primary prevention strategy for HCV-associated HCC has focused on removing infection through antiviral regimes. Currently, highly effective direct-acting antivirals (DAAs) offer extraordinary success across all patient categories, including cirrhotics. Despite these advancements, recent studies have reported that even after sustained virologic response (SVR), individuals with advanced liver disease/cirrhosis at the time of DAA treatment may still face risks of HCC occurrence or recurrence. Based on this premise, this review tries to shed light on the multiple mechanisms that establish a tumorigenic environment, first, during chronic HCV infection and then, after eventual viral eradication by DAAs. Furthermore, it reviews evidence reported by recent observational studies stating that the use of DAAs is not associated with an increased risk of HCC development but rather, with a significantly lower chance of liver cancer compared with DAA-untreated patients. In addition, it seeks to provide some practical guidance for clinicians, helping them to manage HCC surveillance of patients who have achieved SVR with DAAs.

Hepatitis B virus (HBV) infection is a major cause of premature death worldwide. In 2016, the World Health Organization (WHO) called for HBV elimination and set up very ambitious elimination targets. The development of effective vaccines, accurate diagnostic tools and safe antiviral drugs make HBV elimination a realistic goal. However, the most constrained-resource regions, which bear the highest burden of HBV, are facing major challenges in implementing strategies to reduce HBV incidence and mortality. Developing simplified approaches adapted to resource-limited settings and scaling up interventions for the prevention and control of HBV globally are urgently needed. Whether HBV elimination will be achieved in an equitable manner and in a reasonable timeframe remains highly uncertain.

Following viral infection, the innate immune system senses viral products, such as viral nucleic acids, to activate innate defence pathways, leading to inflammation and apoptosis, control of cell proliferation, and consequently, threat to the whole body. The ocular surface is exposed to the external environment and extremely vulnerable to viral infection. Several studies have revealed that viral infection can induce inflammation of the ocular surface and reduce tear secretion of the lacrimal gland (LG), consequently triggering ocular morphological and functional changes and resulting in dry eye disease (DED). Understanding the mechanisms of DED caused by viral infection and its potential therapeutic strategies are crucial for clinical interventional advances in DED. This review summarizes the roles of viral infection in the pathogenesis of DED, applicable diagnostic and therapeutic strategies, and potential regions of future studies.

Clonorchis sinensis, Opisthorchis viverrini, and Opisthorchis felineus are the three important liver flukes, infecting approximately 25 million people worldwide. Despite the reporting of the carcinogenesis of these liver flukes, the comprehensive and systematic analysis of the pathogenicity of these parasites in hepatobiliary system is still not sufficient. We conducted a thorough systematic review and search for published articles in MEDLINE, Embase, Cochrane Library, China National Knowledge Infrastructure databases until early 2024. Cohort studies, case-control studies, and cross-sectional studies associated with C. sinensis, O. viverrini, or O. felineus infection were selected. Pooled risk ratio (RR), odds ratio (OR) and their 95 % confidence intervals (95 % CIs) were calculated to assess the risk of hepatobiliary complications due to these liver fluke infections. From a total of 6488 articles, 22 eligible studies and 34,367 participants were included for review. Our results showed C. sinensis, O. viverrini, and O. felineus infections were significantly associated with cholangiocarcinoma, with an overall OR of 4.24 (95 % CI: 3.33-5.39, P < 0.00001) and an overall RR of 10.43 (95 % CI: 2.90-37.47, P = 0.0003). The ORs for the association between cholangiocarcinoma and C. sinensis and O. viverrini infection were 4.49 (95 % CI:3.43-5.87, P < 0.00001) and 3.69 (95 % CI: 2.07-6.55, P < 0.00001) respectively. For the association between cholelithiasis and C. sinensis infection, the OR was 6.46 (95 % CI: 5.15-8.11, P < 0.00001). C. sinensis infection increased the risk of cholecystitis and cirrhosis, with the RR of 21.02 (95 % CI: 17.27-25.58) and an overall RR of 8.77 (95 % CI: 6.79-11.33, P < 0.00001) respectively. C. sinensis infection was also significantly associated with fatty liver, with an overall OR of 2.46 (95 % CI: 1.79-3.37, P < 0.00001). This comprehensive study, reviewing the largest dataset to date, provided an overall risk of hepatobiliary complications due to Clonorchis and Opisthorchis infections, and aids more systematic understanding for the pathogenicity of Opisthorchiidae family parasites.

This paper presents the development of the METRIC toolkit, aimed at enhancing primary healthcare interventions in the context of hepatitis C control, thus contributing to the World Health Organization's global strategy to achieve the elimination of the disease by 2030.

At the global level, most people living with hepatitis C are unaware of their condition. As such, the eradication of hepatitis C necessitates comprehensive strategies within primary healthcare settings, as it provides an opportunity to reach the general population, facilitates the identification of potential patients who may be unfamiliar with hepatitis C, and guides them toward adequate care. Herein, we propose the METRIC toolkit as a means to optimize the efficiency and efficacy of healthcare services dedicated to hepatitis C control.

The development of the METRIC toolkit was guided by a thorough review of pertinent literature, focusing on primary healthcare interventions in hepatitis C control. Key components were identified, encompassing systematic problem identification, solution formulation, outcome evaluation, and feedback integration.

The METRIC toolkit represents a valuable resource for strengthening primary healthcare interventions in hepatitis C control. By fostering a culture of continuous improvement and data-driven decision-making, this framework holds promise in advancing the global agenda towards hepatitis C elimination. However, its successful application requires careful consideration of contextual factors and ongoing adaptation to local needs and circumstances.

Background: As part of efforts to reach the elimination target by 2030, the WHO and CDC recommend that all HCWs adhere to the three-dose Hepatitis B vaccination schedule to protect themselves against the infection. This study assessed Hepatitis B vaccination coverage and associated factors among personnel working in health facilities in Kumasi, Ashanti Region, Ghana. Materials and Methods: A cross-sectional study involving 530 HCWs was conducted in four hospitals in Kumasi from September to November 2023. An investigator-administered questionnaire was employed in gathering participant demographics and other information related to vaccination coverage. IBM SPSS Version 26.0 and GraphPad Prism 8.0 were used for analysing the data. Results: Even though the majority (70.6%) reported having taken at least one dose of the vaccine, only 43.6% were fully vaccinated (≥ 3 doses). More than a quarter (29.4%) had not taken any dose of the HBV vaccine. Close to a quarter (23.6%) had not screened or tested for HBV infection in their lifetime. The statistically significant variables influencing vaccination status were age, marital status, profession, and status in the hospital. Nearly one-half (44.9%) of the participants who have not taken the vaccine reported they do not have a reason for not taking it, and a high proportion (80.1%) were willing to take the vaccine when given for free. Conclusion: To combat the low Hepatitis B vaccination coverage among healthcare workers in Kumasi, Ghana, amidst the significant public health threat of HBV infection, comprehensive measures are necessary. These include implementing infection prevention control programmes, enhancing occupational health and safety, and conducting health promotion campaigns in healthcare facilities. Extending and intensifying Hepatitis B screening and vaccination initiatives to tertiary institutions and encouraging employers, supervisors, or team leaders to provide these services nationwide are also recommended.

The hepatitis E virus (HEV) is an emerging infectious disease with zoonotic potential, causing acute hepatitis in humans. Infections in healthy individuals are often acute, self-limiting and asymptomatic, thus leading to the underdiagnosis of HEV infections. Asymptomatic HEV infections pose a problem for blood transfusion safety by increasing the risk for transfusion-transmitted HEV infections. Here, we describe the journey from determining the HEV seroprevalence among blood donors to the implementation of routine HEV RNA testing of all blood products in Switzerland in 2018 and summarise the HEV cases detected since. In total, 290 HEV-positive blood donations were detected by mini-pool nucleic acid testing (NAT) in Switzerland in the period of October 2018-December 2023, equal to an incidence of 20.7 per 100,000 donations. Thanks to the implemented scheme, no transfusion-transmitted infections occurred in this period. Furthermore, blood donation monitoring has proven to be an effective means of detecting HEV outbreaks in the general population. HEV cases in Swiss blood donors are caused by two major genotypes, the Swiss-endemic subtypes 3h3 and 3c. Interestingly, 11 HEV cases (5%) were of genotype 3ra, a variant found in wild and farmed rabbits. Our results indicate that mini-pool NAT is an efficient method to reduce the risk of transfusion-transmitted HEV infections.

Chronic viral hepatitis is caused by hepatitis B virus (HBV), hepatitis C virus (HCV), or hepatitis D virus (HDV). Despite different replication strategies, all of these viruses rely on secretion through the host endoplasmic reticulum-Golgi pathway, providing potential host targets for antiviral therapy. Knockdown of transmembrane 6 superfamily member 2 (TM6SF2) in virus cell culture models reduced secretion of infectious HCV virions, HDV virions, and HBV subviral particles. Moreover, in a cohort of people with hepatitis B, a TM6SF2 polymorphism (rs58542926 CT/TT, which causes protein misfolding and reduced TM6SF2 in the liver) correlated with lower concentrations of subviral particles in blood, complementing our previous work showing decreased HCV viral load in people with this polymorphism. In conclusion, the host protein TM6SF2 plays a key role in secretion of HBV, HCV, and HDV, providing the potential for novel pan-viral agents to treat people with chronic viral hepatitis.

Background: Osteoporosis and bone fractures affect health and quality of life. Since bone disease is multifactorial, identifying risk factors is key in prevention. There are multiple reports on how viral hepatitis, especially chronic hepatitis B (CHB) and chronic hepatitis C (CHC), are affecting bone disease, but results vary. Here, we analyzed the potential association between CHB/CHC and osteoporosis or bone fractures in a large outpatient cohort in Germany. Methods: We included 3136 outpatients with CHB and 15,608 matched non-hepatitis individuals as well as 2867 outpatients with CHC and 14,335 matched non-hepatitis individuals from the Disease Analyzer Database between 2005 and 2022. The main outcome was the 5-year cumulative incidence of osteoporosis and bone fractures as a function of either CHB or CHC. Results: Within 5 years of the index date, 2.9% vs. 1.6% of patients with and without CHB were diagnosed with osteoporosis (p = 0.001) and 1.0% vs. 0.4% were diagnosed with bone fractures (p < 0.001). Moreover, 3.3% of CHC patients and 2.2% of individuals without hepatitis C were diagnosed with osteoporosis (p = 0.002). In Cox regression analyses, CHB was significantly associated with an increased risk for osteoporosis (HR: 1.76) and fractures (HR:2.43) and CHC with osteoporosis (HR: 1.54). For both CHB and CHC, the association with osteoporosis was restricted to the female subgroup. Conclusions: CHB and CHC are associated with osteoporosis in women. CHB in male patients is associated with a higher risk of fractures. More research is needed to understand the underlying pathophysiological mechanisms.

This study aims to evaluate the correlation between serum thyroid hormone levels and hepatitis B virus (HBV) DNA and HBV genotypes in pregnant women with chronic hepatitis B. A total of 96 pregnant women with chronic HBV-infected pregnant women between January 2020 and December 2022 were selected as the observational study subjects. About 50 HBV-uninfected pregnant women during the same period were selected as the control group. Serum thyroid hormone levels at different stages of pregnancy, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), thyroperoxidase antibody (TPOAb), and thyroglobulin antibody (TGAb), were compared between the 2 groups. Thyroid hormones levels were also compared between HBV-DNA-positive and HBV-DNA-negative women in the HBV-infected pregnancy group, and to determine the correlation between thyroid hormones levels and HBV-DNA load and HBV genotype in HBV-DNA-positive pregnant women. The TSH levels in mid and late pregnancy and TPOAb levels in early, mid, and late pregnancy of HBV-infected pregnant women were higher than those in the same period in HBV-uninfected pregnant women (P < .05). The TPOAb and TGAb levels in early, mid, and late pregnancy of HBV-DNA-positive pregnant women were higher than those in the same period in HBV-DNA-negative pregnant women (P < .05). The HBV-DNA load and FT3 or FT4 levels were negatively correlated (P < .05), and the HBV-DNA load and TGAb levels were positively correlated (P < .05). However, there was no statistical difference in thyroid hormone levels between different HBV genotypes (P > .05). The thyroid hormone levels will change in pregnant women infected with hepatitis B virus, and there is a certain correlation between HBV-DNA load and thyroid hormone levels. Therefore, timely monitoring of thyroid hormones and HBV-DNA load can provide early prevention and treatment for HBV infection in pregnant women, ensuring the health of pregnant women and fetuses.

Hepatitis B virus (HBV) infection remains a significant global health burden. The genetic variation of HBV is complex. HBV can be divided into nine genotypes, which show significant differences in geographical distribution, clinical manifestations, transmission routes and treatment response. In recent years, substantial progress has been made through various research methods in understanding the development, pathogenesis, and antiviral treatment response of clinical disease associated with HBV genetic variants. This progress provides important theoretical support for a deeper understanding of the natural history of HBV infection, virus detection, drug treatment, vaccine development, mother-to-child transmission, and surveillance management. This review summarizes the mechanisms of HBV diversity, discusses methods used to detect viral diversity in current studies, and the impact of viral genome variation during infection on the development of clinical disease.

The objective of this study is to determine the prevalance of Hepatitis C Virus (HCV) in patients with Opioid Use Disorder and to investigate both the sociodemographic and psychological differences between patients with or without Hepatitis C Virus.

Blood samples were taken from patients diagnosed with Opioid Use Disorder (OUD) who applied to Mersin Provincial Health Directorate Toros State Hospital Alcohol and Drug Addiction Treatment Center (AMATEM) between 01.09.2019-01.09.2020 and hepatitis virus markers, complete blood count and basic biochemistry were assessed. Sociodemographic Evaluation Form, Barratt Impulsivity Scale, Childhood Traumas Scale, Drug Use Disorders Identification Test (DUDIT), Temps-A Temperament Scale, Difficulty in Emotion Regulation Scale were applied to 107 patients with HCV and 101 patients without HCV who were selected by systematic sampling and the findings obtained were compared.

Of the 1190 patients diagnosed with Opioid Use Disorder, 340 (28.5%) were found to be HCV positive. 107 HCV-positive and 101 HCVnegative patients who were selected for comparison were similar in terms of sociodemographic characteristics. Among HCV positive patients, the rate of intravenous drug use and needle sharing were significantly higher (p<0.001, p<0.001). Overall duration of substance use and intravenous substance use were significantly higher in HCV positive patients (p=0.024 and p=0.017). Similarly, HCV positive group were significantly more likely (p<0.001) to have heard of HCV before and significantly more likely (p=0.009) to know that HCV causes cirrhosis and liver cancer. Regarding the scores of Barratt Impulsivity Scale, Childhood Traumas Scale, Substance Use Disorder Recognition Test, DUDIT, Temps -A Temperament Scales applied to HCV positive and HCV negative patients with Opioid Use Disorder, no difference was found. The scores of the 'Non-Acceptance' factor of the Difficulties in Emotion Regulation Scale were found to be significantly higher in HCV positive patients with Opioid Use Disorder (p=0.020).

Patients diagnosed with Opioid Use Disorder (OUD) have higher rates of HCV positivity compared to general public. Intravenous drug use significantly increases this risk. Half of HCV-positive patients were unaware that they have the virus and only a very small proportion received treatment. Therefore, examining each patient with OUD for HCV, treating positive patients in an effective referral system seems to be the an important step in the eradication of this disease in this population.

Chemodynamic therapy (CDT) is a tumor-specific intervention methodology, which is based on the upregulation of reactive oxygen species (ROS) content by triggering the Fenton or Fenton-like reaction within the tumor microenvironment (TME). However, there are still challenges in achieving high-efficiency CDT on account of both the limited intracellular hydrogen peroxide (H2O2) and delivery efficiency of Fenton metal ions. Copper-based nanotherapeutic systems have attracted extensive attention and have been widely applied in the construction of nanotherapeutic systems and multimodal synergistic therapy. Herein, we propose a strategy to synergize chemotherapy drugs that upregulate intracellular ROS content with chemodynamic therapy and construct an artemisinin-copper nanoprodrug for proof-of-concept. With the proposed biomimetic self-assembly strategy, we successfully construct an injectable nanoprodrug with suitable size distribution and high drug loading content (68.1 wt%) through the self-assembly of amphiphilic artemisinin prodrug and copper ions. After reaching the TME, both Cu2+ ions and free AH drugs can be released from AHCu nanoprodrugs. Subsequently, the disassembled Cu2+ ions are converted into Cu+ ions by consuming the intracellular GSH. The generated Cu+ ions serve as a highly efficient Fenton-like reagent for robust ROS generation from both AH and tumor-over-produced H2O2. Results show that the nanoprodrug can realize the cascade amplification of ROS generation via artemisinin delivery and subsequent in situ Fenton-like reaction and a high tumor inhibition rate of 62.48% in vivo. This work provides a promising strategy for the design and development of an efficient nanoprodrug for tumor-specific treatment.

The escalating frequency of environmental pollution incidents has raised significant concerns regarding the potential health impacts of pollutant fluctuations. Consequently, a comprehensive study on the role of pollutants in the prevalence of viral hepatitis is indispensable for the advancement of innovative prevention strategies. Monthly incidence rates of viral hepatitis from 2005 to 2020 were sourced from the Chinese Center for Disease Control and Prevention Infectious Disease Surveillance Information System. Pollution data spanning 2014-2020 were obtained from the National Oceanic and Atmospheric Administration (NOAA), encompassing pollutants such as CO, NO2, and O3. Time series analysis models, including seasonal auto-regressive integrated moving average (SARIMA), Holt-Winters model, and Generalized Additive Model (GAM), were employed to explore prediction and synergistic effects related to viral hepatitis. Spearman correlation analysis was utilized to identify pollutants suitable for inclusion in these models. Concurrently, machine learning (ML) algorithms were leveraged to refine the prediction of environmental pollutant levels. Finally, a weighted quantile sum (WQS) regression framework was developed to evaluate the singular and combined impacts of pollutants on viral hepatitis cases across different demographics, age groups, and environmental strata. The incidence of viral hepatitis in Beijing exhibited a declining trend, primarily characterized by HBV and HCV types. In predicting hepatitis prevalence trends, the Holt-Winters additive seasonal model outperformed the SARIMA multiplicative model ((1,1,0) (2,1,0) [12]). In the prediction of environmental pollutants, the SVM model demonstrated superior performance over the GPR model, particularly with Polynomial and Besseldot kernel functions. The combined pollutant risk effect on viral hepatitis was quantified as βWQS (95% CI) = 0.066 (0.018, 0.114). Among different groups, PM2.5 emerged as the most sensitive risk factor, notably impacting patients with HCV and HEV, as well as individuals aged 35-64. CO predominantly affected HAV patients, showing a risk effect of βWQS (95% CI) = - 0.0355 (- 0.0695, - 0.0016). Lower levels of PM2.5 and PM10 were associated with heightened risk of viral hepatitis incidence with a lag of five months, whereas elevated levels of PM2.5 (100-120 μg/m3) and CO correlated with increased hepatitis incidence risk with a lag of six months. The Holt-Winters model outperformed the SARIMA model in predicting the incidence of viral hepatitis. Among machine learning algorithms, SVM and GPR models demonstrated superior performance for analyzing pollutant data. Patients infected with HAV and HEV were primarily influenced by PM10 and CO, whereas SO2 and PM2.5 significantly impacted others. Individuals aged 35-64 years appeared particularly susceptible to these pollutants. Mixed pollutant exposures were found to affect the development of viral hepatitis with a notable lag of 5-6 months. These findings underscore the importance of long-term monitoring of pollutants in relation to viral hepatitis incidence.

Introduction Hepatitis C virus (HCV) and hepatitis B virus (HBV) among patients receiving hemodialysis (HD) remain a major public health problem. However, information is limited about these infections among HD patients in Yemen. This study aimed to estimate the prevalence and associated risk factors of HBV and HCV infections among HD patients in the Ibb governorate, Yemen, and to identify the risk factors for infections in such patients. Methods A cross-sectional study of 374 patients with renal failure who regularly underwent HD at the Al-Thawra Hospital in Ibb city, Yemen, was performed after they agreed to participate and signed informed consent. Enzyme-linked immunoassay (ELISA) was used to test the serum levels of anti-HCV antibodies and hepatitis B surface antigen (HBsAg). Patient data (demographic characteristics and risk factors) were collected via an interview questionnaire and medical records. Logistic regression analysis and chi-square tests were used to analyze the results. Results The overall prevalence of HCV was 31% (n=116), whereas that of HBV was 6.15% (n=23). Three (0.8%) patients had both HCV and HBV. The logistic regression analysis revealed a significant association between an increased number of units of blood transfused (OR = 3.1; 95% CI: 1.7-5.6; p < 0.001), a long duration of dialysis (OR = 3.2; 95% CI: 1.9-5.2; p = 0.001), and HCV infection in HD patients. On the other hand, a history of cupping therapy (Hijama) was significantly associated (OR = 3.4; 95% CI: 1.3-8.77; p < 0.011) with HBV infection in HD patients. Conclusion HCV and HBV infections are more common among HD patients in Yemen than in most Middle Eastern countries. However, the current prevalence rates are declining compared with previously published data among Yemeni HD patients. The duration of HD and number of blood units were independent risk factors for HCV infection, and patients with a history of cupping were identified as having an increased risk of HBV infection. These findings underscore the need to implement strict infection control in HD units.

Hepatopancreatobiliary (HPB) cancers encompassing malignancies of the liver, pancreas, gall bladder, and bile ducts pose a significant health burden in Africa. While the association of certain occupational carcinogens in cancer is well established globally, their potential role in HPB cancers remains understudied, especially in an African context.

This systematic review delves into the association between occupational carcinogens and HPB cancer in Africa. It examines the current state of research on occupational carcinogens and HPB cancers in Africa, identifying key challenges and knowledge gaps.

This systematic review examined publications (published between 01 January 2012 and 31 May 2023) that highlight occupational carcinogens and HBP cancers in Africa. The search was conducted on electronic databases namely PubMed, Web of Science, and Africa Wide Information.

Due to the lack of information on the association between occupational carcinogens and HPB cancers in Africa, as a result of the paucity of published studies, only four articles were included in this study. Hepatocellular carcinoma (HCC) was the predominant cancer associated with the occupational carcinogen, aflatoxin. Agricultural workers, especially those involved in the production and processing of maize and peanuts, appear to be the most exposed to aflatoxin.

Despite the sample size limitations due to the paucity of research studies on occupational carcinogens and HPB cancers in Africa, this study provides a reasonable tool for subsequent epidemiological studies. There is a need for more research on the association of occupational carcinogens and HPB cancers in Africa, especially with the growing industrialization.

The hepatitis C virus (HCV) continues to pose a significant public health challenge in Iran, mirroring a worldwide concern. This situation calls for a cohesive strategy that aligns with the World Health Organization's (WHO) goals for HCV elimination by 2030. Central to this strategy is targeting high-risk groups, notably people who inject drugs and prisoners, with prevention, screening and treatment. The deployment of point-of-care testing and treatments in prisons and harm reduction facilities is vital. The adoption of cost-effective generic direct-acting antivirals represents a major step forward. Furthermore, innovative educational initiatives for healthcare providers and awareness campaigns for the public are critical. Additionally, tackling stigma, ensuring treatment affordability and upholding strict surveillance and data management, coupled with ongoing policy reviews, are vital components. This comprehensive and integrated approach is designed to drive Iran towards eliminating HCV and can serve as a blueprint for other countries with similar challenges.

Gardenia jasminoides Ellis, a staple in herbal medicine, has long been esteemed for its purported hepatoprotective properties. Its primary bioactive constituent, geniposide, has attracted considerable scientific interest owing to its multifaceted therapeutic benefits across various health conditions. However, recent investigations have unveiled potential adverse effects associated with its metabolite, genipin, particularly at higher doses and prolonged durations of administration, leading to hepatic injury. Determining the optimal dosage and duration of geniposide administration while elucidating its pharmacological and toxicological mechanisms is imperative for safe and effective clinical application. This study aimed to evaluate the safe dosage and administration duration of geniposide in mice and investigate its toxicological mechanisms within a comprehensive dosage-duration-efficacy/toxicity model. Four distinct mouse models were employed, including wild-type mice, cholestasis-induced mice, globally farnesoid X-activated receptor (FXR) knock out mice, and high-fat diet-induced (HFD) NAFLD mice. Various administration protocols, spanning one or four weeks and comprising two or three oral doses, were tailored to each model's requirements. Geniposide has positive effects on bile acid and lipid metabolism at doses below 220 mg/kg/day without causing liver injury in normal mice. However, in mice with NAFLD, this dosage is less effective in improving liver function, lipid profiles, and bile acid metabolism compared to lower doses. In cholestasis-induced mice, prolonged use of geniposide at 220 mg/kg/day worsened liver damage. Additionally, in NAFLD mice, this dosage of geniposide for four weeks led to intestinal pyroptosis and liver inflammation. These results highlight the lipid-lowering and bile acid regulatory effects of geniposide, but also warn of potential negative impacts on intestinal epithelial cells, particularly with higher doses and longer treatment durations. Therefore, achieving optimal therapeutic results requires a decrease in treatment duration as the dosage increases, in order to maintain a balanced approach to the use of geniposide in clinical settings.